Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Stiermaier ◽  
S.J Backhaus ◽  
J Matz ◽  
A Koschalka ◽  
J.T Kowallick ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Myocardial Salvage ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Increased Risk

Abstract Background Right ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking. Purpose To assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI. Methods Cardiac magnetic resonance (CMR) was performed in 1235 patients with MI (STEMI: n=795; NSTEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (edema representing reversible ischemia, irreversible infarction, microvascular obstruction [MVO]) and functional (ejection fraction, global longitudinal strain [GLS]) RV alterations. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE). Results RV ischemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischemia was associated with a significantly increased risk of MACE (10.1% versus 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% versus 3.8%; p<0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (hazard ratio 1.05, 95% confidence interval 1.00–1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020), and left ventricular GLS (p=0.001), while RV ischemia was not independently associated with outcome. Conclusions RV GLS is a predictor of post-infarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome. Funding Acknowledgement Type of funding source: None

Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317184
Author(s):  
Thomas Stiermaier ◽  
Sören J Backhaus ◽  
Jonas Matz ◽  
Alexander Koschalka ◽  
Johannes Kowallick ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Myocardial Salvage ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Increased Risk

ObjectiveRight ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking. Therefore, the aim of this trial was to assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI.MethodsCardiac magnetic resonance (CMR) was performed in 1235 patients with MI (ST-elevation myocardial infarction: n=795; non-STEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (oedema representing reversible ischaemia, irreversible infarction, microvascular obstruction (MVO)) and functional (ejection fraction, global longitudinal strain (GLS)) RV alterations. The clinical end point was the 12-month rate of major adverse cardiac events (MACE).ResultsRV ischaemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischaemia was associated with a significantly increased risk of MACE (10.1% vs 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% vs 3.8%; p<0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (HR 1.05, 95% CI 1.00 to 1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020) and left ventricular GLS (p=0.001), while RV ischaemia was not independently associated with outcome.ConclusionsRV GLS is a predictor of postinfarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome.

scholarly journals Intraventricular flow patterns during right ventricular apical pacing

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001057 ◽  
Author(s):  
Francesco Bianco ◽  
Vincenzo Cicchitti ◽  
Valentina Bucciarelli ◽  
Alvin Chandra ◽  
Enrico Di Girolamo ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Right Ventricular ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Right Ventricular Apical Pacing

ObjectivesTo assess differences in blood flow momentum (BFM) and kinetic energy (KE) dissipation in a model of cardiac dyssynchrony induced by electrical right ventricular apical (RVA) stimulation compared with spontaneous sinus rhythm.MethodsWe cross-sectionally enrolled 12 consecutive patients (mean age 74±8 years, 60% male, mean left ventricular ejection fraction 58%±6 %), within 48 hours from pacemaker (PMK) implantation. Inclusion criteria were: age>18 years, no PMK-dependency, sinus rhythm with a spontaneous narrow QRS at the ECG, preserved ejection fraction (>50%) and a low percentage of PMK-stimulation (<20%). All the participants underwent a complete echocardiographic evaluation, including left ventricular strain analysis and particle image velocimetry.ResultsCompared with sinus rhythm, BFM shifted from 27±3.3 to 34±7.6° (p=0.016), while RVA-pacing was characterised by a 35% of increment in KE dissipation, during diastole (p=0.043) and 32% during systole (p=0.016). In the same conditions, left ventricle global longitudinal strain (LV GLS) significantly decreased from 17±3.3 to 11%±2.8% (p=0.004) during RVA-stimulation. At the multivariable analysis, BFM and diastolic KE dissipation were significantly associated with LV GLS deterioration (Beta Coeff.=0.54, 95% CI 0.07 to 1.00, p=0.034 and Beta Coeff.=0.29, 95% CI 0.02 to 0.57, p=0.049, respectively).ConclusionsIn RVA-stimulation, BFM impairment and KE dissipation were found to be significantly associated with LV GLS deterioration, when controlling for potential confounders. Such changes may favour the onset of cardiac remodelling and sustain heart failure.

Influence of visceral adiposity accumulation on adverse left and right ventricular mechanics in the community

2019 ◽  
Vol 27 (18) ◽  
pp. 2006-2015
Author(s):  
Naoko Sawada ◽  
Koki Nakanishi ◽  
Masao Daimon ◽  
Yuriko Yoshida ◽  
Jumpei Ishiwata ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Speckle Tracking Echocardiography ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Abdominal Adiposity ◽  
Ventricular Mechanics ◽  
Increased Risk

Aims Obesity carries significant risk for unfavorable ventricular remodeling and subsequent heart failure (HF) development, although the association between abdominal fat distribution and subclinical ventricular dysfunction is unclear. This study aimed to compare the subcutaneous and visceral abdominal adiposity with the risk of decreased ventricular strain. Methods We included 340 participants without overt cardiac disease who underwent laboratory testing, abdominal computed tomographic examination, and speckle-tracking echocardiography. Abdominal adiposity was quantitatively assessed as visceral fat area (VFA) and subcutaneous fat area (SFA) at the level of the umbilicus. Speckle-tracking echocardiography was performed to assess left ventricular global longitudinal strain (LVGLS) and right ventricular free-wall longitudinal strain (RVLS). Results Mean age was 56 ± 9 years, and 244 of the participants (72%) were male. The mean LVGLS and RVLS were −19.1 ± 3.0% and −25.0 ± 4.1%, respectively. Both VFA and SFA correlated with LVGLS ( r = 0.46 and r = 0.15, both p < 0.01) and RVLS ( r = 0.38 and r = 0.12, both p < 0.05), demonstrating a stronger correlation between VFA and ventricular strain. Multivariable analysis showed that VFA was significantly associated with LVGLS and RVLS, independent of traditional cardiovascular risk factors as well as pertinent laboratory and echocardiographic parameters (both p < 0.05), whereas SFA was not. Serum adiponectin level was correlated with LVGLS ( r = –0.34, p < 0.001) and RVLS ( r = –0.25, p < 0.001), although it lost statistical significance following multivariable adjustment. Conclusion In a sample of the general population, VFA, but not SFA, accumulation was significantly associated with decreased LV and RV strain, an association that may be involved in the increased risk of HF in obese individuals.

scholarly journals Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Hospital Death ◽  
Inferior Wall ◽  
Mortality And Morbidity ◽  
Killip Class ◽  
Increased Risk ◽  
The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

scholarly journals P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Sakaguchi ◽  
A Yamada ◽  
M Hoshino ◽  
K Takada ◽  
N Hoshino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ejection Fraction ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Stable Condition ◽  
Left Ventricular ◽  
Operating Characteristics ◽  
Cardiac Events

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (&gt; 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p &lt; 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

P624The prognostic value of myocardial deformation in patients with congenital aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R W J Van Grootel ◽  
A T Van Den Hoven ◽  
D Bowen ◽  
T Ris ◽  
J W Roos-Hesselink ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Stenosis ◽  
Prognostic Value ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Congenital Aortic Stenosis

Abstract Background Congenital aortic stenosis (AoS) is associated with significant mortality and morbidity but predictors for clinical outcome are scarce. Strain analysis provides a robust and reproducible method for early detection of left ventricular (LV) dysfunction, which might be of prognostic value. Therefore we aimed to assess the prognostic value of LV global longitudinal strain (GLS) and global longitudinal early diastolic strain rate (GLSre) with regard to cardiovascular events. Methods This prospective study, included clinically stable patients with congenital AoS between 2011–2013. LV GLS and GLSre was performed in the apical 4, 3 and 2-chamber views using Tomtec software. The endpoint was a composite of death, heart failure, hospitalization, arrhythmia, thrombo-embolic events and re-intervention. Results In total 138 patients were included (33 [26–43] years, 86 (62%) male), NYHA class I: 134 (97%). Mean LV GLS was −15.3±3.2%, GLSre 0.66±0.18 s–1. Both correlated with NT-proBNP, LV volumes and ejection fraction (strongest LV GLS with LV EF: r −0.539, p<0.001, strongest LV GLSre with age: r −0.376 p<0.001). During median follow-up of 5.9 [5.5–6.2] years, the endpoint occurred in 53 (38%) patients: 4 patients died, 9 developed heart failure, 22 arrhythmias, 8 thrombo-embolic events and 35 re-interventions. Both LV GLS (standardized HR (sHR 0.62 (95% CI 0.47–0.81) and GLSre (sHR 0.62 (95% CI 0.47–0.83) were associated with the endpoint. Additional multivariable analysis showed that both GLS and GLSre were associated independent of left atrial volume, NT-proBNP and prior re-interventions. Figure 1 Conclusion Left ventricular GLS and GLSre are reduced in adult patients with congenital AoS. Both markers are associated with adverse cardiac events and have clear clinical relevance Acknowledgement/Funding Erasmus Thorax Foundation

scholarly journals 563 Different right ventricle maladaptation in patients with HFrEF and HFpEF: diagnostic and prognostic implications

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gaetano Ruocco ◽  
Filippo Pirrotta ◽  
Andrea Stefanini ◽  
Maria Barilli ◽  
Guido Cavati ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Prognostic Impact ◽  
Preserved Ejection Fraction ◽  
S Wave ◽  
Longitudinal Function ◽  
Increased Risk ◽  
And Function

Abstract Aims The prognostic impact of right ventricular (RV) dysfunction and of pulmonary hypertension (PH) in patients affected by heart failure (HF) is well known. More recently it has been demonstrated that the coupling between the afterload and the function of the right ventricle in terms of TAPSE/PAPS ratio, may provide additional prognostic information. In contrast, sparse and conflicting data have been published regarding the relevance of different echocardiographic features in patients with reduced or preserved ejection fraction. Additionally, RV function and ventricular-arterial coupling is poorly studied in acute setting. We planned a prospective monocentric study aimed at elucidating the role of PH and of RV structure and function, assessed by means of an echocardiographic examination in the early phase of hospital admission of patients with ADHF. We also compared different echo parameters in order to assess the prognostic role in patient affected by HF and reduced ejection fraction (HFrEF) vs. those with preserved ejection fraction (HFpEF). Methods and results we included 381 patients included in the study, 209 had HFrEF and 172 had HFpEF. All the examinations were performed by cardiologists according to the instructions provided by the American Society of Echocardiography. In all patients LV volumes and diastolic function analysis were performed. A detailed examination of RV dimension and function were achieved by the measurement of right ventricular diameter at basal level, Pulmonary systolic pressure (PAPS), Tricuspid anular peak systolic excursion (TAPSE) and s wave by TDI analysis at RV free wall basal level. Finally longitudinal function was measured at lateral RV wall by post processing strain analysis. Overall, the median TAPSE was 19 (16–21) mm, the median of RVEDD was 40 (36–45) mm, the median PASP was 45 (35–50) mmHg and the median s’ wave was 11 (7–14). Patients with HFrEF demonstrated a larger RVEDD compared to HFpEF (44 ± 6 vs. 38 ± 5 P &lt; 0.05) and more reduced TAPSE (16 ± 4 vs. 20 ± 3 P &lt; 0.05). Whereas PAPS values were similar in both groups (47 ± 10 vs. 45 ± 10 NS). Conversely, s’ wave was much more reduced in HFpEF (9 ± 3 vs. 12 ± 4 P &lt; 0.05) RV longitudinal strain was reduced in both group but HFpEF population demonstrated more impaired values (−18 ± 5 vs. −22 ± 8; P &lt; 0.01). TAPSE/PAPS was significantly reduced in HFrEF (0.38 ± 8 vs. 0.43 ± 5 P &lt; 0.01). Conversely s’/PAPS was more pronounced in HFpEF group (0.25 ± 4 vs. 0.29 ± 7 P &lt; 0.05). At univariate analysis several parameters were related to outcome: TAPSE ≤ 14 mm, [HR: 1.70 (1.14–2.52); P = 0.009], PASP≥ 40 mmHg [HR: 1.51 (1.05–2.17); P = 0.02], RVEDD &gt; 38 mm [HR: 1.88 (1.36–2.61); P &lt; 0.001], s wave &lt; 9 [HR: 1.88 (1.3–2.4), P &lt; 0.001], inferior vena cava diameter &gt; 21 mm [HR: 1.90 (1.31–2.75); P = 0.001]. Therefore TAPSE/PAPS was associated with adverse event in HFrEF but not in HFpEF (HR: 1.75 and HR: 1.02). Whereas, s/PAPS was associated with more increased risk in HFpEF (HR: 1.8 and HR: 1.3). Conclusions Right ventricular dysfunction and maladaptation are associated with poor outcome in either HFrEF and HFpEF. However tissue excursion and longitudinal strain are much more impaired in HFpEF, whereas RV dilatation and reduced longitudinal function are closely related to HFrEF. Different prognostic values and evaluation may be comprised during the evaluation of HFrEF and HFpEF.

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