scholarly journals Right ventricular myocardial work: proof-of-concept for non-invasive assessment of right ventricular function

2020 ◽  
Author(s):  
Steele C Butcher ◽  
Federico Fortuni ◽  
Jose M Montero-Cabezas ◽  
Rachid Abou ◽  
Mohammed El Mahdiui ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Systolic Function ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Non Invasive ◽  
Echocardiographic Parameters ◽  
Global Work

Abstract Aims Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure–strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease. Methods and results Non-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59–67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardiovascular disease to allow for comparison between groups. None of the conventional echocardiographic parameters of RV systolic function were significantly correlated with stroke volume or stroke volume index. In contrast, one of the novel indices derived non-invasively by pressure–strain loops, RVGCW, demonstrated a moderate correlation with invasively measured stroke volume and stroke volume index (r = 0.63, P = 0.002 and r = 0.59, P = 0.004, respectively). RVGWI, RVGCW, and RVGWE were significantly lower in patients with HFrEF compared to a healthy cohort, while values of RVGWW were significantly higher. Conclusion RVGCW is a novel parameter that provides an integrative analysis of RV systolic function and correlates more closely with invasively measured stroke volume and stroke volume index than other standard echocardiographic parameters.

Right ventricular myocardial work: new method for non-invasive assessment of right ventricular function in HFrEF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.C Butcher ◽  
F Fortuni ◽  
J.M Montero ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Systolic Function ◽  
Left Ventricular ◽  
The Novel ◽  
Non Invasive ◽  
Echocardiographic Parameters ◽  
Global Work

Abstract Background The prognostic significance of speckle tracking echocardiography derived right ventricular (RV) strain has been repeatedly demonstrated in the heart failure with reduced ejection fraction (HFrEF) patient group. Nevertheless, assessing RV systolic function in the context of afterload is vital as even minimal increases in pulmonary pressures may result in a substantial reduction in RV stroke volume. The novel assessment of Right Ventricular Myocardial Work (RVMW) through the evaluation of pressure-strain loops derived by echocardiography, provides a comprehensive evaluation of RV systolic function, integrating both RV strain and afterload. Purpose To explore the relationship between the non-invasive estimation of RVMW with invasive indices of right heart catherization (RHC) in a cohort of patients with HFrEF. Methods Noninvasive analysis of RVMW was performed in 23 HFrEF patients (median age 60.4 [58.0 to 66.0] years, 74% male) who underwent echocardiography and invasive RHC within 48 hours. The novel indices of RV global constructive work (RVGCW), RV global work index (RVGWI), RV wasted work (RVWW) and RV global work efficiency (RVGWE) were analysed utilizing proprietary software originally developed for the assessment of left ventricular myocardial work by speckle tracking echocardiography. These indices and other standard measurements of RV systolic function were then compared with invasively measured cardiac index (CI), derived by thermodilution during RHC. Results Mean left ventricular ejection fraction was 18.7% (±6.7), with a mean cardiac index of 2.2 L/min/m2(±0.7) and a mean pulmonary arterial pressure of 32 mm Hg (±13). None of the standard echocardiographic parameters of RV systolic function, including fractional area change, RV global longitudinal strain, RV free wall strain and TAPSE were significantly correlated with cardiac index in this cohort of HFrEF patients. In contrast, two of the novel indices derived non-invasively by pressure-strain loops, RVGCW and RVGWI, demonstrated a moderate correlation with invasively measured CI (r=0.55, p=0.006 and r=0.49, p=0.018). Conclusion RVGCW and RVGWI are novel parameters that provide integrative analysis of RV systolic function and correlate more closely with invasively measured CI than other standard echocardiographic parameters. Their potential role in aiding clinical decision-making merits further investigation. Funding Acknowledgement Type of funding source: None

scholarly journals Postoperative continuous non-invasive cardiac output monitoring on the ward: a feasibility study

2020 ◽  
Author(s):  
C. E. King ◽  
A. Kermode ◽  
G. Saxena ◽  
P. Carvelli ◽  
M. Edwards ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Clinical Outcomes ◽  
Feasibility Study ◽  
Continuous Monitoring ◽  
Elective Surgery ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Cardiac Output Monitoring ◽  
Non Invasive

Abstract Postoperative hypotension is common (occurring in one third of patients) and is associated with worse clinical outcomes. The LiDCO CNAP (continuous non-invasive arterial pressure) device measures haemodynamics but has not been widely adopted in ward environments. Improved early detection of hypotension by CNAP might guide interventions to improve clinical outcomes. We aimed to find the proportion of patients who tolerated LiDCO CNAP for 12 h postoperatively, to unmask episodes of hypotension detected by continuous monitoring and to characterise the haemodynamic profile at the time of hypotension. In this feasibility study, patients undergoing major elective surgery were continuously postoperatively monitored using CNAP. Haemodynamic data gathered from CNAP, including nSVRI (nominal systemic vascular resistance index), nSVI (nominal stroke volume index), SVV (stroke volume variation) and blood pressure, were analysed using Microsoft Excel and GraphPad Prism 8. 104 patients (age (mean ± sd): 68 ± 14, male (56%)) had CNAP sited postoperatively. 39% tolerated the CNAP device for at least 12 h. Within the 104 patients a mean of 81.2 min of hypotension detected by CNAP was not detected by usual care. The proportion of low/normal/high nSVI was 71%, 27% and 2%, nSVRI was 43%, 17% and 40%, respectively. CNAP monitoring was not tolerated for 12 h in the majority of patients. There were many episodes of hypotension unmasked through continuous monitoring. Based on the advanced haemodynamic data provided it is possible that the underlying cause of a third of postoperative hypotensive episodes is vasodilation rather than hypovolaemia. Trial registry number: NCT04010058 (ClinicalTrials.gov) Date of registration: 08/07/2019.

scholarly journals P899 Reduced right ventricular longitudinal function in patients with chronic left ventricular disease can be due to left ventricular forward failure and not right ventricular dysfunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Fredholm ◽  
S E Ricksten ◽  
K Karason ◽  
S E Bartfay ◽  
G Dellgren ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Peak Systolic Velocity ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Right Atrial ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Heart Catheterization ◽  
Ventricular Ejection Fraction ◽  
Longitudinal Function

Abstract Background and aim The occurrence of right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important therapeutic and prognostic consequences. Echocardiography (Echo) parameters describing the RV longitudinal function (tricuspid annular plane systolic excursion, TAPSE; peak systolic free wall longitudinal strain, RV-Str; tricuspid annulus peak systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesised that these parameters are load dependent. Methods We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC) and Echo within 48 hours. RHC was performed as part of diagnostic- or pre-transplant work-up. Fifty-six patients (85%) had left ventricular ejection fraction < 40%. From RHC data the patients were divided into three groups: Patients with RV decompensation and increased right atrial pressure (RAP) ≥10 mmHg (iRAP, n = 21), with normal RAP but reduced stroke volume index (SVI < 35 mL/m2) (rSVI, n = 21) and with normal RAP and normal SVI (nSVI, n = 24). Results Patients with iRAP had compared with rSVI/nSVI more advanced LHD with higher PAMP, PCWP and larger RV diastolic area (RVdA). TAPSE, RV-Str and FAC did not differ between iRAP and rSVI patients. The ratio RVdA/RV-Str was significantly higher in iRAP patients compared with rSVI and nSVI. The rSVI and nSVI patients did not differ regarding RAP response during supine exercise (P = 0.84). Conclusions Reduced RV longitudinal function in patients with chronic LHD and normal RAP can be due to left ventricular forward failure and not RV systolic dysfunction. iRAP (n = 21) rSVI (n = 21) nSVI (n = 24) Overall P-value iRAP vs rSVI iRAP vs nSVI rSVI vs nSVI RAP (mmHg) 13 ± 2 5 ± 3 4 ± 2 <0.001 <0.001 <0.001 0.34 PAMP (mmHg) 33 ± 8 24 ± 8 22±] <0.001 0.001 <0.001 0.34 PCWP (mmHg) 22 ± 5 16 ± 8 11 ± 6 <0.001 0.003 <0.001 0.025 CI (l/min/m2) 2.2 ± 0.4 2.2 ± 0.4 2.8 ± 0.5 <0.001 0.75 <0.001 <0.001 PVR (Wood unit) 2.6 ± 1.2 1.5 ± 1.6 1.9 ± 1.0 0.032 0.022 0.035 0.60 RVdA (cm2) 26 ± 7 21 ± 7 21 ± 5 0.012 0.007 0.017 0.63 TAPSE (mm) 12 ± 3 13 ± 3 18 ± 6 <0.001 0.28 <0.001 0.001 TAPSm (cm/s) 8 ± 2 8 ± 2 10 ± 4 0.06 - - - RV-str (%) -15 ± 5 -17 ± 5 -21 ± 6 0.002 0.11 0.001 0.028 FAC (%) 28 ± 9 29 ± 11 39 ± 11 <0.001 0.72 0.001 0.003 RVdA/RV-str (cm2/%) 2.2 ± 1.3 1.3 ± 0.7 1.1 ± 0.6 <0.001 0.013 0.001 0.27

scholarly journals Right ventricular end-diastolic stiffness heralds right ventricular failure in monocrotaline-induced pulmonary hypertension

2016 ◽  
Vol 311 (4) ◽  
pp. H1004-H1013 ◽  
Author(s):  
Mohamed Alaa ◽  
Mahmoud Abdellatif ◽  
Marta Tavares-Silva ◽  
José Oliveira-Pinto ◽  
Lucas Lopes ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Diastolic Pressure ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Positive Pressure ◽  
Stroke Work ◽  
Operating Characteristics ◽  
Diastolic Stiffness

Recent studies suggest right ventricular (RV) stiffness is important in pulmonary hypertension (PH) prognosis. Smaller stroke volume (SV) variation after a certain RV end-diastolic pressure (EDP) respiratory variation as assessed by spectral transfer function (STF) may identify RV stiffness. Our aim was to evaluate RV stiffness in monocrotaline (MCT)-induced PH progression and to validate STF gain between EDP and SV as marker of stiffness. Seven-week-old male Wistar rats randomly injected with 60 mg/kg MCT or vehicle were divided into three groups ( n = 12 each) according to cardiac index (CI): controls (Ctrl), preserved CI (MCT pCI), and reduced CI (MCT rCI). All underwent RV pressure-volume (PV) evaluation 24–34 days after MCT, under halogenate anesthesia and constant positive-pressure ventilation. End-diastolic stiffness (βi), end-systolic elastance (Eesi), arterial elastance for indexed volumes (Eai), and preload recruitable stroke work (PRSW) were obtained and beat-to-beat fluctuations during ventilation assessed by STF. Eai was the strongest determinant of CI, alongside βi but not PRSW. MCT rCI showed impaired ventricular-vascular coupling (VVC) and higher βi, along with low end-diastolic pressure (EDP) and stroke volume index (SVi) STF gain, denoting impaired preload reserve. On multivariate analysis βi and not Eesi correlated with EDP-SVi STF gain ( P < 0.001). Receiver-operating characteristics (ROC) curve analysis of EDP-SVi STF gain showed an area under curve of 0.84 for βi prediction ( P = 0.002). Afterload, impaired VVC and RV stiffness are major players in RV failure. RV stiffness can be assessed by STF gain analysis of respiratory fluctuations between EDP and SVi, which may constitute a prognostic tool in PH.

scholarly journals Right ventricular myocardial work characterisation in patients with pulmonary hypertension: association with invasive haemodynamic parameters

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S C Butcher ◽  
C Feloukidis ◽  
V Kamperidis ◽  
J Stassen ◽  
F Fortuni ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systolic Function ◽  
Group Iv ◽  
Stroke Work ◽  
Non Invasive ◽  
Group I ◽  
Work Index ◽  
Stroke Work Index ◽  
Echocardiographic Parameters ◽  
Global Work

Abstract Background Non-invasive evaluation of indices of right ventricular (RV) myocardial work derived from RV pressure-strain loops may provide novel insights into RV function in pre-capillary pulmonary hypertension. Purpose This study was designed to evaluate the association between the indices of RV myocardial work and invasive haemodynamic parameters in a patient cohort with pulmonary arterial hypertension (Group I) or chronic thromboembolism pulmonary hypertension (Group IV). Methods The non-invasive analysis of echocardiography-derived RV myocardial work (Figure 1, upper panel) was completed in 51 patients (mean age 58.1±12.7 years, 31% male) with Group I (78%) or Group IV (22%) pulmonary hypertension. Conventional echocardiographic measurements of RV systolic function, RV global work index (RV GWI), RV global constructive work (RV GCW), RV global wasted work (RV GWW) and RV global work efficiency (RV GWE) were compared with parameters derived invasively during right heart catheterisation (RHC). Results The median RV GWI, RV GCW, RV GWW and RV GWE were 620 (443 to 857) mmHg%, 830 (650 to 1206) mmHg%, 105 (54 to 169) mmHg% and 87 (82 to 93)%, respectively. Compared to pulmonary artery systolic pressure and conventional echocardiographic parameters of RV systolic function (RV global longitudinal strain [GLS], tricuspid annular plane systolic excursion and RV fractional area change), RV GCW and RV GWI correlated more closely with invasively-derived RV stroke work index (R=0.63, P&lt;0.001 and R=0.60, P&lt;0.001, respectively) (Figure 1, lower panels). Invasively-derived pulmonary vascular resistance (PVR) correlated with RV GWW (R=0.63, P&lt;0.001), RV GWE (R=0.48, P&lt;0.001) and RV GLS (R=0.58, P&lt;0.001). RV GLS correlated more closely with invasively-derived stroke volume index (R=−0.57, P&lt;0.001) than RV GCW, RV GWI and RV GWE (R=0.34, P=0.016, R=0.48, P&lt;0.001 and R=0.47, P&lt;0.001, respectively). Conclusions In a patient cohort with Group I and Group IV pulmonary hypertension, indices of RV myocardial work were more closely correlated with invasively-derived RV stroke work index and PVR than conventional echocardiographic parameters of RV systolic function. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Method and correlations

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