Left atrial strain can predict right ventricular impairment and developement of atrial fibrilation in patients with severe mitral stenosis better than transmitral gradients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Rheumatic heart disease is a major health problem in developing countries and remains the leading cause of mitral valve stenosis (MS) and valve replacement in adults. Left atrial (LA) inflammation due to rheumatic carditis, pressure overload because of mitral stenosis, lead to fibrosis and remodeling to progressive lost of LA reservoir/compliant capacity that might be responsible of the pressure backward load to the pulmonary circulation. The aims of the study were to determine if 1) there is any correlation between LA strain parameters with pulmonary systolic arterial pressure (PASP) and other parameters related with pulmonary pressure and right ventricular (RV) function and 2) if LA strain can better identify those patients who developed atrial fibrilation (AF). Methods. Strain of the LA was measured in 101 patients retrospectively enrolled with severe MS using two dimensional speckle tracking (2DSTE). Sixty of them were in sinus rhythm (SR) and 40 in atrial fibrillation (AF). The LA 2DSTE was measured from the 4 chamber view of 2 consecutive cycles at expiration and offline evaluated. Based on the QRS onset, the positive peak strain curve was defined as LA end systolic strain. The end of the reservoir phase was defined as 1 frame before mitral valve opening (LA- RES). When the patient was in SR, immediately after the P wave, LA contractile function was identified (LA-booster). Strain of the free wall and global RV was measured in 4CH. A standard echocardiographic assessment was done in accordance with the recommendation of the American Society of Echocardiography. Results. Patients mean age was 47.4 ± 11.9 years, 30 males and 71 females. Mean gradient across the mitral valve (MV) was 8.3 ± 5.1 mmHg and the MV area derived by pressure half time was 1.3 ± 0.3 cm2, LVEF was 51.79 ± 11.3%. Right ventricular (RV) function parameters were TAPSE 19.6 ± 5.2 mm, S` 10.5 ± 2.5 cm/s, RV fraction area change 35.6 ± 9.1% and RV free wall peak strain – 17.96 ± 6.5%. LVMi 51.79 ± 11.3 gr/m2, SVi 34.6 ± 10.3 ml/m2. LA-RES 11.18 ± 3.7%, LA volume in systole 128.3 ± 48.3 ml, LAEF 20.1 ± 12.5%. The group was divided according to tertiles of LA-RES (group 1, 33 patients, strain was < =7%, group 2, 32 patients with strain between 8 and 13%, group 3, 32 patients, strain > =14%). There was a decrease in PASP (group 1, 42.3 ± 17.8 mmHg; group 2, 38.3 ± 17.9 mmHg; group 3, 31.6 ± 17.9 mmHg, p =0.028) and PVR (group 1, 2.5 ± 1; group 2, 2.0 ± 0.6; group 3, 1.6 ± 0.4, p< 0.0001) as LA-RES increased. RV function represented by TAPSE, Sm, RVFAC and RV free wall strain significantly increased as LA-RES increased. The area under the ROC curve was calculated for LA-RES, MV mean gradient, MV area derived by PHT and LA systolic volume as a predictors of AF. LA-RES was the one that better predicted the presence of AF. Conclusion. In severe MS, LA-RES was able to better identify those with higher PASP and worst RV function. Moreover LA-RES was also able to better predict those patients who developed AF.

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Role of the tricuspid annulus in functional tricuspid regurgitation development after early isolated mitral valve surgery: is it an old story?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.070 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

V Volpato ◽

V Mantegazza ◽

G Tamborini ◽

P Gripari ◽

M Muratori ◽

...

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Tricuspid Regurgitation ◽

Cardiac Events ◽

Basal Diameter ◽

Functional Tricuspid Regurgitation ◽

Group 2 ◽

Rv Function ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background. Functional Tricuspid Regurgitation (FTR) has been described as a common condition after isolated mitral valve (MV) surgery, affecting patients’ prognosis. Thus, in cases without significant tricuspid regurgitation (TR) but tricuspid annular (TA) dilatation, TV annuloplasty is currently recommended. Studies suggesting the currently used cut-off for definition of TA dilatation were based on 2D echocardiography (2DE) and included patients treated with MV surgery with heterogeneous MV disease, degree of cardiac remodeling and heart rhythm. As the management of severe MR has moved towards an earlier surgical treatment, few data are available about the incidence of FTR in the population undergoing early isolated MV surgery without TR, but 2DE satisfying criteria for TA dilatation. Aims. To test, in patients treated with early isolated MV surgery for MV prolapse (MVP), without TR and either normal or dilated TA (i) if the currently used 2D TA cut-off is predictive of FTR and cardiac events development (ii) how right chambers’ remodeling assessed by 3D echocardiography (3DE) affects TA dimension. Methods. We studied 159 patients (age 61 ± 11) treated with early isolated MV surgery between 2010 and 2017. Eligible patients were those with 3DE images; normal left and right ventricular (LV and RV) function; sinus rhythm; normal or elevated right ventricular systolic pulmonary artery pressure (sPAP); normal or dilated TA by 2DE; absent TR. The decision to not perform TV annuloplasty in patients with TA dilatation was based on the surgical inspection. All patients underwent a complete 2DE, 3DE analysis was performed using custom software, including LV, RV, left atrial (LA) and right atrial (RA) assessment. 3D TA dimension were obtained using MPR. Clinical and 2DE follow-up was performed at 36 ± 6 months after surgery, major adverse cardiac events (MACEs, including cardiac hospitalization, cardiac death, arrhythmias) and FTR were recorded. Results. Based on 2DE TA dimensions, patients were divided in group 1 (N = 68, 43%, TA≥21 mm/m²) and group 2 (N= 91, 57%, normal TA). Patients in group 1 showed larger RA volume, RV basal diameter and TA area (p < 0.05) by 3DE compared to group 2 (Table). At the multivariate analysis, only the 3D RA volume, RV basal diameter and RV function were independently correlated to the TA area (p < 0.05). At the follow-up, no differences were noted between groups in FTR development and MACEs at the Kaplan-Meier analysis (Fig.). At the COX analysis, 2DE TA dilatation failed to result a predictor of cardiovascular events (model’s X2, p > 0.05). Conclusions. In patients undergoing early MV surgery, the currently defined TA dilatation by 2DE may not necessarily evolve in FTR, and a larger cut-off may be needed. In this population, the evaluation of right chambers’ dimension and function may better define the probability to develop FTR. Abstract Figure. Fig

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Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpson’s monoplanar methods

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-6441 ◽

2020 ◽

Vol 40 (3) ◽

pp. 188-196

Author(s):

Mariana R. Coelho ◽

Ruthnea A.L. Muzzi ◽

Elaine M.S. Dorneles ◽

Guilherme G. Pereira ◽

Rosa M. Cabral ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Disease ◽

Left Atrial ◽

Feature Tracking ◽

Atrial Function ◽

Two Dimensional ◽

Contraction Phase ◽

Group 3 ◽

Group 2 ◽

Group 1

ABSTRACT: The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson’s monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson’s monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson’s monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.

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CMR markers for early right ventricular dysfunction in precapillary pulmonary hypertension

European Heart Journal ◽

10.1093/ehjci/ehaa946.0241 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Vos ◽

T Leiner ◽

A.P.J Van Dijk ◽

F.J Meijboom ◽

G.T Sieswerda ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricle ◽

Right Ventricular ◽

Circumferential Strain ◽

Peak Strain ◽

Healthy Controls ◽

Free Wall ◽

Global Circumferential Strain ◽

The Right ◽

Rv Function

Abstract Introduction Precapillary pulmonary hypertension (pPH) causes right ventricular (RV) pressure overload inducing RV remodeling, often resulting in dysfunction and dilatation, heart failure, and ultimately death. The ability of the right ventricle to adequately adapt to increased pressure loading is key for patients' prognosis. RV ejection fraction (RVEF) by cardiac magnetic resonance (CMR) is related to outcome in pPH patients, but this global measurement is not ideal for detecting early changes in RV function. Strain analysis on CMR using feature tracking (FT) software provides a more detailed assessment, and might therefore detect early changes in RV function. Aim 1) To compare RV strain parameters in pPH patients and healthy controls, and 2) to compare strain parameters in a subgroup of pPH patients with preserved RVEF (pRVEF) and healthy controls. Methods In this prospective study, a CMR was performed in pPH patients and healthy controls. Using FT-software on standard cine images, the following RV strain parameters were analyzed: global, septal, and free wall longitudinal strain (GLS, sept-LS, free wall-LS), time to peak strain (TTP, as a % of the whole cardiac cycle), the fractional area change (FAC), global circumferential strain (GCS), global longitudinal and global circumferential strain rate (GLSR and GCSR, respectively). A pRVEF is defined as a RVEF >50%. To compare RV strain parameters in pPH patients to healthy controls, the Mann-Whitney U test was used. Results 33 pPH-patients (55 [45–63] yrs; 10 (30%) male) and 22 healthy controls (40 [36–48] yrs; 15 (68%) male) were included. All RV strain parameters were significantly reduced in pPH patients compared to healthy controls (see table), except for GCS and GCSR. Most importantly, in pPH patients with pRVEF (n=8) GLS (−26.6% [−22.6 to −27.3] vs. −28.1% [−26.2 to −30.6], p=0.04), sept-LS (−21.2% [−19.8 to −23.2] vs. −26.0% [−24.0 to −27.9], p=0.005), and FAC (39% [35–44] vs. 44% [42–47], p=0.02) were still significantly impaired compared to healthy controls. The RV TTP was significantly increased in pPH patients compared to healthy controls (47% [44–57] vs. 40% [33–43], p≤0.001). Conclusions Several CMR-FT strain parameters of the right ventricle are impaired in pPH patients when compared to healthy controls. Moreover, even in pPH patients with a preserved RVEF multiple RV strain parameters (GLS, sept-LS, and FAC) remained significantly impaired, and TTP significantly prolonged, in comparison to healthy controls. This suggests that RV strain parameters may be used as an early marker of RV dysfunction in pPH patients. Funding Acknowledgement Type of funding source: None

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Abstract 13073: ECG, Clinical, and Imaging Characteristics of Arrhythmogenic Right Ventricular Cardiomyopathy With Fat and Fibrotic Invasion Into the Left Ventricular Myocardium Revealed by Four-dimensional (4D) Cardiac CT

Circulation ◽

10.1161/circ.142.suppl_3.13073 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nobusada FUNABASHI ◽

Yoshio Kobayashi

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Cardiac Ct ◽

4D Ct ◽

Imaging Characteristics ◽

Group 3 ◽

Clinical Heart Failure ◽

Group 2 ◽

Group 1 ◽

T Waves

Introduction: 4D cardiac CT can reveal characteristics of arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) such as fat and fibrotic invasion into the RV and LV myocardium (RVM, LVM), an enlarged RV, reduced RV motion and bulging. Hypothesis: We could differentiate ARVC patients with fat and fibrotic invasion into the LVM from those without, using ECG, clinical, and other imaging characteristics. Methods: Retrospective analysis of 17 patients (11 males, 57±17 years) with suspected ARVC who underwent 4D cardiac CT. Results: 9 patients met the 2010 ARVC task force criteria. 4 had fat and fibrotic invasion into the LVM (group 1) but 5 did not (group 2). The remaining 8 did not fulfill the ARVC criteria (group 3). The proportion of males and age did not differ between groups. In groups 1, 2 and 3, respectively, 3 (75%), 4 (80%), and 1 (13%) patients had epsilon waves in V1-3 (group 1>3, P=0.033, group 2>3, P=0.005). 2 (50%), one (20%) and 4 (50%) had complete right bundle branch block (CRBBB) (all P=NS). Three (75%), 3 (60%), and 1 (13%) had inverted T waves in V1-3 or beyond (group 1>3, P=0.033). One (50%), 3 (75%), and 2 (50%) had terminal activation duration of QRS ≥55 ms measured from the nadir of the S wave to the end of the QRS, including R’, in V1, V2, or V3, in the absence of CRBBB (all P=NS). One (25%), 4 (80%) and 1 (13%) had sustained ventricular tachycardia (SVT; group 2>3, P=0.005). Two (50%), 1 (20%), and 3 (38%) had non-SVT (all P=NS). 4 (100%), 2 (40%), and 2 (25%) had clinical heart failure (group 1>2, P=0.019, group 1>3, P<0.001). Finally, 4 (100% and 80%) and 6 (75%) had RV enlargement on TTE (all P=NS). On 4D CT, 4 (100%), 5 (100%), and 5 (63%) of patients in groups 1, 2 and 3, showed RV enlargement (all P=NS); 4 (100%), 2 (40%), and 1 (13%) showed reduced RV motion (group 1>2, P=0.019, group 1>3, P<0.001); 75, 100, and 0%, had RV fat invasion (group 1>3, P=0.002, group 2>3, P<0.001); and 25, 0, and 0% showed bulging (all P=NS). Conclusions: Most patients had RV enlargement on TTE and/or 4D CT. Presence of epsilon waves, reduced RV motion, and RV fat invasion on 4D CT may differentiate groups 1 and 2 from group 3, inverted T waves in V1-3 leads or beyond may differentiate group 1 from group 3, SVT may differentiate group 2 from group 3 but only clinical heart failure may differentiate groups 1 and 2.

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Abstract 16078: Pulmonary Vasculopathy Assessed By Intravascular Ultrasound in Persistent Pulmonary Hypertension After Mitral Valve Replacement, Comparation to Idiopathic Pulmonary Arterial Hypertension and Healthy Controls

Circulation ◽

10.1161/circ.132.suppl_3.16078 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Juan Carlos J Grignola ◽

Leticia L Fernandez-Lopez ◽

Enric E Domingo-Ribas ◽

Rio R Aguilar ◽

Cristian Humberto C Arredondo ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Elastic Modulus ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Persistent Pulmonary Hypertension ◽

Pulmonary Arterial ◽

Group 3 ◽

Group 2 ◽

Group 1

Purpose: The aim of the study is to assess pulmonary vasculopathy (wall fibrosis, pulmonary arterial pulsatility and elastic modulus ) in patients with persistent pulmonary hypertension (pulmonary systolic pressure by ECHO > 50 mmhg ) at least 1 year after mitral valve replacement with normal function of the valve. The evaluation was carried out by intravascular ultrasound (IVUS) in medium sized pulmonary arteries. We compared three groups: Group 1 ( persistent pulmonary hypertension after mitral valve replacement), Group 2 (pulmonary hypertension belonging to the group 1 of the Dana Point classification) and Group 3 (healthy controls). Methods: We studied 43 patients, 15 in Group 1 , 18 Group 2 and 10 in Group 3. Group 1: 13 females, the mean age of this group was 74+-7 years; Group 2: 14 females, 53+-14 years and Group 3: 6 females, 51+-5 years. All patients were submitted to left and right heart catheterization, and IVUS in medium sized elastic PA ( 2-3 mm diameter ) of the inferior lobes. Studied variables were: mean pulmonary artery pressure (PAP, mm Hg), pulmonary wedge pressure, aortic pressure, cardiac output (CO,l/min), pulmonary vascular resistance (PVR, Wood Units), IVUS pulsatility and elastic modulus (EM,mm Hg). Local pulsatility was estimated by IVUS: (systolic- diastolic lumen area/ diastolic lumen area) X 100. PA stiffness was assessed by the elastic modulus (EM= pulse pressure/ IVUSp). Results: In Group 3 all variables were statistically different from the other 2 groups (p<0.01). Variables are shown in table. Conclusions: Group 1, even with a lower mean PAP than Group 2 (p<0.05) showed a similar anatomical ( wall fibrosis ) and similar functional wall remodeling ( EM ).

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Right ventricular failure in septic shock: characterization, incidence and impact on fluid responsiveness

Critical Care ◽

10.1186/s13054-020-03345-z ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Antoine Vieillard-Baron ◽

Amélie Prigent ◽

Xavier Repessé ◽

Marine Goudelin ◽

Gwenaël Prat ◽

...

Keyword(s):

Septic Shock ◽

Right Ventricular ◽

Venous Pressure ◽

Fluid Challenge ◽

Venous Congestion ◽

Critical Care Echocardiography ◽

Group 3 ◽

Potential Impact ◽

Group 2 ◽

Group 1

Abstract Objective Incidence of right ventricular (RV) failure in septic shock patients is not well known, and tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values. Design Ancillary study of the HEMOPRED prospective multicenter study includes patients under mechanical ventilation with circulatory failure. Setting This is a multicenter intensive care unit study Patients Two hundred and eighty-two patients with septic shock were analyzed. Patients were classified in three groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded. Interventions None. Measurements and main results In total, 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had a normal TAPSE. Conclusions RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

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Right ventricular failure in septic shock. Characterization, incidence and impact on fluid-responsiveness

10.21203/rs.3.rs-52215/v1 ◽

2020 ◽

Author(s):

Antoine Vieillard-Baron ◽

Amélie Prigent ◽

Xavier Repessé ◽

Marine Goudelin ◽

Gwenaël Prat ◽

...

Keyword(s):

Septic Shock ◽

Right Ventricular ◽

Venous Pressure ◽

Fluid Challenge ◽

Venous Congestion ◽

Critical Care Echocardiography ◽

Group 3 ◽

Potential Impact ◽

Group 2 ◽

Group 1

Abstract Objective Incidence of right ventricular (RV) failure in septic shock patients is not well-known and Tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values.Design Ancillary study of the HEMOPRED prospective multicenter study including patients under mechanical ventilation with circulatory failure.Setting Multicenter intensive care unit studyPatients 282 with septic shock were analyzed. Patients were classified in 3 groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded.Interventions NoneMeasurements And main results 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had anormal TAPSE.Conclusions RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

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P1505 Echocardiographic assessment of different pulmonary hypertension groups

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.929 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Fontes Oliveira ◽

M Trepa ◽

R Costa ◽

A Dias Frias ◽

I Silveira ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Interventricular Septum ◽

Pulmonary Vascular Disease ◽

Eccentricity Index ◽

Group 4 ◽

Global Strain ◽

Group 3 ◽

Group 2 ◽

Rv Function ◽

Group 1

Abstract Introduction Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Different etiology groups might have different echocardiographic phenotypes. In this study, we aimed to study echocardiographic characterization of the different PH groups and its ability to predict pulmonary vascular disease severity. Methods We collected echocardiographic and right heart catheterization (RHC) data from 97 (75% female, age 65 ± 15 years) consecutive patients referred to an expert tertiary care referral PH centre from 12/2016 to 11/2018. Echocardiographic analysis was performed using Echo-Pac software from GE Healthcare®. Group 3 and 5 were not included in the group comparison analysis due to few patients included. Results Group 2 PH was the most frequent etiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population as a whole showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7. PH group 1 had a significantly lower FAC (26 ± 4%, p = 0.0025), higher eccentricity index (IE) (1.5 ± 0.1, p = 0.01), and more frequently RV outflow tract (RVOT) notching than other groups (62%, p = 0.012). Group 4 presented an intermedium echocardiographic phenotype between group 1 and 2, and showed more abnormal strain values than the other groups. Group 2 had fewer patients in sinus rhythm (atrial fibrillation in 34% of patients, p = 0.02), presented a thicker interventricular septum (11.3 ± 1.8, p = 0.014), a higher FAC (35 ± 3%, p = 0.0025), higher E mitral wave velocity (72 ± 6 cm/s, p < 0.001) and E/E’ ratio (12.7 ± 10.2, p = 0.006), and larger left (45 ± 3 cm3/m3, p < 0.01) and right atria (25 ± 2 cm2, p = 0.03). PH groups 1 and 4 had higher Pulmonary Vascular Resistance (PVR) and Pulmonary Mean Arterial Pressure (PMAP) values than group 2, which significantly correlated with echocardiographic RV function parameters as TAPSE, FAC, RV global strain and IE. In PH group 2, eccentricity index was the only predictor of PVR (β=4.1, p = 0.018). In this population, a left atria volume < 32.7 cm3/m2 (OR 4.25, CI 1.71 - 10.55) and a E/e’ ratio < 12 (OR 4.72, CI 2.05 - 10.87) predicted PECP < 15 mmHg. RV global strain > -17.1 predicted PVR > 3 wood (OR 3.46, CI 1.50 - 8.02) and PMAP > 20 mmHg (OR 4.92, CI 1.67 - 14.51). TAPSE < 18 mm predicted PVR > 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72). Conclusion Different PH groups present mild echocardiographic differences between them. PH group 1 presented with more echocardiographic signs of RV disfunction, and PH group 2 had higher FAC, E/E’ and larger right and left atria. RV function parameters predicted PVR in PH groups 1 and 4, and EI was the only predictor of PVR in PH group 2. Abstract P1505 Figure.

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Right ventricular failure in septic shock. Characterization, incidence and impact on fluid-responsiveness.

10.21203/rs.3.rs-52215/v2 ◽

2020 ◽

Author(s):

Antoine Vieillard-Baron ◽

Amélie Prigent ◽

Xavier Repessé ◽

Marine Goudelin ◽

Gwenaël Prat ◽

...

Keyword(s):

Septic Shock ◽

Right Ventricular ◽

Venous Pressure ◽

Fluid Challenge ◽

Venous Congestion ◽

Critical Care Echocardiography ◽

Group 3 ◽

Potential Impact ◽

Group 2 ◽

Group 1

Abstract Objective: Incidence of right ventricular (RV) failure in septic shock patients is not well-known and Tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values. Design: Ancillary study of the HEMOPRED prospective multicenter study including patients under mechanical ventilation with circulatory failure.Setting: Multicenter intensive care unit studyPatients: 282 with septic shock were analyzed. Patients were classified in 3 groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded.Interventions: noneMeasurements and main results: 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had anormal TAPSE. Conclusions: RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

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The Role of Right Ventricular Function in Mitral Valve Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20121080 ◽

2013 ◽

Vol 16 (3) ◽

pp. 170 ◽

Cited By ~ 5

Author(s):

Xiumei Sun ◽

Jennifer Ellis ◽

Louis Kanda ◽

Paul J. Corso

Keyword(s):

Survival Rate ◽

Mitral Valve ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Right Ventricular Dysfunction ◽

Group 2 ◽

Grade 3 ◽

Severe Grade ◽

Group 1

Background: An impaired right ventricular function is associated with a poor survival rate in patients with heart failure. Few investigations have analyzed the prognostic value of right ventricular function on the outcomes of mitral valve (MV) surgery. The objectives of this study were to define the effect of right ventricular function on postoperative outcomes after MV repair (MVP) or replacement (MVR).Methods: From September 2007 to February 2012, 335 consecutive patients underwent MVP or MVR at our institution. Preoperative transthoracic and transesophageal echocardiography (TEE) and postoperative TEE were used to define right ventricular function and MV performance. Preoperative right ventricular function was graded as normal to mild (grade 1-2) or as moderate to severe (grade 3-4). MV or tricuspid valve regurgitation was graded as non-trivial to mild (grade 0-2) or as moderate to severe (grade 3-4) preoperatively and postoperatively. Survival rate was evaluated at 1 year after surgery.Results: Of the 334 patients in the study, 280 patients showed a normal to a mildly impaired right ventricular function preoperatively (group 1). Fifty-four patients presented with moderate to severe right ventricular dysfunction (group 2). Patients with a compromised right ventricular function were more likely to undergo MVR (28.6% versus 53.7%, P <.001). The mean pulmonary artery pressure was 23.6 mm Hg in group 1 and 34 mm Hg in group 2 (P <.001). The left atrial diameter was 4.6 cm in group 1 and 5.3 cm in group 2 (P <.001). The 2 groups were not different with respect to operative mortality, but the patients in group 2 experienced more transfusion of blood products (588.4 mL versus 1180.6 mL, P <.001), longer intensive care unit stays (83.9 versus 149.6 hours, P <.001), and hospital stays (8.9 versus 12.8 days, P = .005). The rate of postoperative MV regurgitation was significantly higher in group 2 (1.8 versus 14.8%, P <.001). The overall 1-year survival rate was 92.5% in group 1 and 94.5% in group 2 (P = .59).Conclusions: This study has shown that a dysfunctional preoperative right ventricular function uses more resources and is associated with postoperative MV regurgitation, but it is not associated short- and mid-term mortality after MV surgery.

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