scholarly journals 429 Right ventricular longitudinal and radial fiber contractility in patients undergoing mitral valve surgery: a PREPARE-MVR substudy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B K Lakatos ◽  
M Tokodi ◽  
Z Toser ◽  
S Szigeti ◽  
K B Koritsanszky ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Volume Index ◽  
Stroke Work ◽  
Work Index ◽  
Depth Analysis ◽  
Radial Fiber ◽  
Stroke Work Index ◽  
Pulmonary Arterial

Abstract Severe mitral regurgitation results in significant hemodynamic demands of not only the left, but the right ventricle (RV) as well. Increased pulmonary pressures and consequential pressure overload of the RV induces complex remodeling, which can be partially restored by mitral valve repair/replacement (MVR). MVR is associated with marked changes of RV deformation, however, the clinical significance of these changes is not well estabilished. The PREPARE-MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) aims to determine parameters, which may predict the perioperative risk of acute RV failure. In this current substudy, our aim was to determine the changes of RV global, longitudinal and radial fiber contractility before and following MVR. Our study group consisted of 27 MVR patients (mean age: 64 ± 12 years, m/f: 19/8). Transthoracic 3D echocardiography was performed before the operation and following intensive care unit discharge. 3D beutel model of the RV was created and RV end-diastolic volume index (EDVi) among with RV ejection fraction (RVEF) were calculated using commercially available software. For in-depth analysis of RV mechanics, we have decomposed the motion of the RV using our custom software (ReVISION) to determine longitudinal (LEF) and radial ejection fraction (REF). Right heart catheterization was also performed before MVR and 24 hours after MVR as well to measure pulmonary arterial mean systolic pressure (mPAP), pulmonary arterial wedge pressure (PAWP) and RV stroke work index (RVSWi). Using the aforementioned parameters, we have calculated RV longitudinal (longRVSWi) and RV radial stroke work index (radRVSWi), which represent RV longitudinal and radial fiber contractility. RV morphology did not change significantly according to RVEDVi (preop vs. postop: 71 ± 17 vs. 72 ± 20 mL/m², p = NS). RVEF slightly decreased after MVR (50 ± 6 vs. 48 ± 7 %, p < 0.05), however, RV motion pattern markedly changed. Postoperative LEF was significantly lower compared to preoperative values (25 ± 6 vs. 16 ± 6%, p < 0.0001), among with an increase in REF (21 ± 7 vs. 27 ± 7%, p < 0.01). As expected, mPAP and PAWP decreased in response to MVR (mPAP: 30 ± 10 vs. 25 ± 7 mmHg; PAWP: 19 ± 7 vs. 13 ± 3 mmHg, both p < 0.01). Global RV contractility decreased after surgery (RVSWi: 603 ± 355 vs. 474 ± 251 mmHg*mL/m², p < 0.05). While RV longitudinal contractility also significantly reduced (longRVSWi: 289 ± 179 vs. 166 ± 122 mmHg*mL/m², p < 0.001), radial contractility was maintained following MVR (radRVSWi: 240 ± 141 vs. 261 ± 144 mmHg*mL/m², p = NS). MVR is associated with marked changes of RV function and hemodynamics. RV longitudinal and radial contractility have distinct response to surgery, which may be important in postoperative patient management. The PREPARE-MVR study aims to examine the role of preoperative RV mechanics in clinical outcome.

5939Perioperative shift in right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of right ventricular failure?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Tokodi ◽  
B K Lakatos ◽  
E Kispal ◽  
Z Toser ◽  
K Racz ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Right Ventricular Failure ◽  
Volume Index ◽  
Significant Shift ◽  
Stroke Work ◽  
Ventricular Failure ◽  
Contraction Pattern ◽  
Depth Analysis

Abstract Background Severe mitral regurgitation (MR) induces significant changes not only in the left, but also in the right ventricular (RV) morphology and function. Early treatment of MR is recommended, however, surgical procedure disrupts the native RV contractile pattern and predisposes the at-risk ventricle to develop postoperative RV failure (RVF) which is associated with poor outcomes. Purpose Accordingly, the PREPARE-MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) aims to explore the alterations of RV contraction pattern in patients undergoing MVR and to investigate the association of preoperative echocardiographic findings with early postoperative RVF. Methods We prospectively enrolled 70 patients (62±12 years, 67% males) undergoing open heart MVR. Thirty age and gender matched healthy volunteers served as control group. Transthoracic 3D echocardiography was performed preoperatively and at intensive care unit discharge. Furthermore, focused 2D echocardiogram was also obtained during the ICU stay. Forty-three patients also completed 6 months follow-up. 3D model of the RV was reconstructed and end-diastolic volume index (EDVi) along with RV ejection fraction (RVEF) were calculated. For in-depth analysis of RV mechanics, we decomposed the motion of the RV to compute longitudinal (LEF) and radial ejection fraction (REF). Right heart catheterization was performed to monitor RV stroke work index (RVSWi). Results RV morphology as assessed by EDVi was unaffected by surgery (preoperative vs postoperative; 73±17 vs 71±16 mL/m2, p=NS). RVEF was slightly decreased after MVR (52±6 vs 48±7%, p<0.05), whereas RV contraction pattern has changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic function (LEF/RVEF vs REF/RVEF; 0.53±0.10 vs 0.43±0.12; p<0.001), whereas in controls the longitudinal and radial shortening contributed equally to RVEF (0.47±0.07 vs 0.43±0.09; p=NS). Postoperatively, the radial motion became dominant (0.35±0.08 vs 0.47±0.09; p<0.001). However, this shift was only temporary as 6 months later the contraction pattern became similar to controls showing equal contribution of the two components (0.44±0.10 vs 0.42±0.11; p=NS). Postoperative RVF (defined as RVSWi <300 mmHg*mL/m2 or ICU TAPSE <10 mm) was detected in 14 [20%] patients. Preoperative LEF was associated with postoperative RVSWi (r=−0.61, p<0.001) and it was an independent predictor of postoperative RVF (OR=1.16 [1.03–1.35], p<0.05). Conclusion Severe MR induces a significant shift in the RV mechanical pattern which may influence the development of postoperative RV dysfunction and failure after MVR. Advanced indices of RV mechanics are associated with invasively measured parameters of RV contractility and may predict postoperative RVF.

scholarly journals Right ventricular stroke work index by echocardiography in adult patients with pulmonary arterial hypertension

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Raluca Jumatate ◽  
Annika Ingvarsson ◽  
Gustav Jan Smith ◽  
Anders Roijer ◽  
Ellen Ostenfeld ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Adult Patients ◽  
Stroke Work ◽  
Non Invasive ◽  
Work Index ◽  
Stroke Work Index ◽  
Pulmonary Arterial ◽  
Rv Function

Abstract Background In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, resulting in a poor prognosis. In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) measured by right heart catheterization (RHC) represents a promising index for RV function. The aim of the present study was to comprehensively evaluate non-invasive measures to calculate RVSWI derived by echocardiography (RVSWIECHO) using RHC (RVSWIRHC) as a reference in adult PAH patients. Methods Retrospectively, 54 consecutive treatment naïve patients with PAH (65 ± 13 years, 36 women) were analyzed. Echocardiography and RHC were performed within a median of 1 day [IQR 0–1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP)—mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2 = (TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmeanPG) x SVIECHO and RVSWIECHO-4 = (TRmeanPG–mRAPECHO) x SVIECHO. Estimation of mRAPECHO was derived from inferior vena cava diameter. Results RVSWIRHC was 1132 ± 352 mmHg*mL*m−2. In comparison with RVSWIRHC in absolute values, RVSWIECHO-1 and RVSWIECHO-2 was significantly higher (p < 0.001), whereas RVSWIECHO-4 was lower (p < 0.001). No difference was shown for RVSWIECHO-3 (p = 0.304). The strongest correlation, with RVSWIRHC, was demonstrated for RVSWIECHO-2 (r = 0.78, p < 0.001) and RVSWIECHO-1 ( r = 0.75, p < 0.001). RVSWIECHO-3 and RVSWIECHO-4 had moderate correlation (r = 0.66 and r = 0.69, p < 0.001 for all). A good agreement (ICC) was demonstrated for RVSWIECHO-3 (ICC = 0.80, 95% CI 0.64–0.88, p < 0.001), a moderate for RVSWIECHO-4 (ICC = 0.73, 95% CI 0.27–0.87, p < 0.001) and RVSWIECHO-2 (ICC = 0.55, 95% CI − 0.21–0.83, p < 0.001). A poor ICC was demonstrated for RVSWIECHO-1 (ICC = 0.45, 95% CI − 0.18–0.77, p < 0.001). Agreement of absolute values for RVSWIECHO-1 was − 772 ± 385 (− 50 ± 20%) mmHg*mL*m−2, RVSWIECHO-2 − 600 ± 339 (-41 ± 20%) mmHg*mL*m−2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m−2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m−2. Conclusion The correlation with RVSWIRHC was moderate to strong for all echocardiographic measures, whereas only RVSWIECHO-3 displayed high concordance of absolute values. The results, however, suggest that RVSWIECHO-1 or RVSWIECHO-3 could be the preferable echocardiographic methods. Prospective studies are warranted to evaluate the clinical utility of such measures in relation to treatment response, risk stratification and prognosis in patients with PAH.

scholarly journals High Right Ventricular Stroke Work Index Is Associated with Worse Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction

2018 ◽  
Vol 8 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Napatt Kanjanahattakij ◽  
Natee Sirinvaravong ◽  
Francisco Aguilar ◽  
Akanksha Agrawal ◽  
Parasuram Krishnamoorthy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Linear Regression Analysis ◽  
Stroke Work ◽  
Work Index ◽  
Patients With Heart Failure ◽  
Stroke Work Index ◽  
Ventricular Stroke Work Index ◽  
Right Ventricular Stroke Work

Background: In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. Right ventricular stroke work index (RVSWI) is a parameter of right ventricular function. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF. Method: This was a single-center cross-sectional study. HFpEF is defined as patients with documented heart failure with ejection fraction > 50% and pulmonary wedge pressure > 15 mm Hg from right heart catheterization. RVSWI (normal value 8–12 g/m/beat/m2) was calculated using the formula: RVSWI = 0.0136 × stroke volume index × (mean pulmonary artery pressure – mean right atrial pressure). Univariate and multivariate linear regression analysis was performed to study the correlation between RVSWI and GFR. Result: Ninety-one patients were included in the study. The patients were predominantly female (n = 64, 70%) and African American (n = 61, 67%). Mean age was 66 ± 12 years. Mean GFR was 59 ± 35 mL/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant independent inverse relationship between RVSWI and GFR (unstandardized coefficient = –1.3, p = 0.029). In the subgroup with combined post and precapillary pulmonary hypertension (Cpc-PH) the association remained significant (unstandardized coefficient = –1.74, 95% CI –3.37 to –0.11, p = 0.04). Conclusion: High right ventricular workload indicated by high RVSWI is associated with worse renal function in patients with Cpc-PH. Further prospective studies are needed to better understand this association.

Sweating, hemodynamic responses, and thermal equilibration during hyperthermia in humans

1987 ◽  
Vol 62 (4) ◽  
pp. 1596-1602 ◽  
Author(s):  
A. S. Tonnesen ◽  
C. Marnock ◽  
J. M. Bull ◽  
C. J. Morgenweck ◽  
K. D. Fallon
Keyword(s):  
Heart Rate ◽  
Heat Stress ◽  
Venous Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Stroke Work ◽  
Work Index ◽  
Stroke Work Index ◽  
Ventricular Stroke Work Index ◽  
Pulmonary Arterial

Hyperthermia, to 42 degrees C, for treatment of cancer, was induced 23 times in 13 anesthetized patients utilizing an extracorporeal heat-exchange circuit. Sweating rate over the chest, abdomen, arm and forearm ranged from 0.2 to 0.9 mg sweat X min-1 X cm-2. Cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index, and right ventricular stroke work index initially increased to 221 +/- 12.5, 162 +/- 9.6, 142 +/- 11, and 203 +/- 29% but later fell to 169–173, 113–120, 69, and 148–117% of control, respectively. Heart rate initially rose to 145 +/- 5.9% and then stabilized at 160–162% of control. Pulmonary arterial occlusion pressure and central venous pressure initially fell to 82 +/- 8 and 93 +/- 9% but later rose to 87–102 and 105–120% of control levels, respectively. The hemodynamic response to severe heat stress in anesthetized humans was characterized by peripheral vasodilation accompanied by compensatory increases in heart rate and CI. Ventricular function, as reflected by SVI and CI, declined with continued heat stress, despite reduced afterload and stable or increased filling pressures. Pulmonary arterial temperature rose fastest, followed by the esophageal, rectal, and bladder temperatures, respectively. Jugular bulb temperature also rose rapidly.

scholarly journals Right ventricular stroke work index in adult patients with pulmonary arterial hypertension: - a comparison between echocardiography and right heart catheterization

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Jumatate ◽  
A Ingvarsson ◽  
G Smith ◽  
A Roijer ◽  
E Ostenfeld ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Heart Catheterization ◽  
Adult Patients ◽  
Heart Catheterization ◽  
Stroke Work ◽  
Work Index ◽  
Significant Difference ◽  
Stroke Work Index ◽  
Pulmonary Arterial ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swedish Society of Pulmonary Hypertension Background In adult patients with pulmonary arterial hypertension (PAH), right ventricular (RV) failure may worsen rapidly, constituting a negative prognostic factor.  In this population, non-invasive assessment of RV function is challenging. RV stroke work index (RVSWI) reflects right ventricular function and has been proposed to predict outcome in PAH. However, RVSWI assessed by echocardiography (ECHO) has not been thoroughly compared to measures with right heart catheterization (RHC) in adults. The aim of the present study was to therefore evaluate RVSWI derived by echocardiography (RVSWIECHO) vs. RHC (RVSWIRHC). Methods  Fifty-four consecutive treatment naïve adult patients with PAH, were retrospectively analysed. All patients performed echocardiography and RHC with a median time of 1 day [IQR 0-1 days]. RVSWIRHC was calculated as: (mean pulmonary arterial pressure (mPAP) – mean right atrial pressure (mRAP)) x stroke volume index (SVI)RHC. Four methods for RVSWIECHO were evaluated: RVSWIECHO-1 = Tricuspid regurgitant maximum pressure gradient (TRmaxPG) x SVIECHO, RVSWIECHO-2=(TRmaxPG-mRAPECHO) x SVIECHO, RVSWIECHO-3 = TR mean gradient (TRmPG) x SVIECHO and RVSWIECHO-4=(TRmPG–mRAPECHO) x SVIECHO. Vena cava inferior diameter and its collapsibility were used for estimation of mRAPECHO.. Pearson’s correlation coefficients were used and data was expressed as mean ± standard deviation. Results Mean RVSWIRHC was 1132 ± 352 mmHg*mL*m-2.  Mean RVSWIECHO-1-4 was: 1904 ± 568, 1732 ± 531, 1090 ± 366 and 918 ± 336 mmHg*mL*m-2, respectively. There was no significant difference between RVSWIRHC and RVSWIECHO-3 in mean values, although they exhibited the lowest correlation, but moderate (r = 0.66). The strongest correlation was demonstrated for  RVSWIECHO-2 (r = 0.78, p &lt; 0.001), followed by a moderate correlation for  RVSWIECHO-1 and RVSWIECHO-4 (r = 0.75 and r = 0.69, p &lt; 0.001). The absolute (relative) bias for RVSWIECHO-1 was  -772 ± 385 (-50 ± 20%) mmHg*mL*m-2, RVSWIECHO-2 -600 ± 339 (-41 ± 20%) mmHg*mL*m-2, RVSWIECHO-3 42 ± 286 (5 ± 25%) mmHg*mL*m-2 and for RVSWIECHO-4 214 ± 273 (23 ± 27%) mmHg*mL*m-2. Conclusion RVSWIECHO-3, using the mean tricuspid gradient and SVIECHO, showed no significant difference to RVSWIRHC, albeit a moderate correlation between the methods. RVSWIECHO-1, RVSWIECHO- 2 and RVSWIECHO-4 exhibited moderate to strong correlations to RVSWIRHC, but poor concordance between absolute values. The clinical utility of RVSWIECHO and RVSWIRHC in assessing RV function in relation to PAH prognosis, risk stratification and treatment response remains to be evaluated in a larger clinical context.

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