P1413 Complexity of changes in right ventricular function in patients undergoing cardiac surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Wejner-Mik ◽  
J D Kasprzak ◽  
E Szymczyk ◽  
K Wdowiak-Okrojek ◽  
A Ammer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Right Ventricular ◽  
Artery Bypass ◽  
Longitudinal Function ◽  
Echocardiographic Examination ◽  
Echocardiographic Parameters ◽  
Study Population ◽  
And Function ◽  
2D And 3D ◽  
Rv Function

Abstract Background An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique. Methods The study population comprised 105 patients (76 men, mean age 65 ± 16 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2 ± 2 days prior to surgery (TTE1) , and 7 ± 4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12 ± 2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function, such as TAPSE, systolic velocity of tricuspid annulus (S"), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS). Results Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S’ and GLS; p < 0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function. Conclusion Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. After 12 months, an improvement of the longitudinal function can be observed.

Right ventricular morphology and function undergo complex changes after cardiac surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Wejner-Mik ◽  
J.D Kasprzak ◽  
E Szymczyk ◽  
K Wdowiak-Okrojek ◽  
A Ammer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Right Ventricular ◽  
Artery Bypass ◽  
Public Institution ◽  
Transverse Diameter ◽  
Funding Source ◽  
Longitudinal Function ◽  
Echocardiographic Examination ◽  
And Function ◽  
Rv Function

Abstract Background An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique. Methods The study population comprised 122 patients (92 men, mean age 65±11 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2±2 days prior to surgery (TTE1), and 7±4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12±2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function (such as TAPSE, systolic velocity of tricuspid annulus (S'), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS), as well as a new parameter introduced by our team - RV shortening fraction (RV SF), calculated as the change in mid RV transverse diameter. Results Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S' and GLS; p<0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. Additionally during the postoperative period an increase in the value of a RV SF by 12.85% was observed. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function. Conclusion Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Grant Polish Cardiac Society

scholarly journals Immediate and midterm impact of percutaneous transvenous mitral valve commisurotomy (PTMC) on right ventricular function

2015 ◽  
Vol 9 (2) ◽  
pp. 88-98
Author(s):  
Mohammad Abdur Rahman ◽  
Syed Ali Ahsan ◽  
Md Abu Siddique ◽  
SM Ahsan Habib ◽  
Md Abu Salim ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Mitral Stenosis ◽  
Systolic Function ◽  
Systemic Hypertension ◽  
Tei Index ◽  
Echocardiographic Measurement ◽  
Study Population ◽  
Mitral Commissurotomy ◽  
2D And 3D ◽  
Rv Function

Mitral stenosis (MS) affects right ventricular (RV) function as a result of myocardial and hemodynamic factors. Although the long-term effects of mitral commissurotomy are well known, the aim of this study was to evaluate the immediate and midterm impact of percutaneous mitral commissurotomy (PTMC) on RV function in patients with MS. This is an observational study conducted at University cardiac centre, Bangabandhu Sheikh Mujib Medical University during December 2012 to November 2013 (one year), among 50 patients Patients presenting with mitral stenosis, who fulfill the criteria to PTMC procedure attending Cardiology department of BSMMU during the study period were enrolled in this study whereas, patients with systemic hypertension, diabetes mellitus, more than mild mitral and aortic regurgitation and or aortic stenosis, with history of previous mitral and aortic valve surgery, atrial fibrillation and bundle branch block were excluded from the study. The current study shows female predominance (66%) and majority (68%) of study population were in age group between 36-40 years. 90% of study population presented with fatigue and other symptoms includes shortness of breath (85%), palpitation (65%), chest pain (28%), dizziness (25%), ankle edema (15%) and headache among 10%. Echocardiographic measurement showed, MVA significantly improved immediately and 6 months after PTMC among the study population. Hemodynamic function of the study sample revealed significantly reduction of PASP, PADP and mean PAP immediately and 6 months after PTMC. 2 D echocardiographic parameter of right ventricular systolic function showed RVOTfs%, Tei index significantly improved immediately and 6 months after PTMC.Others parameters of RV systolic function TAPSE, RVFAC and RVEF(2D and 3D) remain stable immediately after but showed significant improvement 6 months after PTMC. There was significant reduction in IVA during the immediate period following PTMC and also after 6 months.. Immediately and 6 months after successful PTMC, significant decrease in RV contractility as assessed by IVA was observed whereas other parameters of infundibular and global RV function as assessed by RVOTfs and Tei index showed significant improvement. TAPSE,RVFAC and RVEF(2D and 3D) remain stable immediately after PTMC but showed significant improvement 6 months after PTMC. Further work using larger numbers of patients is needed to confirm our findings and to assess their utility in patient followup and management.University Heart Journal Vol. 9, No. 2, July 2013; 88-98

scholarly journals Echocardiographic Evaluation of Right Ventricular (RV) Performance over Time in COVID-19-Associated ARDS—A Prospective Observational Study

2021 ◽  
Vol 10 (9) ◽  
pp. 1944
Author(s):  
Golschan Asgarpur ◽  
Sascha Treskatsch ◽  
Stefan Angermair ◽  
Michaela Danassis ◽  
Anna Maria Nothnagel ◽  
...  
Keyword(s):  
Observational Study ◽  
Right Ventricular ◽  
Prospective Observational Study ◽  
Linear Regression Analysis ◽  
University Hospital ◽  
Normal Range ◽  
Echocardiographic Evaluation ◽  
Echocardiographic Parameters ◽  
And Function ◽  
Rv Function

(1) Background: To evaluate time-dependent right ventricular (RV) performance in patients with COVID-19-associated acute respiratory distress syndrome (ARDS) undergoing intensive care (ICU) treatment. (2) Methods: This prospective observational study included 21 ICU patients with COVID-19-associated ARDS in a university hospital in 2020 (first wave). Patients were evaluated by transthoracic echocardiography at an early (EE) and late (LE) stage of disease. Echocardiographic parameters describing RV size and function as well as RV size in correlation to PaO2/FiO2 ratio were assessed in survivors and nonsurvivors. (3) Results: Echocardiographic RV parameters were within normal range and not significantly different between EE and LE. Comparing survivors and nonsurvivors revealed no differences in RV performance at EE. Linear regression analysis did not show a correlation between RV size and PaO2/FiO2 ratio over all measurements. Analysing EE and LE separately showed a significant increase in RV size correlated to a lower PaO2/FiO2 ratio at a later stage of COVID-19 ARDS. (4) Conclusion: The present study reveals neither a severe RV dilatation nor an impairment of systolic RV function during the initial course of COVID-19-associated ARDS. A trend towards an increase in RV size in correlation with ARDS severity in the second week after ICU admission was observed.

scholarly journals P990 Multi-plane echocardiographic analysis of right ventricular function in patients with systemic and subpulmonic physiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Van Berendoncks ◽  
D J Bowen ◽  
J Mcghie ◽  
J Cuypers ◽  
M Kauling ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Congenital Heart ◽  
Systolic Function ◽  
Daily Practice ◽  
Specific Analysis ◽  
Echocardiographic Parameters ◽  
Apical View ◽  
First Time ◽  
Coronal View ◽  
Rv Function

Abstract Background Right ventricular (RV) function is recognized as a prognostic factor in congenital heart disease (CHD). Accurate echocardiographic parameters to assess systolic function in systemic RV (sRV) lacking. We previously introduced a novel four-view approach with different RV walls visualized in their long axis from one apical view using 2D-multi-plane transthoracic echocardiographic (TTE) (iRotate). Aims To extensively evaluate RV systolic function using iRotate echocardiography in CHD patients with systemic RV compared with a whole spectrum of CHD patients with abnormally loaded subpulmonic RV. Methods and Results Thirty CHD patients with sRV and 112 age, gender and BSA matched patients with abnormally loaded subpulmonic RV were recruited from the outpatient clinic. All subjects underwent complete TTE with evaluation of TAPSE, TDI S’ and peak systolic global longitudinal RV strain (RV-GLS) from the RV walls using the four-view iRotate model. The feasibility of TAPSE and TDI S’ ranged between 94% and 100%. The feasibility of RV-GLS in CHD was 98%, 69%, 87% and 72% respectively in the lateral, anterior, inferior and inferior coronal view walls. All echocardiographic parameters were significantly lower in sRV compared to versus subpulmonic RV cohort (p < 0.001) (Table). Conclusion This study provides for the first time an extensive RV specific analysis of the systemic RV. The feasibility of all RV parameters in the four-view iRotate model is excellent in CHD and represents a reproducible, easily applicable and complete RV assessment in daily practice. Systolic function is significantly reduced in systemic RV compared to subpulmonic RV physiology. Abstract P990 Figure.

Right ventricular morphology and function analysis in moderately preterm-born young adults

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Mohamed ◽  
P Lamata ◽  
W Williamson ◽  
M Alsharqi ◽  
C.M.J Tan ◽  
...  
Keyword(s):  
Principal Component Analysis ◽  
Young Adults ◽  
Right Ventricular ◽  
Pulmonary Circulation ◽  
Principal Component ◽  
Funding Source ◽  
Moderately Preterm ◽  
Preterm Born ◽  
And Function ◽  
Rv Function

Abstract Background Previous studies have shown that prematurity leads to altered right ventricular (RV) geometry and performance with persistent impairments in RV systolic function in young adulthood. It is unknown to what extent pulmonary physiology impacts these findings. Purpose To better quantify known alterations in RV morphology and function in preterm-born young adults and to determine to what extent these changes are influenced by the pulmonary circulation. Methods A total of 101 normotensive preterm-born (n=47, mean gestational age 32.8±3.2 weeks) and term-born (n=54) young adults were recruited. Echocardiography and cardiovascular magnetic resonance (CMR) imaging were performed to characterise RV morphology, RV function, pulmonary hemodynamics and RV-pulmonary arterial vascular (PA) coupling. CMR cine images were used to create a 3D computational atlas of the RV geometry and principal component analysis was undertaken to identify the key modes of shape variation. Spirometry was performed to assess lung function. Results RV CMR revealed a higher absolute and indexed RV mass (P<0.05) and lower ejection fraction (54.90±5.17 versus 57.48±4.39%, P=0.008) in young adults born preterm. RV end-diastolic areas and volumes for CMR and echocardiography were lower in preterm-born compared to term-born young adults (P≤0.001). Principal component analysis of the computational atlas defined the anatomical modes of the RV geometry, with mode 1 accounting for 25.3% of the population variance. Preterm and term cohorts showed significant differences (P<0.001) in mode 1, which represented a smaller and shorter RV cavity in the preterm group (Figure 1). Measurements of RV function by echocardiography, including RV fractional area of change (FAC) and tricuspid annular plane systolic excursion (TAPSE), were lower in preterm-born compared to term-born adults (P<0.05). Despite lower pulmonary artery acceleration times (PAAT) in those born preterm (141.1±15.1 versus 159.2±21.6msec, P<0.001), indicating increased pulmonary vascular resistance, the RV remained coupled to its pulmonary circulation (TAPSE/PAAT: 0.13±0.02 versus 0.14±0.03m/sec, P=0.153). Reduced RV performance in preterm-born individuals remained significant when adjusting for pulmonary function parameters (P<0.05). Conclusions Multimodality cardiac imaging demonstrated that moderately preterm-born young adults exhibit structural and functional RV alterations, independent of lung physiology. Their RV remains hemodynamically coupled to its pulmonary circulation despite higher RV afterload, lower RV function and altered morphology. Figure 1. Statistical shape model of the RV Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

scholarly journals Biomarkers in the Diagnosis, Management, and Prognostication of Perioperative Right Ventricular Failure in Cardiac Surgery—Are We There Yet?

2019 ◽  
Vol 8 (4) ◽  
pp. 559 ◽  
Author(s):  
Habib Jabagi ◽  
Lisa M. Mielniczuk ◽  
Peter P. Liu ◽  
Marc Ruel ◽  
Louise Y. Sun
Keyword(s):  
Cardiac Surgery ◽  
Risk Factor ◽  
Right Ventricular ◽  
Clinical Utility ◽  
Right Ventricular Failure ◽  
Current Evidence ◽  
Potential Utility ◽  
Ventricular Failure ◽  
Galectin 3 ◽  
Rv Function

Right ventricular failure (RVF) is a major risk factor for end organ morbidity and mortality following cardiac surgery. Perioperative RVF is difficult to predict and detect, and to date, no convenient, accurate, or reproducible measure of right ventricular (RV) function is available. Few studies have examined the use of biomarkers in RVF, and even fewer have examined their utility in the perioperative setting of patients undergoing cardiac surgery. Of the available classes of biomarkers, this review focuses on biomarkers of (1) inflammation and (2) myocyte injury/stress, due to their superior potential in perioperative RV assessment, including Galectin 3, ST2/sST2, CRP, cTN/hs-cTn, and BNP/NT-proBNP. This review was performed to help highlight the importance of perioperative RV function in patients undergoing cardiac surgery, to review the current modalities of RV assessment, and to provide a review of RV specific biomarkers and their potential utilization in the clinical and perioperative setting in cardiac surgery. Based on current evidence, we suggest the potential utility of ST2, sST2, Gal-3, CRP, hs-cTn, and NT-proBNP in predicting and detecting RVF in cardiac surgery patients, as they encompass the multifaceted nature of perioperative RVF and warrant further investigation to establish their clinical utility.

scholarly journals Postoperative Echocardiographic Reduction of Right Ventricular Function: Is Pericardial Opening Modality the Main Culprit?

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Marco Zanobini ◽  
Matteo Saccocci ◽  
Gloria Tamborini ◽  
Fabrizio Veglia ◽  
Alessandro Di Minno ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Right Ventricular ◽  
Systolic Function ◽  
Right Ventricular Systolic Function ◽  
Main Culprit ◽  
Echocardiographic Parameters ◽  
Group A ◽  
Group B ◽  
Rv Function

Echocardiographic reduction of RV function, measured using TAPSE, is a well described phenomenon after cardiac surgery. The aim of the present study was to investigate the relation between the modality of pericardial opening (lateral versus anterior) and the postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair. 34 patients with severe mitral regurgitation due to mitral valve prolapse underwent traditional (sternotomy) operation (Group A) or minimally invasive surgery with right anterolateral thoracotomy (Group B). A postoperative TAPSE fall was found in both groups. Group A experienced a significant postoperative TAPSE fall versus Group B withp<0.0001.

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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