scholarly journals Echocardiographic parameters as predictors of three-months mortality in patients with 2019 Coronavirus infection

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Miranda Aquino ◽  
J M Pereira-Forcado ◽  
B Ordonez-Salazar ◽  
G Dominguez-Trejo ◽  
A Rangel-Guerra ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Clinical Laboratory ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Ventricular Dilation ◽  
Echocardiographic Parameters ◽  
The Right ◽  
Right Ventricular Dilation

Abstract Background Coronavirus disease 2019 is a systemic entity, where cardiac involvement has been described. The echocardiogram is a diagnostic tool that describes myocardial damage with good certainty. Objectives Determine which echocardiographic parameters are predictors of mortality. Analyze if there is a difference in clinical, laboratory and echocardiographic variables in terms of patients who died versus those who survived. Investigate the cut-off point of the echocardiographic parameters that is best associated with mortality. Methods Prospective, analytical, comparative study. Patients admitted to the hospital with Coronavirus 2019 infection. Clinical, laboratory and echocardiographic variables will be assessed. The association with three-month mortality of the different variables will be determined. We used ROC-curves for the best cut-off associated with mortality. The association with three-month mortality was analized using Cox regression, unadjusted analysis of the variables was performed, as well as adjusted analysis for age and gender. Results 84 patients were included, a mortality of 29% was documented. Significant differences were found in the left atrial volumen index, the E/e', the proportion of dilatation of the right ventricle and diastolic dysfunction. Tricuspid annulus anterior systolic excursion (TAPSE), pulmonary artery acceleration time (PAA), tricuspid regurgitation velocity (TRV), pulmonary artery systolic pressure (PASP), left ventricular longitudinal strain (LVGLS), of the left atrium (LAGLS) and the right ventricular free wall longitudinal strain (RVFWLS). Right ventricular dilation, right ventricular shortening fraction, TAPSE, PASP, TRV, LVGLS, LAGLS, and RVFWLS were associated with mortality. Conclusion Right ventricular dilation, right ventricular shortening fraction, TAPSE, PASP, TRV, LVGLS, LAGLS, and RVFWLS are the echocardiographic parameters that were associated with three-month mortality. FUNDunding Acknowledgement Type of funding sources: None. Table 2

Norepinephrine and dobutamine improve cardiac index equally by supporting opposite sides of the heart in an experimental model of chronic pulmonary hypertension

2021 ◽  
Author(s):  
Janus Adler Hyldebrandt ◽  
Nikolaj Bøgh ◽  
Camilla Omann Christensen ◽  
Peter Agger
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Index ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Contractility ◽  
End Diastolic Volume ◽  
Chronic Pulmonary Hypertension ◽  
Blood Pressures ◽  
The Right

Abstract Background: Pulmonary hypertension is a significant risk factor in patients undergoing surgery. The combined effects of general anaesthesia and positive pressure ventilation can aggravate this condition and cause increased pulmonary blood pressures, reduced systemic blood pressures and ventricular contractility. Although perioperative use of inotropic support or vasopressors is almost mandatory for these patients, preference is disputed. In this study, we investigated the effects of norepinephrine and dobutamine and their ability to improve the arterio-ventricular relationship and haemodynamics in pigs suffering from chronic pulmonary hypertension.Method: Pulmonary hypertension was induced in five pigs by banding the pulmonary artery at 2–3 weeks of age. Six pigs served as controls. After 16 weeks of pulmonary artery banding, the animals were re-examined under general anaesthesia using biventricular conductance catheters and a pulmonary artery catheter. After baseline measurements, the animals were exposed to both norepinephrine and dobutamine infusions in incremental doses, with a stabilizing period in between the infusions. The hypothesis of differences between norepinephrine and dobutamine with incremental doses was tested using repeated two-way ANOVA and Bonferroni multiple comparisons post-test. Results: At baseline, pulmonary artery banded animals had increased right ventricular pressure (+39%, p=0.04), lower cardiac index (-23% p=0.04), lower systolic blood pressure (-13%, p=0.02) and reduced left ventricular end-diastolic volume (-33%, p=0.02). When incremental doses of norepinephrine and dobutamine were administered, the right ventricular arterio-ventricular coupling was improved only by dobutamine (p<0.05). Norepinephrine increased both left ventricular end-diastolic volume and left ventricular contractility to a greater extent (p<0.05) in pulmonary artery banded animals. While the cardiac index was improved equally by norepinephrine and dobutamine treatments in pulmonary artery banded animals, norepinephrine had a significantly greater effect on mean arterial pressure (p<0.05) and diastolic arterial pressure (p<0.05).Conclusion: While norepinephrine and dobutamine improved cardiac index equally, it was obtained in different manners. Dobutamine significantly improved the right ventricular function and the arterio-ventricular coupling. Norepinephrine increased systemic resistance, thereby improving arterial pressures and left ventricular systolic function by maintaining left ventricular end-diastolic volume.

End-systolic and end-diastolic ventricular interaction

1986 ◽  
Vol 251 (5) ◽  
pp. H1062-H1075 ◽  
Author(s):  
B. K. Slinker ◽  
S. A. Glantz
Keyword(s):  
Right Ventricular ◽  
Interventricular Septum ◽  
Systolic Pressure ◽  
Direct Interaction ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Physiological Mechanisms ◽  
In Series ◽  
The Right ◽  
Transient And Steady State

Right ventricular volume affects left ventricular volume via direct interaction across the interventricular septum and series interaction because the right and left hearts are connected in series through the lungs. Because it is difficult to sort out complex physiological mechanisms in the intact circulation, the relative importance of these two effects is unknown. We used statistical analyses of transient changes in left and right ventricular pressures and dimensions following pulmonary artery and venae caval constrictions to separate and quantitate the direct (immediate) from the series (delayed) interaction effects on left ventricular size at end systole and end diastole. With the pericardium closed, direct interaction was one-half as important as series interaction at end diastole and was one-third as important at end systole. With the pericardium removed, direct interaction was one-fifth as important as series interaction at end diastole and one-sixth as important at end systole. These results suggest that differences between transient and steady-state end-systolic pressure-volume relationships are largely explained by direct interaction and that direct end-systolic interaction is important for maintaining balanced right and left heart outputs.

Unequal right and left ventricular ejection with ectopic beats

1962 ◽  
Vol 203 (6) ◽  
pp. 1141-1144 ◽  
Author(s):  
Jay M. Levy ◽  
Emmanuel Mesel ◽  
Abraham M. Rudolph
Keyword(s):  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Flow ◽  
Anesthetized Dogs ◽  
Ectopic Beats ◽  
The Difference ◽  
The Right ◽  
Ventricular Depolarization

Simultaneous right and left ventricular stroke volumes were measured with electromagnetic flow probes in open-chest, anesthetized dogs. Atrial ectopic beats with normal ventricular depolarization produced differences between right and left ventricular stroke output, although the right and left ventricular pressures were proportionately reduced to an equal extent. This imbalance in volume ejected was a result of the differences in diastolic level, related to peak systolic pressure, in the aorta compared with pulmonary artery. With ventricular ectopic beats, the stimulated ventricle failed to develop the same percentage of control pressure as did the contralateral ventricle. The difference between aortic and pulmonary flow was thus less marked with right ventricular ectopic beats, and exaggerated with left ventricular ectopic beats.

scholarly journals Novel Neuromodulation Approach to Improve Left Ventricular Contractility in Heart Failure

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Vivek Y. Reddy ◽  
Jan Petrů ◽  
Filip Málek ◽  
Lee Stylos ◽  
Steve Goedeke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Diastolic Pressure ◽  
Acute Decompensated Heart Failure ◽  
Systolic Pressure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Ventricular Contractility ◽  
Right Pulmonary Artery ◽  
The Right

Background: Morbidity and mortality outcomes for patients admitted for acute decompensated heart failure are poor and have not significantly changed in decades. Current therapies are focused on symptom relief by addressing signs and symptoms of congestion. The objective of this study was to test a novel neuromodulation therapy of stimulation of epicardial cardiac nerves passing along the posterior surface of the right pulmonary artery. Methods: Fifteen subjects admitted for defibrillator implantation and ejection fraction ≤35% on standard heart failure medications were enrolled. Through femoral arterial access, high fidelity pressure catheters were placed in the left ventricle and aortic root. After electro anatomic rendering of the pulmonary artery and branches, either a circular or basket electrophysiology catheter was placed in the right pulmonary artery to allow electrical intravascular stimulation at 20 Hz, 4 ms pulse width, and ≤20 mA. Changes in maximum positive dP/dt (dP/dt Max ) indicated changes in ventricular contractility. Results: Of 15 enrolled subjects, 5 were not studied due to equipment failure or abnormal pulmonary arterial anatomy. In the remaining subjects, dP/dt Max increased significantly by 22.6%. There was also a significant increase in maximum negative dP/dt (dP/dt Min ), mean arterial pressure, systolic pressure, diastolic pressure, and left ventricular systolic pressure. There was no significant change in heart rate or left ventricular diastolic pressure. Conclusions: In this first-in-human study, we demonstrated that in humans with stable heart failure, left ventricular contractility could be accentuated without an increase in heart rate or left ventricular filling pressures. This benign increase in contractility may benefit patients admitted for acute decompensated heart failure.

scholarly journals Icariin Attenuates Monocrotaline-Induced Pulmonary Arterial Hypertension via the Inhibition of TGF-β1/Smads Pathway in Rats

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yijia Xiang ◽  
Changhong Cai ◽  
Yonghui Wu ◽  
Lebing Yang ◽  
Shiyong Ye ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Pulmonary Artery ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Matrix Metalloproteinase 2 ◽  
Western Blots ◽  
Pulmonary Arterial ◽  
The Right ◽  
Tgf Β1

Background. Pulmonary artery remodeling is important in the development of pulmonary artery hypertension. The TGF-β1/Smads signaling pathway is activated in pulmonary arterial hypertension (PAH) in rats. Icariin (ICA) suppresses the TGF-β1/Smad2 pathway in myocardial fibrosis in rats. Therefore, we investigated the role of icariin in PAH by inhibiting the TGF-β1/Smads pathway. Methods. Rats were randomly divided into control, monocrotaline (MCT), MCT + ICA-low, and MCT + ICA-high groups. MCT (60 mg/kg) was subcutaneously injected to induce PAH, and icariin (50 or 100 mg/kg.d) was orally administered for 2 weeks. At the end of the fourth week, right ventricular systolic pressure (RVSP) was obtained and the right ventricular hypertrophy index (RI) was determined as the ratio of the right ventricular weight to the left ventricular plus septal weight (RV/LV + S). Western blots were used to determine the expression of TGF-β1, Smad2/3, P-Smad2/3, and matrix metalloproteinase-2 (MMP2) in lung tissues. Results. Compared to the control group, RVSP and RI were increased in the MCT group (ρ < 0.05). Additionally, TGF-β1, Smad2/3, P-Smad2/3, and MMP2 expressions were obviously increased (ρ < 0.01). Compared to the MCT group, RVSP and RI were decreased in the MCT + ICA group (ρ < 0.05). TGF-β1, Smad2/3, P-Smad2/3, and MMP2 expressions were also inhibited in the icariin treatment groups (ρ < 0.05). Conclusions. Icariin may suppress MCT-induced PAH via the inhibition of the TGFβ1-Smad2/3 pathway.

scholarly journals Post-COVID-19 syndrome: morpho-functional abnormalities of the heart and arrhythmias

2021 ◽  
Vol 26 (7) ◽  
pp. 4485
Author(s):  
M. V. Chistyakova ◽  
D. N. Zaitsev ◽  
A. V. Govorin ◽  
N. A. Medvedeva ◽  
A. A. Kurokhtina
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Cardiac Arrhythmias ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Upper Respiratory Tract ◽  
Regional Strain ◽  
Group 3 ◽  
The Right ◽  
Group 1

Aim. To study the myocardial morpho-functional abnormalities, the incidence and nature of cardiac arrhythmias in patients 3 months after the coronavirus disease 2019 (COVID-19).Material and methods. The study included 77 patients (mean age, 35,9 years) treated for coronavirus infection, which underwent echocardiography and 24-hour Holter monitoring 3 months after COVID-19. The patients were divided into 3 groups: group 1 — 31 patients with upper respiratory tract involvement; group 2 — 27 patients with bilateral pneumonia (CT grade 1, 2), 3 — 19 patients with severe pneumonia (CT grade 3, 4). Statistical processing was carried out using Statistica 10.0.Results. According to echocardiography, the peak tricuspid late diastolic velocity and isovolumetric contraction time in all groups increased (P<0,001). The tricuspid and mitral Em/Am ratio decreased depending on the disease severity. In group 3, the right ventricular and atrial size increased (P<0,001). The pulmonary artery systolic pressure, left atrial volume in patients of the 2nd and 3rd groups was higher than in the control one (P<0,001). In group 1 and 2 patients, the regional strain in basal and basal/middle segments decreased, respectively, while, in group 3, not only regional but also global left ventricular (LV) strain decreased (P<0,001). In all groups, cardiac arrhythmias and pericardial effusion were found. The relationship was established between coronavirus activity and the structural and functional myocardial parameters (P<0,001).Conclusion. Cardiovascular injury 3 months after COVID-19 was found in 71%, 93%, and 95% of patients with mild, moderate and severe course. In mild course patients, a decrease in regional myocardial strain in LV basal segments, signs of past pericarditis, and various cardiac arrhythmias were noted. In patients of moderate severity, these changes were more pronounced and were accompanied by an additional decrease in regional strain in LV middle segments, impaired right ventricular diastole and increased pulmonary artery pressure. In severe patients, in addition to the above changes, dilatation of the right heart and inferior vena cava was recorded, as well as LV diastolic and global systolic function decreased.

scholarly journals EVALUATION OF THE RELATIONSHIP BETWEEN PULMONARY ARTERY STIFFNESS AND RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH BEHÇET’S DISEASE USING TRANSTHORACIC ECHOCARDIOGRAPHY

2021 ◽  
Author(s):  
Salim Yaşar ◽  
Murat Unlu ◽  
suat gormel ◽  
Emre Yalcinkaya ◽  
Baris BUGAN ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Patient Group ◽  
Behcet’S Disease ◽  
Left Ventricular ◽  
Significant Difference ◽  
Artery Stiffness ◽  
The Right ◽  
The Relationship ◽  
Ventricular Functions

Background: Behçet’s disease is a systemic vasculitis that can affect all sizes of arteries and veins. Arterial stiffness is a term used to describe the visco-elastic properties of vessel wall. In this study, we aimed to evaluate the relationship between pulmonary artery stiffness (PAS) and the right ventricular (RV) functions in asymptomatic Behçet’s patients with no cardiovascular risk factors. Methods: We studied 40 patients who were diagnosed by the international diagnostic criteria of Behçet’s disease and 40 healthy individuals who were matching demographic properties with the patients. Two groups were matched by age, gender, clinical history and other clinical features. Substantial medical history concerning the factors that can affect right ventricle diastolic function (such as medications, smoking status, other comorbities, etc.) was taken and general physical examination was carried out. The right and left ventricular functions as well as valvular functions were evaluated by using echocardiography. Also Two-dimensional, M-mode, pulsed wave (PW) Doppler echocardiographic parameters were measured for right ventricular functions. PW Doppler flow trace was obtained from the pulmonary valve with regards to pulmonary artery stiffness. Results: There was no significant difference in terms of clinical and demographic properties. No statistically significant difference was found upon comparison of the left ventricular end of systole and diastole diameters, the diastolic and systolic thicknesses of the interventricular septum (IVS) and left ventricular posterior wall (LVPW), left atrium (LA) diameter and left ventricular ejection fraction (LVEF) values (p>0.05) of the two groups. Right ventricular myocardial performance index (MPI) value was found higher in Behçet’s patients and a statistically significant difference was detected between the groups (p<0.01). Tricuspid annular plane systolic excursion (TAPSE) values were found to be statistically significantly lower in the patient group as compared to the control group (p<0.01). In PW Doppler measurements, early passive filling (E) wave flow velocity and E/A ratio were found to be statistically significantly lower, deceleration time (DT) was higher in the patient group (p<0.01). In Behçet’s patients without clinical pulmonary involvement, the pulmonary artery systolic pressure (PASP) was found to be statistically significantly higher in the patient group (p<0.01). The values of pulmonary artery stiffness (PAS) were found to be significantly higher in the patient group (p<0.01). The relationship between the right ventricular function markers and PAS were evaluated in the patient group. There was no statistically significant relationship between PAS and MPI and TAPSE. But there was a significant correlation between PAS and PASP and duration of illness (p<0.001 and r=0.682 ; p=0.047 and r=0,316). Conclusion: Behçet’s patients without cardiac symptoms and signs, reduction in right ventricular functions and increase in PAS was detected. Although there is no correlation between right ventricular functions and PAS, increased PAS may be an early marker of reduction of the right ventricular functions. Consequently, routine cardiological examination and detailed evaluation of biventricular functions by using echocardiography should be greatly beneficial in Behcet’s patients, even though there are no signs or symptoms.

End-systolic pressure length relations of stunned right and left ventricles after inotropic stimulation

1993 ◽  
Vol 265 (6) ◽  
pp. H2099-H2109 ◽  
Author(s):  
R. Krams ◽  
L. K. Soei ◽  
E. O. McFalls ◽  
E. A. Winkler Prins ◽  
L. M. Sassen ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Segment Length ◽  
Atrial Pacing ◽  
Regression Equations ◽  
External Work ◽  
Left And Right ◽  
The Right

Regional end-systolic pressure-segment length relationships (ESPSLR) were used to compare the degree of right and left ventricular stunning induced by a 10-min occlusion of the left anterior descending coronary artery and the response to subsequent atrial pacing (50 beats/min above intrinsic heart rate) without and with dobutamine (2 micrograms.kg-1.min-1) in nine anesthetized open-chest pigs. From the ESPSLR, the slope (Ees) (at 100 mmHg for the left and 25 mmHg for the right ventricle) and the total area of the pressure-length relationship (PLA) were determined. From the latter, the distribution into external work (EW) and potential energy (PE) as well as the efficiency of energy transfer (EET = EW/PLA) were calculated. In both the stunned left and right ventricular myocardium Ees and EW were reduced according to the same linear regression equations (delta Ees = 0.7 Ees,baseline - 11.4, r2 = 0.86 and delta EW = 0.4 EWbaseline + 2.3, r2 = 0.67), where Ees,baseline and EWbaseline are Ees and EW at baseline, respectively. EET of the stunned left and right ventricular segments decreased as PLA remained unchanged, due to an increase in PE. EET decreased from 0.84 +/- 0.02 to 0.71 +/- 0.03 (P < 0.05) in the stunned right ventricular segment and from 0.71 +/- 0.02 to 0.44 +/- 0.03 (P < 0.05) in the stunned left ventricular segment. Atrial pacing did not affect EET with respect to stunning levels, whereas the additional infusion of dobutamine restored Ees, EW, and PE and consequently EET to baseline values. In conclusion, the right ventricle is susceptible to stunning. During atrial pacing the EET was lower than expected from the Ees, which could, in agreement with the time-varying elastance concept, be explained by an increase in afterload (a consequence of the decrease in stroke volume). Dobutamine not only increased Ees, EW, and EET but also restored the relationship between Ees and EET in both ventricular stunned segments.

scholarly journals Echocardiographic assessment of right heart indices in dogs with elevated pulmonary artery pressure associated with chronic respiratory disorders, heartworm disease, and chronic degenerative mitral valvular disease

2013 ◽  
Vol 58 (No. 12) ◽  
pp. 613-620 ◽  
Author(s):  
HP Tai TC Huang
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Aortic Root ◽  
Peak Velocity ◽  
Root Diameter ◽  
Left Ventricular ◽  
Right Heart ◽  
Respiratory Disorders ◽  
Heartworm Disease ◽  
The Right

The aim of this study was to evaluate right ventricular (RV) remodeling and right heart failure associated with different causes of elevated pulmonary arterial pressure (PAP) in dogs. In total, 169 client-owned dogs with tricuspid regurgitation (TR) and 40 client-owned clinically healthy dogs were included. Dogs with TR were further categorised as suffering from chronic respiratory disorders (CRD), heartworm disease (HWD), mild/moderate chronic degenerative mitral valvular disease (CDMD), and severe CDMD. Among the echocardiographic indices of the right heart, no significant difference in the tricuspid annular plane systolic excursion to aortic root diameter ratio was found among the clinical healthy controls and the four different TR categories. No significant differences in TR peak velocity and pulmonic regurgitation peak velocity were found among dogs in the four different TR categories. The ratio of the right to left ventricular basal diameter in the right ventricular-focused view was significantly higher in dogs with chronic respiratory disorders and dogs with heartworms. Left ventricular compression quantified using the eccentricity index and the ratio of the main pulmonary artery to aortic root diameter were significantly higher in dogs with HWD. Their right ventricular acceleration to ejection time (AT/ET) was significantly lower in dogs with HWD. Based on these findings, we conclude that right heart indices are affected by CRD, HWD, and moderate to severe CDMD. However, right heart indices derived from left heart measurements might be underestimated in dogs with CDMD.

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