Right ventricular longitudinal deformation correlates closely with right ventricular myocardial fibrosis in patients with end-stage heart failure

Background: Speckle-tracking echocardiography (STE) has emerged as a more accurate tool for assessing the right ventricular (RV) function.We aimed to assess RV myocardial mechanics by 2D- and 3D-STE in patients with end-stage heart failure (HF). Methods: We enrolled 105 patients with end-stage HF and 50 normal subjects. The results of coronary artery angiography divided these patients into two subgroups : ischaemic cardiomyopathies (ICM, n=23) and non-ischaemic cardiomyopathies subgroups (NICM, n=82). RV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) were measured by 3D-STE. RV free wall longitudinal strain (RVLS-fre),and RV septal wall LS (RVLS-sep) were also determined by 3D-and 2D-STE. The conventional RV function parameters (fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]) were obtained. We compared these parameters between patients and normal subjects. RVLS-fre and RVLS-sep obtained by 3D- and 2D-STE were compared between ICM and NICM. Results: Compared with controls, patients had higher RVEDV, RVESV(P<0.001),and lower RVLS-fre, RVLS-spe, RVEF, RVSV, FAC, TAPSE(P<0.001).In 105 patients, 3D-RVLS-fre was lower than 2D-RVLS-fre (-11.43±3.83% VS -12.30±3.95%;P=0.003); whereas 3D-RVLS-sep was not different from 2D-RVLS-sep. Patients with NICM had significant lower 3D-RVLS-fre(-10.68±3.55% VS -14.06±3.70%;P<0.001)and 3D-RVLS-sep (-6.68±2.76% VS -8.26±2.64%;P=0.006)than patients with ICM. There was no difference in 2D-STE between the two subgroups. Conclusions: End-stage HF patients present significant difference in RVLS values between 3D- and 2D-STE. 3D-STE is superior to 2D-STE for RV systolic function assessment in end-stage HF patients with different pathologies.

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The effect of prolonged Intraaortic ballon pump (IABP) support on right ventricular function in end-stage heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0943 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M.J Bonios ◽

I Armenis ◽

N Kogerakis ◽

A Thodou ◽

S Fragkoulis ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Total Bilirubin ◽

Left Ventricular ◽

Function Optimization ◽

Circulatory Support ◽

Iabp Support ◽

End Stage Heart Failure ◽

End Stage ◽

Rv Function

Abstract Introduction Right Ventricular (RV) function has prognostic implications in end-stage heart failure (ESHF) patients. RV failure following Left Ventricular Assist Device (LVAD) implantation increases morbidity and mortality. Achieving optimal RV function before LVAD implantation is of paramount importance. Purpose Purpose was to investigate the effect of Intra-aortic Balloon Pump (IABP) on RV function optimization in patients with bi-ventricular ESHF. Methods ESHF patients with poor RV function, presenting with acutely decompensated heart failure resistant to inotropes/vasopressors, thus requiring IABP for stabilization, were prospectively enrolled. Serum biochemistry, echocardiography and invasive hemodynamics were applied and eligibility for LVAD according to RV function was determined on the basis of pre-specified criteria (Right atrium Pressure (RAP) <12mmHg, Pulmonary Artery Pulsatility index (PAPi) >1.85, RAP/Pulmonary Capillary Wedge Pressure (PCWP) <0.67, RV strain <−14%). LV and RV tissue was harvested during LVAD or bi-ventricular mechanical circulatory implantation or at the time of heart transplantation. Fibrosis of the myocardial tissue was quantified. Results Sixteen patients aged 38±14 years were enrolled. Duration of IABP support was 62±50 (3–180) days. Three patients deteriorated requiring additional mechanical circulatory support. Two patients were stabilized without RV function improvement. In the remaining 11 patients, RV improved and fulfilled LVAD eligibility criteria (IABP responders); RA and RA/PCWP decreased from 18±6 to 10±4mmHg (p=0.0001) and from 0.60±0.19 to 0.42±0.11 (p=0.011) respectively. PAPi and RV strain improved from 1.46±0.65 to 3.20±0.58 (p=0.0001) and from −12.9±3.4% to −18.7±1.7% (p=0.0001) respectively. Significantly lower baseline NTproBNP and total bilirubin values were observed in the responders group. Six patients finally received LVAD and none suffered RV failure post-operatively (the remaining 5 were successfully transplanted). RV fibrosis correlated with post-IABP NTproBNP (r=0.91, p=0.001), total bilirubin (r=0.79, p=0.011), RAP (r=0.78, p=0.014), PAPi (r=−0.69, p=0.040), RAP/PCWP (r=0.74, p=0.022) and LV fibrosis (r=0.77, p=0.016), but not with baseline (pre-IABP) parameters. Conclusions Prolonged IABP support contributes to partial RV function recovery in patients with ESHF and bi-ventricular failure, thus leading to eligibility for LVAD implantation. RV fibrosis may predict RV response to IABP and post-IABP eligibility for LVAD. FUNDunding Acknowledgement Type of funding sources: None.

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