P4533Homeometric adaptation to pulmonary vascular load determines right ventricular dimensions and function in patients with advanced systolic left heart disease with and without secondary pulmonary hypert

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Excutive Yuan, Taiwan Background Tricuspid regurgitation (TR) is traditionally classified as primary or secondary TR. The effects of TR on right ventricular (RV) function were not consistent. We hypothesized that secondary TR is not a unique group, sophisticated sub-grouping can be useful for studying effects of TR on RV function. Methods 207 consecutive patients identified as significant TR (moderate and severe) by echocardiography were recruited. Standard measurements for right heart were done according to guideline. Lateral tricuspid annulus systolic tissue velocity (S’) and RV fractional area change (FAC) were used for RV function. We classified these patients into primary TR and 6 subgroups of secondary TR according to a new systemic approach. Results Mean age of subjects was 71.2 ± 14.7 years, and there were 84 (40.6%) male. There were 29 (14%) primary TR. Secondary TR was further classified into 6 groups included 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13.0%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Among 4 major groups (congenital heart disease and RV myopathy were not included in analysis due to low numbers) of secondary TR, S’ was significant higher in idiopathic TR and RV FAC were higher in pacemaker related and idiopathic TR. RV dysfunction was defined as FAC < 35%. RV dysfunction presented mostly in pulmonary hypertension related TR and leastly in idiopathic TR (59.3% vs. 14%, p <0.001). Multivariate analysis using idiopathic TR as reference and controlled TR maximal velocity, RV end-diastolic area, right atrial area, and severity of TR, left heart disease related TR had higher risk of RV dysfunction (OR 4.178, 95% CI 1.490-11.703, p = 0.007). Conclusions Effects of TR on RV function were different among different subgroups of secondary TR. Left heart disease related TR had highest risk for RV dysfunction. Secondary TR should not be regarded as a single disease.

Download Full-text

P1361 Loading conditions might mimic right ventricular longitudinal dysfunction in patients with chronic left heart disease and forward failure

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.796 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

O Bech-Hanssen ◽

M Fredholm ◽

S E Bartfay ◽

K Karason ◽

G Dellgren ◽

...

Keyword(s):

Heart Disease ◽

Stroke Volume ◽

Right Ventricular ◽

Venous Pressure ◽

Right Atrial ◽

Volume Index ◽

Loading Conditions ◽

Left Heart ◽

Peak Vo2 ◽

Left Heart Disease

Abstract Background and aim Right ventricular failure (RVF) in patients with chronic left heart disease (LHD) has important prognostic implications. RV longitudinal function parameters (tricuspid annular plane systolic excursion, TAPSE; peak systolic longitudinal strain, RV-Str; tricuspid annulus systolic velocity, TAPSm) are today commonly used to define RV dysfunction. In the present study we hypothesized that longitudinal RV dysfunction (LDF) might be due to loading conditions and not necessarily RV dysfunction. Methods We retrospectively included 66 patients with LHD (age 52 ± 13 years, males 79%) that underwent right heart catheterization (RHC), ergospirometry (n = 47) and echocardiography (Echo) within 48 hours. Patients were divided into three groups from Echo data: normal RV function (TAPSE ≥17 mm + normal central venous pressure (CVP) from collapsibility of cava inferior, n = 18); LDF (TAPSE < 17 mm + normal CVP, n = 22) and RVF (CVP≥10 mmHg, n = 26). Results Patients with RVF had compared with normal and LDF lower peak VO2, more advanced LHD, enlarged RV and higher RV afterload (Table). Patients with LDF had compared with normal reduced stroke volume index (SVI). The patients with normal and LDF did not differ regarding right atrial pressure (RAP) response during exercise (P = 0.84). The longitudinal parameters did not differ between patients with LDF and RVF. Conclusions Longitudinal parameters in patients with chronic LHD and normal CVP should be interpreted with caution. Loading conditions with reduced stroke volume might mimic LDF. Normal (n = 18) LDF (n = 22) RVF (n = 26) Overall P-value Normal vs LDF Normal vs RVF LDF vs RVF Peak VO2 (mlO2/min/m2) 14.8 ± 3.3 13.5 ± 3 11 ± 2 0.001 0.29 <0.001 0.005 RAP (mmHg) 4 ± 3 4 ± 4 12 ± 3 <0.001 0.55 <0.001 <0.001 PASP (mmHg) 32 ± 13 37 ± 14 47 ± 11 <0.001 0.28 <0.001 0.002 PCWP (mmHg) 10 ± 6 14 ± 7 22 ± 5 <0.001 0.03 <0.001 <0.001 SVI(ml/m2) 43 ± 10 34 ± 6 30 ± 9 <0.001 <0.001 <0.001 0.15 PVR (Wood unit) 2.0 ± 1.1 2.0 ± 0.8 2.3 ± 1.1 0.29 - - - RVdA (cm2) 19 ± 3 22 ± 7 26 ± 7 0.003 0.16 <0.001 0.04 RVsax (mm) 23 ± 4 25 ± 8 34 ± 8 <0.001 0.42 <0.001 <0.001 TAPSE (mm) 21 ± 4 12 ± 3 12 ± 3 <0.001 <0.001 <0.001 0.98 TAPSm (cm/s) 11 ± 3 8 ± 2 8 ± 2 <0.001 <0.001 <0.001 0.55 RV-Str (%) -24 ± 5 -16 ± 5 -15 ± 5 <0.001 <0.001 <0.001 0.87 PASP, pulmonary systolic pressure; PCWP, pulmonary capillary wedge pressure; PVR, pulmonary vascular resistance; RVdA, RV diastolic area; RVsax, RV short axis diameter.

Download Full-text

Right ventricular and pulmonary vascular changes in pulmonary hypertension associated with left heart disease

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00159.2019 ◽

2019 ◽

Vol 316 (5) ◽

pp. H1144-H1145 ◽

Cited By ~ 1

Author(s):

Junichi Omura ◽

Sébastien Bonnet ◽

Shelby Kutty

Keyword(s):

Pulmonary Hypertension ◽

Heart Disease ◽

Right Ventricular ◽

Left Heart ◽

Vascular Changes ◽

Left Heart Disease

Download Full-text

Pulmonary hypertension and right ventricular dysfunction in left heart disease (group 2 pulmonary hypertension)

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2012.07.007 ◽

2012 ◽

Vol 55 (2) ◽

pp. 104-118 ◽

Cited By ~ 10

Author(s):

Sean R. Wilson ◽

Stefano Ghio ◽

Laura Scelsi ◽

Evelyn M. Horn

Keyword(s):

Pulmonary Hypertension ◽

Heart Disease ◽

Right Ventricular ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Left Heart ◽

Disease Group ◽

Left Heart Disease ◽

Group 2

Download Full-text

Modeling survival using decision tree analysis in pulmonary hypertension due to left heart disease. the prognostic significance of PVR <3WU when TAPSE <16mm

European Heart Journal ◽

10.1093/ehjci/ehaa946.2287 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

O Raitiere ◽

E Berthelot ◽

C Fauvel ◽

P Guignant ◽

N Si-Belkacem ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Heart Disease ◽

Decision Tree ◽

Pressure Gradient ◽

Right Ventricular ◽

Decision Tree Analysis ◽

Left Heart ◽

Tree Analysis ◽

Left Heart Disease ◽

Wedge Pressure

Abstract Aims In 2019, PVR<3 WU was adopted to stratify patients at low risk of pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether the supervised machine learning with Decision Tree analysis that provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification. Methods 202 consecutive patients (mean age: 69±11 y, females 42%) with mean pulmonary artery pressure (mPAP)≥20mmHg and wedge pressure>15mmHg were recruited. Transpulmonary pressure gradient ≥12mmHg, pulmonary vascular resistance (PVR) ≥3WU, diastolic pressure gradient ≥7mmHg, pulmonary arterial capacitance<1.1 ml/mmHg, TAPSE<16 mm, peak systolic tissue Doppler velocity<10cm/s and right ventricular end-diastolic area ≥25 cm2 were the seven categorical values to enter the model. To predict the mortality from the Decision Tree, we used the CHAID method. Each node and branch were compared using survival analysis at 6-year follow-up. Results Mean PAP, wedge pressure, cardiac index, and PVR were 40.3±10.0mmHg, 22.3±7.1mm Hg, 2.9±0.8L/min/m2, and 3.6±2.1WU, respectively. Among the seven dichotomous values linked to the prognosis in PH-LHD, only 2 variables entered the model. To predict the mortality, TAPSE was first selected following by PVR. Compared to patients with PVR<3WU and TAPSE ≥16mm, patients with PVR ≥3WU and TAPSE ≥16mm or patients with PVR ≥3WU and TAPSE <16 mm has significant increased mortality (HR=3,0, 95% CI: [1,4–6,4], p=0.006 and HR=3,3, 95% CI: [1,6–6,9], p=0.002, respectively), while patients with PVR <3WU and TAPSE <16 mm exhibiting the worst prognosis (HR=7,2, 95% CI: [3,3–15,9], p=0.0001). Conclusion Used for solving regression and classification problems, decision tree analysis indicates that among 7 prognostic factors, TAPSE and PVR have to be interpreted altogether and simultaneously in PH-LHD for mortality assessment. Therefore, in future research, PVR <3 WU should be understood primarily based on right ventricular systolic function assessed by echocardiography whether TAPSE is or not ≥16 mm. Funding Acknowledgement Type of funding source: None

Download Full-text