P4504Pulmonary circulatory-right ventricular uncoupling in acute decompensated heart failure: a key mediator of congestion

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Losito ◽  
M Barki ◽  
V Labate ◽  
A Giammarresi ◽  
M Caracciolo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Right Atrial ◽  
Maximum Diameter ◽  
Group Iii ◽  
Non Invasive ◽  
Group I ◽  
Group Ii

Abstract Background The degree of congestion in patients hospitalized for acute decompensated heart failure (ADHF) is estimated using traditional non-invasive markers such as echo-derived inferior vena cava diameter (IVCD) and NT-proBNP levels. The deterioration of right ventricular (RV) function and its uncoupling to pulmonary circulation (Pc) represents a turning point in terms of prognosis and clinical outcome in patients affected by heart failure. However, how RV-to-Pc uncoupling correlates with markers of decompensation and congestion in ADHF patients has never been explored. Purpose To investigate, in a cohort of ADHF patients, the association between the degree of RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), IVCD and right atrial pressure (RAP) estimated at echocardiography. Methods Fourty-six ADHF patients both with reduced and preserved EF (mean age 73.15±10.85 years, 60.8% males) admitted to the Cardiology Department were prospectively enrolled within 24–48 hours from admission. In the acute phase all patients underwent transthoracic echocardiography and laboratory blood tests. Patients were then stratified in tertiles according to TAPSE/PASP ratio (group I: <0.4 mm/mmHg; group II: 0.4 to 0.6 mm/mmHg and group III: >0.6 mm/mmHg) correlating the degree of RV-to-Pc with non-invasive markers of congestion such as NT-proBNP, IVC maximum diameter and RAP. Other echocardiographic parameters including left ventricular (LV) systolic function and LV filling pressures were considered. Results An exponential inverse relationship was found between NT-pro-BNP levels at admission with levels decreasing progressively with the increment of the ratio (Group I: 12828±10600 ng/l; Group II 5549±5383 ng/l; Group III 3695±3870 ng/l; p=0.004) (Figure 1a). An analogous correlation was observed when considering the IVC maximum diameter (Group I: 20.87±5.37 mm; Group II 18.08±4.35 mm; Group III 10.9±3.36 mm; p<0.001) (Figure 1b) and the RAP estimated at echocardiography (Group I: 12.875±5.25 mmHg; Group II 9.157±4.82 mmHg; Group III 4±1.61 mmHg; p<0.001) (Figure 1c). In addition, progressively increasing values of LVEF (Group I: 28±11.3%; Group II 42±17.3%; Group III 49±11.8%; p=0.001) were detected from the lowest to the highest TAPSE/PASP tertiles. No correlation was observed in the three groups for E/E' values at admission (Group I: 17.17±6.7; Group II 19.42±8.36; Group III 15.92±5.7; p=0.5). Figure 1 Conclusions In ADHF, the association between RV to Pc uncoupling, echo-derived measures of congestion and natriuretic peptide levels is here described for the first time. The extent of RV dysfunction in ADHF deserves attention and seems to represent a critical and quite underestimated key mechanism between congestion resolution and in-hospital worsening HF.

P4553Clinical and prognostic value of right ventricular dysfunction in patients with chagas heart disease during acute decompensated heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S R R Siqueira ◽  
S M Ayub-Ferreira ◽  
P R Chizzola ◽  
V M C Salemi ◽  
S H G Lage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Jugular Venous Distension

Abstract Introduction The occurrence of right ventricular disfunction (RVD) is common in heart failure (HF) patients due to Chagas' disease (ChD). However, its clinical and prognostic value has not been studied during episodes of acute decompensated heart failure (ADHF). Purpose Evaluate the prognostic value of RVD in ADHF patients with ChD during hospitalization and after 180 days of discharge compared to other etiologies. Methods We analysed a prospective cohort of consecutive 768 patients admitted for ADHF between March 2013 and October 2018; 490 (63.7%) patients were male and the median age was 58 (48.3–66.8) years and left ventricular ejection fraction was 26% (median) (IQR 22–35%). We compared the clinical characteristics and the prognosis of ChD patients according to the presence of RVD in the echocardiogram to other etiologies. Results RVD was presented in 289 (37.6%) patients. Among patients with non-chagasic etiologies, those with RVD were younger [53 (41–62) vs 61 (52–70) years, p<0.0001], had high levels of BNP in the moment of hospitalization [1195 (606–2209) vs 886 (366– 555) pg/mL], p<0,0001], received more inotropes (79.2% vs 57.9%, p<0,0001), had longer hospitalization [35 (17–51) vs 21 (10–37) days, p<0.001] and more clinical signs of congestion as hepatomegaly (49% vs 28.6%, p<0.0001); jugular venous distension (68.3% vs 41.2%, p<0.0001) and leg edema (65.4% vs 49.2%, p=0.001). Among patients with ChD, those with RVD were older [61 (48- 66) vs 58 (48 - 67) years, p=0.017], and had more frequently signs of hypoperfusion (56.8% vs 36.5%, p=0.029), jugular venous distension (72.8% vs 52.8%, p=0.01) and hepatomegaly (56.8% vs 31.1%, p=0.011), higher BNP levels [1288 (567–2180) vs 1066 (472–2007) pg/mL, p=0.006] and more frequent use of intravenous inotropes (88.9% vs 67.1%, p=0.003); additionally ChD patients with RVD had a higher rate of death and transplant during hospitalization (51.2% vs 38.3%, p=0.001). When all groups were compared together, ChD patients with RVD had the highest rate of death, transplant and readmissions at 180-days of follow-up (Figure). Figure 1 Conclusion Patients with RVD demonstrated a distinct clinical presentation, biomarkers and worse prognosis in all etiologies. ChD patients with RVD in ADHF had the worst prognosis with the highest rate of death, heart transplant e rehospitalization in follow-up.

scholarly journals An Incidentally Detected Right Ventricular Pseudoaneurysm

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Vamsi C. Gaddipati ◽  
Angel I. Martin ◽  
Mauricio O. Valenzuela ◽  
Asef Mahmud ◽  
Aarti A. Patel
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Right Ventricular ◽  
Chest Trauma ◽  
Clinical Presentation ◽  
Acute Decompensated Heart Failure ◽  
Imaging Techniques ◽  
Decompensated Heart Failure ◽  
Advanced Imaging ◽  
Fatal Complication

Ventricular pseudoaneurysm is an uncommon, potentially fatal complication that has been associated with myocardial infarction, cardiac surgery, chest trauma, and infectious processes. Diagnosis can be challenging, as cases are rare and slowly progressing and typically lack identifiable features on clinical presentation. As a result, advanced imaging techniques have become the hallmark of identification. Ahead, we describe a patient who presents with acute decompensated heart failure and was incidentally discovered to have a large right ventricular pseudoaneurysm that developed following previous traumatic anterior rib fracture.

The Novel Non-Invasive Measurement to Predict Arterial Underfilling in Patients with Acute Decompensated Heart Failure

2016 ◽  
Vol 22 (9) ◽  
pp. S180
Author(s):  
Nanao Matsusaki ◽  
Taiki Sakaguchi ◽  
Akio Hirata ◽  
Kazunori Kashiwase ◽  
Yoshiharu Higuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
The Novel ◽  
Non Invasive ◽  
Invasive Measurement

Adverse cardiovascular outcome predicted by left atrial strain in acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Barki ◽  
M Losito ◽  
M Carrozzo ◽  
M.M Caracciolo ◽  
M Rovida ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Atrial ◽  
Acute Decompensated Heart Failure ◽  
Significant Proportion ◽  
Decompensated Heart Failure ◽  
Primary Role ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
B Lines

Abstract Background A significant proportion of patients hospitalized for acute decompensated heart failure (ADHF) are readmitted to the hospital within 30 days, resulting in a major social and economic burden. Thus, risk stratification and identification of targets of therapy is of basic importance. Non-invasive imaging modality such as transthoracic echocardiography (TTE) represents a cornerstone tool to approach this clinical scenario for early recognition of high-risk patients. Purpose To define whether left atrial (LA) dynamics, evaluated by means of speckle tracking echocardiography (STE), may represent a predictor of cardiac events and early re-hospitalization in patients admitted to the emergency department (ED) for ADHF, in comparison with other non-invasive established prognostic index in heart failure (HF) such as NT-proBNP, B-lines at lung ultrasonography (LUS) and right ventricular (RV) to Pulmonary Circulation (PC) uncoupling evaluated through Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio. Methods Seventy patients (mean age 75.6±11 years, 57% males) presenting with ADHF were prospectively enrolled within 24–48 hours from admission. In the acute phase and at pre-discharge the following variables have been collected: NT-proBNP, B-lines, TAPSE/PASP ratio, Left Atrial Volume indexed (LAVi) and global-peak atrial longitudinal strain (G-PALS). Results During a median follow-up of nine months we observed 18 events consisting of 7 deaths, 8 re-hospitalizations for ADHF, 1 re-hospitalization for acute coronary syndrome, 1 stroke and 1 mitral valve replacement. Multivariate Cox-regression analysis identified LAVi and GPALS at discharge, along with NT-proBNP, B-lines and TAPSE/PASP ratio, as independent predictors of major adverse CV events (LAVi: p=0.04; GPALS: p=0.05; NT-proBNP: p&lt;0.001; B-lines: p=0.03; TAPSE/PASP: p&lt;0.001) (Table 1). Conclusions Short-term re-hospitalization in ADHF is crucial and the identification of a higher risk through sensitive and potentially new hemodynamic phenotypes is of relevance. Our findings, although preliminary, may suggest a primary role of LA dynamics in this context. Funding Acknowledgement Type of funding source: None

What Is the Best Method for Reporting Tumor Diameter in Vestibular Schwannoma?

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 634-638 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Kazuhiro Hongo ◽  
Tsuyoshi Tada ◽  
Shigeaki Kobayashi
Keyword(s):  
Tumor Volume ◽  
Three Dimensional ◽  
Internal Auditory Canal ◽  
Vestibular Schwannomas ◽  
Maximum Diameter ◽  
Tumor Diameter ◽  
Constructive Interference ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Abstract OBJECTIVE Various methods have been used to report the tumor diameter of vestibular schwannomas. To clarify the most appropriate method to represent the tumor volume, tumor diameters according to various measuring methods were statistically compared with the actual tumor volume. METHODS Tumor volume was measured by three-dimensional constructive interference in steady state images in 52 unselected vestibular schwannomas. Pearson's correlation coefficient was obtained between the tumor volume and various tumor diameters, such as diameter parallel to the petrous edge (a); a pons-to-petrous diameter (b); √ab, a maximum diameter of the portion in the cerebellopontine angle cistern (max CPA); a maximum diameter of the whole tumor (Max); and a diameter through an axis of the internal auditory canal (Axis). The tumors were divided into three groups on the basis of tumor volume, as follows: Group I (small, &3x003C;0.5 cm3), Group II (medium, 0.5–2 cm3), and Group III (large, &gt;2 cm3). RESULTS Max and Axis correlated best with the tumor volume in Group I and correlated least with the tumor volume in Group II. Any of these measurements was acceptable in Group III tumors. The max CPA consistently revealed good correlation with the tumor volume in all three tumor groups. CONCLUSION The max CPA measurement is the simplest and most appropriate way to represent the tumor volume in unselected tumors. Max or Axis is better only when small tumors (&lt;0.5 cm3 in volume) are being assessed—that is, those with a max CPA of less than 1 cm.

Abstract 13532: Comparison of Inferior Vena Cava and Subclavian Vein Collapsibility Index by Ultrasound for Determination of Relative Intravascular Volume in Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yvonne E Kaptein ◽  
Pedro D Salinas ◽  
Payal Sharma ◽  
Ana Christina Perez Moreno ◽  
Nasir Sulemanjee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Inferior Vena Cava ◽  
Subclavian Vein ◽  
Inferior Vena ◽  
Acute Decompensated Heart Failure ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Right Atrial ◽  
Intravascular Volume ◽  
Collapsibility Index

Introduction: Accurate assessment of relative intravascular volume is needed to guide management of acute decompensated heart failure (ADHF). Current assessments include history and physical examination (specific but not sensitive), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (sensitive but not specific).Ultrasound (US) of inferior vena cava (IVC) collapsibility with respiration is commonly used to assess intravascular volume and right atrial pressure (RAP) but may be technically challenging. US of subclavian vein (SCV) collapsibility may provide an alternative assessment. Hypothesis: In ADHF, SCV collapsibility index (CI) may correlate with IVC CI and RAP. Methods: Prospective study of non-ventilated patients with ADHF who had NT-proBNP within 24 hours of paired IVC and SCV diameter measurements by US. Results: Forty-two patients (median age 66.5 years, 45% female, and 64% white) were enrolled, with 52 encounters. Cardiovascular comorbidities included hypertension (93%), chronic kidney disease (64%), coronary artery disease (55%), atrial fibrillation/flutter (55%), and valvular disease (55%). Of 38 patients with known heart failure, 63% had HFrEF, 16% HFmrEF, and 21% HFpEF.Correlation of paired IVC CI and SCV CI with relaxed breathing was R = 0.65 (N = 36). Correlation of paired IVC CI and SCV CI with forced inhalation was R = 0.47 (N = 36). Log 10 NT-proBNP was inversely correlated with IVC CI (R = -0.35; N = 51) and SCV CI (R = -0.33; N = 36). For patients with right heart catheterization within 24 hours of US, correlation of RAP to IVC CI was R = -0.53 (N = 9), and RAP to SCV CI was R = -0.65 (N = 9). Moderate or severe tricuspid regurgitation decreased CI independently of intravascular volume and RAP (figure). Conclusions: US measurements of SCV CI correlate well with paired IVC CI in non-ventilated ADHF. RAP by RHC correlated better with SCV CI than with IVC CI. SCV CI may be a reliable alternative to IVC CI in assessing relative intravascular volume.

Abstract P147: Office Blood Pressure: An Inadequate Guide to the Diagnosis and Treatment of Hypertension

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Jay Cohn ◽  
Sue Duval ◽  
Natalia Florea ◽  
Lynn Hoke ◽  
Daniel Duprez
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Invasive Disease ◽  
Office Blood Pressure ◽  
Group Iii ◽  
Non Invasive ◽  
Group I ◽  
Group Ii ◽  
Cv Disease ◽  
Asymptomatic Individuals

Hypertension is a cardiovascular (CV) disease with high risk for CV morbid events (ME) that benefits from anti-hypertensive therapy. Resting blood pressure (BP) >140/90 mmHg serves as the diagnostic criterion for hypertension, and management has been aimed at BP reduction. Progression of CV disease in the absence of elevated blood pressure identifies individuals who might benefit from CV-protective therapy but are not currently being recognized as in need of treatment. In 2017 asymptomatic individuals evaluated for early functional and structural CV abnormalities, 1534 not taking anti-hypertensive drugs were available to determine the relationship between office blood pressure and the severity of CV abnormalities, as defined by a 10-test non-invasive disease score (DS) of 0-20. Previous studies have documented the high predictive value of DS for future CVME. The population was 53% male, average age 50±11 years, BP 122/77mmHg, LDL cholesterol 129±38 mg/dL, HDL 52±17mg/dL, triglycerides 109 mg/dL. DS was adjusted by eliminating the score for BP, but 9-test DS was still directly related to BP: 2.3 in those (n=550) <120/80 mmHg (Group I), 3.2 in those 120-129/80-85 mmHg (n=600) (Group II), 4.1 in those 130-139/85-89 mmHg (n=236) (Group III), and 5.7 in those 140+/90+mmHg (n=148) (Group IV). Nonetheless, DS of >6 indicative of high risk was present in 10% of Group I, 20% of Group II and 30% of Group III. BP was largely overlapping in individuals with no CV disease (DS 0-2), early disease (DS 3-5) and advanced disease (DS 6+). Therefore, reliance on resting BP leaves many at-risk individuals undiagnosed and untreated for early CV disease likely to progress. The hypertensive state exists in the absence of elevated BP and should be recognized and treated to prevent CVME.

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