scholarly journals 604 Echocardiographic assessment of right ventricular function and pulmonary pressures in hospitalized patients with COVID-19

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Maria Vincenza Polito ◽  
Marco Di Maio ◽  
Angelo Silverio ◽  
Michele Bellino ◽  
Serena Migliarino ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Systolic Pulmonary Artery Pressure ◽  
Icu Patients ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

Abstract Aims Pulmonary involvement in Coronavirus 19 disease (COVID-19) may affect right ventricular (RV) function and pulmonary pressures resulting in further deterioration of patient clinical status. However, the prognostic value of echocardiographic parameters including tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PASP), and TAPSE/PASP ratio has been poorly investigated in this clinical setting. Methods and results This is a multicentre Italian study including patients admitted for severe COVID-19 in seven Italian Hospitals. Transthoracic echocardiography (TTE) was performed within 48 h from admission in all cases. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. Of 1401 patients with severe COVID-19, 227 (16.1%) subjects underwent TTE within 48 h from admission and were included in this study. The mean age was 68 ± 13 years and 62.6% of patients were male. Intensive care unit (ICU) admission was reported in 73 patients (32.2%); ICU patients showed lower left ventricular ejection fraction (LVEF), lower TAPSE, and higher LV end systolic volume and PASP values than non-ICU patients. Also, ICU patients showed higher incidence of acute respiratory distress syndrome (82.2% vs. 30.5%; P < 0.001), acute cardiac injury (46.6% vs. 22.7%; P < 0.001), acute heart failure (34.2% vs. 9.1%; P < 0.001), and death (63.9% vs. 14.3%; P < 0.001) compared with non-ICU patients. By stratifying the study population into tertiles according to TAPSE, PASP, and TAPSE/PASP values, patients in the lower TAPSE and TAPSE/PASP ratio tertiles, and those in the higher PASP tertile, showed a significantly higher incidence of death during the hospitalization. At univariable logistic regression analysis, TAPSE, PASP, and TAPSE/PASP were significantly associated with a higher risk of death and PE, both in patients admitted or not to ICU. After propensity score weighting adjustment for multiple baseline potential confounders and further multivariable adjustment for LVEF value, the regression analysis showed that TAPSE, PASP and TAPSE/PASP were independently associated with risk of death (TAPSE: OR: 0.85, CI: 0.74–0.97, P = 0.017; PASP: OR: 1.08, CI: 1.03–1.13, P = 0.002; TAPSE/PASP: OR: 0.02, CI: 0.02 × 10−1—0.20, P < 0.001) and with the risk of PE (TAPSE: OR: 0.70, CI: 0.60–0.82, P < 0.001; PASP: OR: 1.10, CI: 1.05–1.14, P < 0.001; TAPSE/PASP: OR: 0.02 × 10−1, CI: 0.01 × 10−2—0.04, P < 0.001) during the hospitalization. The risk death according to TAPSE, PASP, and TAPSE/PASP ratio tertiles was estimated considering discharge alive as competing risk (Figure). The lowest TAPSE and TAPSE/PASP tertiles, and the highest PASP tertile, were significantly associated with poorer survival during the hosptialization (P < 0.001). Conclusions Echocardiographic evidence of RV systolic dysfunction, increased PASP and a poor RV-arterial coupling assessed by TAPSE/PAPS ratio may help to identify COVID-19 patients at higher risk of mortality and PE during the hospitalization.

scholarly journals Prognostic Implications of Right Ventricular Function and Pulmonary Pressures Assessed by Echocardiography in Hospitalized Patients with COVID-19

2021 ◽  
Vol 11 (12) ◽  
pp. 1245
Author(s):  
Maria Vincenza Polito ◽  
Angelo Silverio ◽  
Marco Di Maio ◽  
Michele Bellino ◽  
Fernando Scudiero ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Pulmonary Involvement ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Systolic Pulmonary Artery Pressure ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Multivariable Regression

Aims: Pulmonary involvement in Coronavirus disease 2019 (COVID-19) may affect right ventricular (RV) function and pulmonary pressures. The prognostic value of tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (PAPS), and TAPSE/PAPS ratios have been poorly investigated in this clinical setting. Methods and results: This is a multicenter Italian study, including consecutive patients hospitalized for COVID-19. In-hospital mortality and pulmonary embolism (PE) were identified as the primary and secondary outcome measures, respectively. The study included 227 (16.1%) subjects (mean age 68 ± 13 years); intensive care unit (ICU) admission was reported in 32.2%. At competing risk analysis, after stratifying the population into tertiles, according to TAPSE, PAPS, and TAPSE/PAPS ratio values, patients in the lower TAPSE and TAPSE/PAPS tertiles, as well as those in the higher PAPS tertiles, showed a significantly higher incidence of death vs. the probability to be discharged during the hospitalization. At univariable logistic regression analysis, TAPSE, PAPS, and TAPSE/PAPS were significantly associated with a higher risk of death and PE, both in patients who were and were not admitted to ICU. At adjusted multivariable regression analysis, TAPSE, PAPS, and TAPSE/PAPS resulted in independently associated risk of in-hospital death (TAPSE: OR 0.85, CI 0.74–0.97; PAPS: OR 1.08, CI 1.03–1.13; TAPSE/PAPS: OR 0.02, CI 0.02 × 10−1–0.2) and PE (TAPSE: OR 0.7, CI 0.6–0.82; PAPS: OR 1.1, CI 1.05–1.14; TAPSE/PAPS: OR 0.02 × 10−1, CI 0.01 × 10−2–0.04). Conclusions: Echocardiographic evidence of RV systolic dysfunction, increased PAPS, and poor RV-arterial coupling may help to identify COVID-19 patients at higher risk of mortality and PE during hospitalization.

scholarly journals Analysis of cardiac involvement in patients recovered from Covid-19 without troponin elevation, evaluated by cardiovascular magnetic resonance.

2021 ◽  
Author(s):  
Adrian Carlessi ◽  
Leonel Perello ◽  
Cristian Pantaley ◽  
Armando Borsini ◽  
Lucia Rossi ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Cardiac Involvement ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Troponin Elevation

Abstract Background The disease caused by coronavirus (COVID-19) affects the cardiovascular system, whether by direct viral aggression or indirectly through systemic inflammation and multiple organ compromise. A widely used method to determine cardiac injury is troponin measurement. The aim of this study is to evaluate the prevalence of cardiac involvement (CINV) in a population recovered from COVID-19, referred to cardiac MRI (CMR), who did not present troponin elevation. Methods There were 156 patients that recovered from COVID-19 and who did not present troponin elevation referred to CMR. CINV was considered to be the presence of: late gadolinium enhancement (LGE), edema, myocarditis, pericarditis, left ventricular systolic dysfunction (LVSD) and/or depressed right ventricular systolic dysfunction (RVSD). Results Prevalence of CINV was 28.8%, being more frequent in men (p = 0.002), in patients who required hospitalization (p = 0.04) and in those who experienced non-mild cases of infection (p = 0.007). RVSD (17.9%) and LVSD (13.4%) were the most frequent findings. The rate of myocarditis was 0.6%. LGE manifested in 7.1% of patients and its presence was related to less left ventricular ejection fraction (LVEF) (p = 0.0001) and right ventricular ejection fraction (RVEF) (p = 0.04). Conclusion In patients who recovered from COVID-19, 28.8% of CINV was found. It was more frequent in men, in patients who required admission and in patients with cases of non-mild infection. The patients that presented LGE had less LVEF and RVSF.

scholarly journals Additive Value of Biomarkers and Echocardiography to Stratify the Risk of Death in Heart Failure Patients with Reduced Ejection Fraction

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Calogero Falletta ◽  
Francesco Clemenza ◽  
Catherine Klersy ◽  
Valentina Agnese ◽  
Diego Bellavia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Troponin I ◽  
Cox Model ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic Pulmonary Artery Pressure ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Risk Of Death

Background. Risk stratification is a crucial issue in heart failure. Clinicians seek useful tools to tailor therapies according to patient risk. Methods. A prospective, observational, multicenter study on stable chronic heart failure outpatients with reduced left ventricular ejection fraction (HFrEF). Baseline demographics, blood, natriuretic peptides (NPs), high-sensitivity troponin I (hsTnI), and echocardiographic data, including the ratio between tricuspid annular plane excursion and systolic pulmonary artery pressure (TAPSE/PASP), were collected. Association with death for any cause was analyzed. Results. Four hundred thirty-one (431) consecutive patients were enrolled in the study. Fifty deaths occurred over a median follow-up of 32 months. On the multivariable Cox model analysis, TAPSE/PASP ratio, number of biomarkers above the threshold values, and gender were independent predictors of death. Both the TAPSE/PASP ratio ≥0.36 and TAPSE/PASP unavailable groups had a three-fold decrease in risk of death in comparison to the TAPSE/PASP ratio <0.36 group. The risk of death increased linearly by 1.6 for each additional positive biomarker and by almost two for women compared with men. Conclusions. In a HFrEF outpatient cohort, the evaluation of plasma levels of both NPs and hsTnI can contribute significantly to identifying patients who have a worse prognosis, in addition to the echocardiographic assessment of right ventricular-arterial coupling.

scholarly journals Using deep learning algorithms to simultaneously identify right and left ventricular dysfunction from the electrocardiogram.

2021 ◽  
Author(s):  
Akhil Vaid ◽  
Kipp W Johnson ◽  
Marcus A Badgeley ◽  
Sulaiman Somani ◽  
Mesude Bicak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Deep Learning ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
External Validation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Left And Right

Background Rapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECG) can assist diagnostic workflow. However, DL tools to estimate right ventricular (RV) function do not exist, while ones to estimate left ventricular (LV) function are restricted to quantification of very low LV function only. Objectives This study sought to develop deep learning models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population. Methods A multi-center study was conducted with data from five New York City hospitals; four for internal testing and one serving as external validation. We created novel DL models to classify Left Ventricular Ejection Fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation. Results We obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used Natural Language Processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients. For LVEF classification in internal testing, Area Under Curve (AUC) at detection of LVEF<=40%, 40%<LVEF<=50%, and LVEF>50% was 0.94 (95% CI:0.94-0.94), 0.82 (0.81-0.83), and 0.89 (0.89-0.89) respectively. For external validation, these results were 0.94 (0.94-0.95), 0.73 (0.72-0.74) and 0.87 (0.87-0.88). For regression, the mean absolute error was 5.84% (5.82-5.85) for internal testing, and 6.14% (6.13-6.16) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (0.84-0.84) in both internal testing and external validation. Conclusions DL on ECG data can be utilized to create inexpensive screening, diagnostic, and predictive tools for both LV/RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography, and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease. Keywords Artificial Intelligence, Deep Learning, Machine Learning, HFrEF, Right Ventricular Dilation, Right Ventricular Systolic Dysfunction, echocardiography, electrocardiogram, ECG, EKG, LVEF, Left Ventricular Ejection Fraction, Left Heart Failure, Right Heart Failure

Myocardial infarction with cardiogenic shock---the experience of a primary PCI centre from North-East Romania

2021 ◽  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
Severe Form ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Vessel Disease

Objectives: To evaluate the severity of acute myocardial infarction (AMI) complicated with cardiogenic shock (CS), by comparison with inferior and right ventricular AMI, which is also considered a severe form of myocardial infarction. Methods: In an observational study, from 774 patients with STEMI hospitalized in our Cardiology Institute, over one year and a half, only 120 patients met the inclusion and exclusion criteria (60 patients with CS and 60 patients with right ventricular AMI). Data collected included age, sex, vital signs, oxygen saturation, respiratory rate, left ventricular ejection fraction, right ventricular dysfunction, complications during hospitalization and coronarography results. Results: Patients with CS had a more severe systolic dysfunction (median ejection fraction 22.72 ± 12.30% vs. 41.93 ± 10.50%, P < 0.0001). Single-vessel disease was the most common in both groups, left anterior descending artery being the culprit artery in most patients with cardiogenic shock, 25% of them having residual lesions with a severity >75%. Using a multivariate analysis, we observed that for patients with CS, delayed coronary angiography evaluation, as well as the presence of severe triple-vessel disease, were associated with a higher risk of death. In-hospital mortality (53.33% vs. 8.33%, P < 0.0001) and ventricular arrhythmia were significantly higher in patients with CS (48.3% vs. 11.3%, P < 0.0001). Conclusions: Our study suggests that patients with AMI and CS can be considered the most severe form of myocardial infarction and should, therefore, benefit of prompt and appropriate treatment, to improve the outcome.

Right ventricular function as a predictor of appropriate therapy of implantable cardioverter defibrillator

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Chiba ◽  
T Kajiyama ◽  
M Sugawara ◽  
M Kitagawa ◽  
H Takahira ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Basal Diameter ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Icd Therapy ◽  
Appropriate Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Aim The purpose of this study was to evaluate the association of RV function and appropriate therapy of ICD.Methods: This study was a single-center retrospective cohort study. Consecutive patients who underwent ICD implantation for any diseases were enrolled except for non-dilated phase hypertrophic cardiomyopathy and channelopathy. Transthoracic echocardiographic parameters including left ventricular ejection fraction (LVEF), RV basal diameter, RV end-diastolic area, and right ventricular fractional area change (RVFAC) were evaluated. RV systolic dysfunction was defined as RVFAC &lt;35%. Cox regression analysis was used to analyze the effects of those parameters on appropriate ICD therapy after the implantation. Results In total, 151 patients (60.9 ± 13.6 years, 117 males) consisting of 67 old myocardial infarction, 34 dilated cardiomyopathy, 19 cardiac sarcoidosis, and 31 others were enrolled. Eighty patients received an ICD as a secondary prophylaxis. Mean LVEF and RVFAC were 37.8 ± 13.9% and 33.2 ± 10.8%, respectively. RV systolic dysfunction was present in 86 (57.0%) patients, which was significantly associated with ICD therapy (odds ratio 2.313; 95% confidence interval 1.067-5.014; P = 0.034) according to a univariate analysis. There was no correlation between RVFAC and LVEF (correlation coefficient =0.064). Regarding the subjects LVEF &gt; 35%, RV systolic dysfunction was an independent predictor of ICD therapy in a multivariate analysis. Conclusion RV systolic dysfunction was independently associated with increased ICD therapy despite of relatively preserved LVEF.

scholarly journals Right ventricular systolic dysfunction in patients with coronary artery disease: gender-related differences

2017 ◽  
Vol 95 (10) ◽  
pp. 894-900
Author(s):  
Alexey N. Sumin ◽  
E. V. Korok ◽  
O. G. Arhipov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Insurance Fund ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Right ventricular (RV) dysfunction is one of the most significant independent predictors of prognosis in patients with coronary artery disease (CAD) presenting with and without myocardial infarction (MI). However, gender-related differences in RV function of CAD patients are still poorly understood. Aim. To elucidate gender-related differences in echocardiographic parameters of the right chambers of the heart in CAD patients. Material and Methods. 719 patients with coronary artery disease undergoing medical examination in the Federal Budgetary Institution Rehabilitation Center «Topaz» of the RF Social Insurance Fund were included in the study. All patients were assigned to two groups according to the gender: Group 1 - men (n = 432, 61 [55; 67] years), Group 2 - women (n = 287, 62 [56; 67] years). Results. The analysis of the structure and systolic function of the RV showed that RV and right atrium (RA) end-diastolic dimension, diastolic RV wall thickness, and RA area were significantly higher in men than in women (p <0.001). Thus, the prevalence of RV systolic dysfunction (SD) was similar in both groups of patients: 17.6% in men and 15% in women (p = 0.356). The independent predictors of LV SD in both groups were as follows: prior coronary artery bypass grafting (CABG), decreased early mitral flow propagation velocity (p > 0.05). However, reduced left ventricular ejection fraction (LVEF; p <0.001) was found only in men. Conclusion. The prevalence of right ventricular systolic dysfunction in patients with coronary artery disease was similar in both men and women. Men demonstrated lower values of systolic and diastolic LV function. The factors associated with RV systolic dysfunction in both groups were as follows: prior CABG and diastolic LV dysfunction. Reduced LVEF was found only in men. The results of this study can be used to assess gender-related differences in RV dysfunction in CAD patients.

scholarly journals Treatable cardiac disease in hospitalised COPD exacerbations

2021 ◽  
Vol 7 (1) ◽  
pp. 00756-2020
Author(s):  
Paul Leong ◽  
Martin I. MacDonald ◽  
Paul T. King ◽  
Christian R. Osadnik ◽  
Brian S. Ko ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Antiplatelet Agent ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Dynamic Ct ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

IntroductionAcute exacerbations of COPD (AECOPD) are accompanied by escalations in cardiac risk superimposed upon elevated baseline risk. Appropriate treatment for coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) could improve outcomes. However, securing these diagnoses during AECOPD is difficult, so their true prevalence remains unknown, as does the magnitude of this treatment opportunity. We aimed to determine the prevalence of severe CAD and severe HFrEF during hospitalised AECOPD using dynamic computed tomography (CT).MethodsA cross-sectional study of 148 patients with hospitalised AECOPD was conducted. Dynamic CT was used to identify severe CAD (Agatston score ≥400) and HFrEF (left ventricular ejection fraction ≤40% and/or right ventricular ejection fraction ≤35%).ResultsSevere CAD was detected in 51 of 148 patients (35%), left ventricular systolic dysfunction was identified in 12 cases (8%) and right ventricular systolic dysfunction was present in 18 (12%). Clinical history and examination did not identify severe CAD in approximately one-third of cases and missed HFrEF in two-thirds of cases. Elevated troponin and brain natriuretic peptide did not differentiate subjects with severe CAD from nonsevere CAD, nor distinguish HFrEF from normal ejection fraction. Undertreatment was common. Of those with severe CAD, only 39% were prescribed an antiplatelet agent, and 53% received a statin. Of individuals with HFrEF, 50% or less received angiotensin blockers, beta blockers or antimineralocorticoids.ConclusionDynamic CT detects clinically covert CAD and HFrEF during AECOPD, identifying opportunities to improve outcomes via well-established cardiac treatments.

Can Right Ventricular Lead Position Influence Paced QRS Duration in Patients with Abnormal and Normal Left Ventricular Function?

2017 ◽  
Author(s):  
Melissa Moey
Keyword(s):  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valuable Insight ◽  
Ventricular Ejection Fraction ◽  
Lead Position ◽  
Lead Placement ◽  
Ventricular Lead ◽  
Qrs Duration

Right ventricular apical pacing (RVAP) in pacemaker or implantable cardioverter‐defibrillator (ICD) therapy has been associated with the development and exacerbation of heart failure (HF). Studies have suggested that RVAP resulting in dyssynchronous left ventricular (LV) activation and prolonged QRS duration leads to progressive mechanical dysfunction, decreased systolic function and increased mortality. These data suggest that the effect may be most pronounced in patients with pre‐existing LV systolic dysfunction. Pacing at the RV septum however has demonstrated narrower paced QRS durations and is being considered as an alternative pacing site to the RVA. In this study, the effect of RV lead placement on the QRS duration in patients with LV systolic dysfunction who demonstrate a left ventricular ejection fraction (LVEF) < 35% and normal LVEF was compared.  Patients of a minimum age of 18 years with LVEF ≥ 50% (normal cohort) and LVEF ≤ 30% (HF cohort) were recruited. Four 3 minute high resolution recordings were obtained from an orthogonal lead position for subsequent offline signal averaging. Recordings of native rhythm and pacing at three RV sites: right ventricular outflow tract (RVOT), mid‐septum and RV apex (RVA) were obtained. A 12‐lead electrocardiogram (ECG) recording at each pacing site was stored for later confirmation of pacing location and comparison with paced averaged QRS duration. The QRS duration at different RV sites in the two populations was then compared.  As studies to date are limited, this study provided valuable insight on RV lead placement on QRS duration in device therapy for HF treatment.  

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