scholarly journals P1282BODY COMPOSITION AND VENTRICULAR FUNCTION IN HEMODIALYSIS, CLOSED COMPARTMENTS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Javier Carbayo ◽  
Soraya Abad Esttebanez ◽  
Eduardo Verde ◽  
Alejandra Muñoz de Morales ◽  
Ángela González-Rojas ◽  
...  
Keyword(s):  
Body Composition ◽  
Mortality Rate ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Volume Overload ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular

Abstract Background and Aims Right ventricular dysfunction is common among hemodialysis (HD) patients and it has been recently described as a marker of cardiovascular morbidity and mortality. Nevertheless, mechanisms responsible for have not been clearly elucidated. Volume overload, retrograde left ventricular dysfunction, pulmonary hypertension, left-right shunt and mineral bone disease have been related. Similarly, body composition and chronic fluid overload are closely linked to survival in dialysis patients. However, there are no data about correlation between body composition and echocardiographic parameters in previous studies The aim of this study was to assess the relationship between body composition and changes in right and left ventricular function in patients on maintenance hemodyalisis. Method We conducted a retrospective and longitudinal observational cohort study over a population of 78 patients on maintenance hemodyalisis at a single hospital. They were on chronic hemodyalisis program of three weekly sessions of 240 minutes duration. A transthoracic echocardiogram (TTE) and a bioimpedance (BI) were performed in the same month, in the first inter-dialysis day of the week, being the patients asymptomatic and clinically stable, at the beginning and at the end of the study. The follow-up time since the completion of first and second ETT and BI was 19.5 months, with an average total follow-up of 29.7 months. Cardiovascular and general mortality events were recorded during that period. Echocardiography data about cardiac cavities measurement, ventricular and valvular function was collected. Left ventricular ejection fraction was evaluated by Simpson’s method (LVEF, %) and right ventricular function by tricuspid annular plane systolic excursion (TAPSE, mm).We gathered information about fluid status and corporal composition. Statistical analysis was performed using SPSS Statistics, version 21 (SPSS, Inc., Chicago, IL, USA). Results Patients with RV dysfunction (35.7%), determined as TAPSE < 20, experienced a higher mortality rate (20%) compared to those who maintained TAPSE ≥ 20 (63.2%), who had a mortality rate of 2.3%. These results were statistically significant in the Kaplan-Meier survival analysis (Log Rank 6.65; p = 0.010). There were not statistically significant differences regarding age, diabetes, years on dialysis and status of volume overload between patients with and without right ventricular dysfunction. No significant differences were found between any other of the echocardiography parameters and overall mortality. Equally, neither bioimpedance measure at the beginning of the study was associated with mortality. Patients who had an FTI above the average (9.20 kg / m2) suffered a greater fall in TAPSE (-1 ± 4.3 mm) (p = 0.032) and LVEF (-4.2 ± 6.8) (p = 0.045), regarding those with lower FTI: TAPSE +2.3 ± 4.3 and LVEF +3.7± 10.4. These results seems to be related to a disproportionate LTI/LTI index rather than a greater total mass of fat due to patients with FTI > 9.2 kg/m2 had a mean LTI/FTI index of 1.1, meanwhile those with FTI < 9.2 kg/m2 a mean LTI/FTI of 5.9. No statistically significant relationship was found with absolute or relative volume overload, nor with changes in them over time. Conclusion The results presented suggest that high fat tissue index, and an underlying lower LTI/FTI index, could be associated with a higher risk of right and left ventricular dysfunction, which has been associated with higher mortality in hemodialysis patients.

scholarly journals Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

Infection ◽  
2021 ◽  
Author(s):  
Stéphanie Bieber ◽  
Angelina Kraechan ◽  
Johannes C. Hellmuth ◽  
Maximilian Muenchhoff ◽  
Clemens Scherer ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Myocardial Injury ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection Fraction ◽  
Strain Echocardiography

Abstract Purpose SARS-COV-2 infection can develop into a multi-organ disease. Although pathophysiological mechanisms of COVID-19-associated myocardial injury have been studied throughout the pandemic course in 2019, its morphological characterisation is still unclear. With this study, we aimed to characterise echocardiographic patterns of ventricular function in patients with COVID-19-associated myocardial injury. Methods We prospectively assessed 32 patients hospitalised with COVID-19 and presence or absence of elevated high sensitive troponin T (hsTNT+ vs. hsTNT-) by comprehensive three-dimensional (3D) and strain echocardiography. Results A minority (34.3%) of patients had normal ventricular function, whereas 65.7% had left and/or right ventricular dysfunction defined by impaired left and/or right ventricular ejection fraction and strain measurements. Concomitant biventricular dysfunction was common in hsTNT+ patients. We observed impaired left ventricular (LV) global longitudinal strain (GLS) in patients with myocardial injury (-13.9% vs. -17.7% for hsTNT+ vs. hsTNT-, p = 0.005) but preserved LV ejection fraction (52% vs. 59%, p = 0.074). Further, in these patients, right ventricular (RV) systolic function was impaired with lower RV ejection fraction (40% vs. 49%, p = 0.001) and reduced RV free wall strain (-18.5% vs. -28.3%, p = 0.003). Myocardial dysfunction partially recovered in hsTNT + patients after 52 days of follow-up. In particular, LV-GLS and RV-FWS significantly improved from baseline to follow-up (LV-GLS: -13.9% to -16.5%, p = 0.013; RV-FWS: -18.5% to -22.3%, p = 0.037). Conclusion In patients with COVID-19-associated myocardial injury, comprehensive 3D and strain echocardiography revealed LV dysfunction by GLS and RV dysfunction, which partially resolved at 2-month follow-up. Trial registration COVID-19 Registry of the LMU University Hospital Munich (CORKUM), WHO trial ID DRKS00021225.

scholarly journals Impact of right ventricular dysfunction after MitraClip treatment as a bridge to heart transplantation: insights from the MitraBridge registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Munafo ◽  
A Scotti ◽  
R Estevez-Loureiro ◽  
D Arzamendi ◽  
N.P Fam ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Right Ventricular ◽  
Primary Outcome ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
End Point

Abstract Background MitraClip treatment has been recently proposed as a “bridge strategy” solution for advanced heart failure (HF) patients with significant functional mitral regurgitation (MR), who are potential candidates or are waiting for cardiac replacement therapy (LVAD or heart transplantation, HTx). In this clinical scenario, left-ventricular-related right ventricular dysfunction (RVD) represents an important prognostic factor. Purpose Our study aimed to investigate the possible prognostic implication of RVD in advanced HF patients treated with MitraClip as a bridge to HTx strategy. Methods RVD was assessed using the relationship between tricuspid annular peak systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). All patients from the MitraBridge registry for whom these two echocardiographic parameters were available, were included in the study. A cut-off value of TAPSE/PASP ratio <0.36 was used to defined RVD, as previously reported. The primary outcome was a composite end-point of all-cause death or rehospitalization for HF at 2-year. For patients who underwent LVAD implantation or HTx, follow-up data were censored at the time of those events. Results A total of 80 patients were included in the study. The median TAPSE/PASP ratio was 0.35 (25th-75th: 0.27–0.46), with 43 (54%) patients having a TAPSE/PASP ratio <0.36 (RVD group). The latter had a prevalent MR ischemic etiology (49% vs 38%), with a more frequent history of percutaneous coronary intervention (46.5% vs 22%, p=0.02). Except for TAPSE (15.7±3.6 mm vs 19.2±3.7 mm, p=0.001) and PASP (61±14 mmHg vs 39.5±9.5 mmHg, p<0.001), the other echocardiographic characteristics were similar between the two study groups (overall mean left ventricular ejection fraction 26.9±8%, median left ventricular end-diastolic volume index 120.7, 25th-75th: 102.2–146.5 mL/m2). After a median follow-up time of 508 (25th-75th: 160–899) days, elective HTx occurred in 12 patients (7 from the RVD group), while LVAD implantation was performed in 13 patients (7 from the RVD group). The primary outcome occurred in 30 patients (38%) with a 2-year Kaplan-Meier estimate of freedom from the composite end-point of 41%. At univariate (HR 1.3 95% CI 0.6–2.8, p=0.451) and multivariate (HR 1.6 CI 0.7–3.8, p=0.249) Cox-regression analysis, TAPSE/PASP ratio <0.36 was not identified as an independent predictor of primary outcome. Indeed, at follow-up echocardiographic control (median time 252, 25th-75th: 122–365 days), a significant improvement in TAPSE/PASP ratio was observed in the RVD group (baseline median TAPSE/PASP ratio 0.27, 25th-75th: 0.22–0.32 vs follow-up median TAPSE/PASP ratio 0.37, 25th-75th: 0.28–0.47, p<0.001). Conclusion In advanced HF patients with functional MR, MitraClip treatment could prevent or ameliorate left-ventricular-related RVD, allowing safe access to HTx or LVAD. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Evaluation of ventricular systolic dysfunction as a risk factor for acute kidney injury in intensive care unit

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Ahmed Aly Obiedallah ◽  
Ashraf Anwar E. L. Shazly ◽  
Noura Gamal Nasr ◽  
Essam M. Abdel Aziz
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Right Ventricular ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Systolic Dysfunction ◽  
Kidney Injury ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction

Abstract Background Heart failure (HF) is a major health problem. Cardiac and renal diseases interact in a complex bidirectional manner in both acute and chronic settings. Renal dysfunction in the setting of heart failure, termed the cardio renal syndrome (CRS), has been considered consequence of left ventricular dysfunction (LVD), whereby decreasing cardiac output (COP) results in renal under perfusion and consequent decreased glomerular filtration rate (GFR). Main body of the abstract This study showed that 500 patients were admitted to internal care unit (ICU), and out of them, 100 (20%) patients developed acute kidney injury (AKI) while 400 (80%) patients did not develop AKI. It is also showed that 67 (67%) of those with AKI and 100 (25%) of those with no-AKI had baseline ventricular systolic dysfunction, left ventricular dysfunction (LVD), right ventricular dysfunction (RVD), and biventricular dysfunction (BiVD)presented in 23 (23%), 16 (16%), and 28 (28%) patients of AKI group, respectively, and presented in 60 (15%), 30 (7.50%), and 10 (2.50%) patients, respectively, in patients without acute kidney injury (AKI) Short conclusion Our study revealed that AKI has highest incidence in patient with biventricular dysfunction followed by left ventricular dysfunction and lastly those with right ventricular dysfunction.

Left ventricular function in experimental volume overload hypertrophy

1989 ◽  
Vol 256 (4) ◽  
pp. H974-H981 ◽  
Author(s):  
B. A. Carabello ◽  
K. Nakano ◽  
W. Corin ◽  
R. Biederman ◽  
J. F. Spann
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Contractile Function ◽  
Weight Ratio ◽  
Volume Overload ◽  
Left Ventricular ◽  
Mean Velocity

Left ventricular function in volume overload hypertrophy is controversial. In humans, chronic severe volume overload eventually results in left ventricular dysfunction; paradoxically, experimental volume overload hypertrophy has nearly always been associated with normal left ventricular function. However, in most cases, experimental volume overload hypertrophy has either been mild or only present for a short duration. To help resolve the issue of contractile function in volume overload hypertrophy, we examined ventricular function in a recently described model of severe chronic experimental mitral regurgitation. Left ventricular function was measured before and 3 mo after the creation of severe mitral regurgitation (averaged regurgitant fraction 0.64 +/- 0.04). At 3 mo end-diastolic volume had increased from 78 +/- 5 to 114 +/- 7 ml (P less than 0.01). Significant left ventricular hypertrophy had occurred with an increase in the left ventricular weight-to-body weight ratio from 3.84 +/- 0.2 to 5.22 +/- 0.2 (P less than 0.01). All indicators of left ventricular function (ejection fraction, the end ejection stress-volume relationship, this relationship corrected for eccentric hypertrophy, and mean velocity of circumferential fiber shortening at a common stress) were reduced at 3 mo. Our study produced 64% volume overload which was maintained for 3 mo at which time there was a 36% increase in left ventricular mass. This amount of volume overload of this duration produced significant left ventricular dysfunction.

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