Abnormalities of right ventricular long axis function after atrial repair of transposition of the great arteries

BACKGROUNDWhile volume derived global indices of right ventricle (RV) function are frequently abnormal after the Mustard procedure, the mechanism for these abnormalities is poorly understood. RV muscle fibres are predominantly arranged longitudinally and thus indices derived in the long axis may better describe RV function.METHODS20 survivors of the Mustard operation were studied (age 7.8–37.3 years, median 14.2 years). Long axis recordings from the apical four chamber view were obtained with the M mode cursor positioned through the lateral angle of the tricuspid valve annulus. M mode traces were recorded on paper and later digitised to derive total atrioventricular ring excursion, peak lengthening rate, and peak shortening rate. These data were averaged and compared with control data for the normal RV and left ventricle (LV).RESULTSRV total atrioventricular ring excursion was lower than that for the RV (p < 0.0001) or LV (p < 0.005) of controls. Peak lengthening rate was lower than the normal RV (p < 0.0001) and LV (p < 0.0001) rates. Furthermore, peak shortening rate was less than that of normal RV (p < 0.0001) and normal LV (p < 0.005) controls.CONCLUSIONSystemic RV long axis function is notably reduced compared with that of either the normal subpulmonary RV or the systemic LV. This presumably reflects the response of the predominantly longitudinally arranged myocardial fibres to increased afterload. However, such measurements may provide a more sensitive marker for progressive changes in global function during long term follow up.

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P1517 Prognostic value of echocardiographic parameters for RV function in long term follow up of patients presenting with ST elevation myocardial infarction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.941 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Guzu ◽

D Zamfir ◽

S Onciul ◽

A Pascal ◽

A Scarlatescu ◽

...

Keyword(s):

Myocardial Infarction ◽

Prognostic Value ◽

Free Wall ◽

Long Term Follow Up ◽

Echocardiographic Parameters ◽

St Elevation ◽

Rv Function ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Funding Acknowledgements : This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by theERDF Background The prognostic value of right ventricular (RV) function assessed by echocardiography in patients with acute ST elevation myocardial infarction ( STEMI ) treated by primary percutaneous coronary intervention (PCI) remains controversial, especially in terms of long term follow up . AIMS To evaluate the relation between RV function assessed by various echocardiographic parameters in patients presenting with STEMI and the occurrence of major cardiovascular adverse events (MACE) whithin a long period of follow-up. Methods We have prospectively analyzed a cohort of 37 patients (mean age: 62.49+/- 1.67 years, 28 males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary diseases were excluded. All patients underwent serial conventional 2D echocardiography, tissue Doppler imaging ( TDI ), speckle tracking echocardiography (STE) and 3D echocardiography at 24 hours after the acute event, at discharge, at 6 month, 1 year and 4 years of follow up. We measured in each patient the following RV functional parameters : tricuspid annular plane systolic excursion (TAPSE) , RV free wall systolic velocity (St ) assessed by TDI , RV free wall strain (RVFWS) and RV global longitudinal strain (RVGLS), RV myocardial performance index assessed by pulsed wave Doppler (RV MPI -PW) and right ventricular ejection fraction (RVEF). The mean follow up duration was 36 +/-4 months . The combined end-point of MACE was defined as all cause mortality, recurrent myocardial infarction, need for repeat revascularization or stroke. Results During the follow-up period 8 patients ( 18.9 % ) reached the combined end-point . In the analyzed group we observed that of all the studied parameters that reflect RV function, only RV MPI –PW and St at discharge were predictors of worse outcomes independent of LVEF or the culprit coronary artery. RV MPI was predictive at a cut-off value greater than 0,56 with a sensitivity of 66,6% and a specificity of 85,7 % ( 95% CI 0.51 to 0.67, p = 0.017, AUC= 0.71), respectively St at a cut -off value lower than 0,13 m/s with a sensitivity of 92 % and a specificity of 41 % ( 95% CI 0.12 to 0.16 p = 0.012, AUC = 0.64 ). Conclusions In STEMI patients treated by primary PCI, RV global function and RV regional systolic function evaluated at discharge provide prognostic information for long term MACE, independendent of infarct size or location. Our results need to be confirmed in larger cohorts of patients.

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Long-term follow-up and sex differences in adults operated for tetralogy of Fallot

Open Heart ◽

10.1136/openhrt-2021-001738 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001738

Author(s):

Alessia Quattrone ◽

Oyvind H Lie ◽

Eirik Nestaas ◽

Charlotte de Lange ◽

Kirsti Try ◽

...

Keyword(s):

Sex Differences ◽

Tetralogy Of Fallot ◽

Heart Function ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Long Term Follow Up ◽

Qrs Duration ◽

Rv Function

ObjectiveAdults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up.MethodsWe included TOF-operated patients≥18 years from our centre’s registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator.ResultsWe included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, −15.8±3.1% vs −18.8±3.2%, p=0.001) and right ventricular (RV) GLS (−15.8±3.9% vs −19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (−18.1±4.0 ms vs −16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06).ConclusionsOur results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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