Abstract 13594: Adverse Right Ventricular Remodelling, Function and Stress Responses in Obesity: Implications for Severe Acute Respiratory Illness

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andrew J Lewis ◽  
William Watson ◽  
Hani Mahmoud-Elsayed ◽  
William Moody ◽  
Ayisha M Khan-Kheil ◽  
...  
Keyword(s):  
Weight Loss ◽  
Right Ventricular ◽  
Stress Responses ◽  
Systolic Function ◽  
Respiratory Illness ◽  
Dobutamine Stress ◽  
Adverse Outcomes ◽  
Diastolic Filling ◽  
Class Iii ◽  
And Function

Introduction: The mechanisms linking obesity to increased mortality in patients with coronavirus-disease 2019 (COVID-19) are unclear. Hypothesis: We hypothesised that obesity would be associated with adverse right ventricular (RV) remodelling and function which might be further exacerbated by COVID-19 associated increases in RV afterload/demand. Methods: We used echocardiography and computed tomography to establish links between RV dimensions and function and bodyweight in patients with severe COVID-19. In obese and non-obese participants without COVID-19, we used cardiovascular magnetic resonance to define the effects of obesity upon RV volumes, energetics, systolic function and stress reserve. Results: In patients with severe COVID-19, increasing bodyweight was associated with disproportionate RV dilatation (n=26, echocardiography, R=0.42, P=0.03, CT n=34, R=0.23, P=0.004) and impairment of RV systolic function (fractional area change (FAC) R=-0.45, P=0.04); obesity (BMI >30kg/m2) was associated with a 32% reduction in RV FAC (P=0.03). Similar associations were seen in a validation cohort (n=91, all P<0.05). In participants without COVID-19, class III obesity (n=54, BMI 47±4 kg/m 2 ) was associated with RV remodelling, impaired cardiac energetics (PCr/ATP ratio 23% lower, P<0.001) and reduction in RV systolic function at rest (by 3±1%, P=0.01), which was related to reduced energetics (R=0.3, P=0.04). Participants with class I-II obesity (BMI 35±5 kg/m 2 , n=27) had impaired RV diastolic filling rate at rest (P<0.001) and blunted RV dobutamine stress systolic response (by 68%, P=0.03) and diastolic response (by 78%, P=0.008). Surgical weight loss in patients obesity (n=37, 34±15kg weight loss) was associated with improvement in RV volume (12±26 ml lower, P=0.006) and function (ejection fraction 2±5% higher, P=0.03). Conclusions: Increasing body weight is associated with both significant alterations in RV volumes, systolic function and stress responses which are mitigated with weight loss and also with disproportionate RV dilatation and dysfunction in severe COVID-19. RV dysfunction is a modifiable mechanism which might link obesity to adverse outcomes in patients with COVID-19 and other disorders stressing the right heart.

scholarly journals Adverse right ventricular remodelling, function, and stress responses in obesity: insights from cardiovascular magnetic resonance

2021 ◽  
Author(s):  
Andrew J M Lewis ◽  
Ines Abdesselam ◽  
Jennifer J Rayner ◽  
James Byrne ◽  
Barry A Borlaug ◽  
...  
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Cardiovascular Magnetic Resonance ◽  
Stress Responses ◽  
Severe Obesity ◽  
Systolic Function ◽  
Healthy Weight ◽  
Class Iii ◽  
End Diastolic Volume ◽  
Class Iii Obesity

Abstract Aims We aimed to determine the effect of increasing body weight upon right ventricular (RV) volumes, energetics, systolic function, and stress responses using cardiovascular magnetic resonance (CMR). Methods and results We first determined the effects of World Health Organization class III obesity [body mass index (BMI) &gt; 40 kg/m2, n = 54] vs. healthy weight (BMI &lt; 25 kg/m2, n = 49) upon RV volumes, energetics and systolic function using CMR. In less severe obesity (BMI 35 ± 5 kg/m2, n = 18) and healthy weight controls (BMI 21 ± 1 kg/m2, n = 9), we next performed CMR before and during dobutamine to evaluate RV stress response. A subgroup undergoing bariatric surgery (n = 37) were rescanned at median 1 year to determine the effects of weight loss. When compared with healthy weight, class III obesity was associated with adverse RV remodelling (17% RV end-diastolic volume increase, P &lt; 0.0001), impaired cardiac energetics (19% phosphocreatine to adenosine triphosphate ratio reduction, P &lt; 0.001), and reduction in RV ejection fraction (by 3%, P = 0.01), which was related to impaired energetics (R = 0.3, P = 0.04). Participants with less severe obesity had impaired RV diastolic filling at rest and blunted RV systolic and diastolic responses to dobutamine compared with healthy weight. Surgical weight loss (34 ± 15 kg weight loss) was associated with improvement in RV end-diastolic volume (by 8%, P = 0.006) and systolic function (by 2%, P = 0.03). Conclusion Increasing body weight is associated with significant alterations in RV volumes, energetic, systolic function, and stress responses. Adverse RV modelling is mitigated with weight loss. Randomized trials are needed to determine whether intentional weight loss improves symptoms and outcomes in patients with obesity and heart failure.

scholarly journals Subtle Right Ventricular Affection in Patients with Acute Myocardial Infarction, Echocardiographic Assessment

2020 ◽  
Vol 8 (B) ◽  
pp. 1212-1218
Author(s):  
Abdallah Mohamed ◽  
Shaaban Alramlawy ◽  
Samir El-Hadidy ◽  
Mohamed Ibrahiem Affify ◽  
Waheed Radwan
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Significant Relationship ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
The Right ◽  
And Function

BACKGROUND: The right ventricle (RV) has historically received less attention than its counterpart of the left side of the heart, yet there is a substantial body of evidence showing that RV size and function are perhaps equally important in predicting adverse outcomes in cardiovascular diseases. AIM: The aim of our work was to evaluate incidence and impact of right ventricular (RV) affection in patients with acute left ventricular myocardial infarction subjected to primary percutaneous coronary intervention (1ry PCI). METHODS: The study was conducted on 80 patients who had acute left ventricle ST elevated myocardial infarction (LV STEMI) and subjected to 1ry PCI. The study was done in Cairo University, critical care department. All patients were studied within 2 days after 1ry PCI, RV function was assessed by echocardiography through tricuspid annular plane systolic excursion (TAPSE) and speckle tracking echocardiography. We excluded patients with RV infarction, moderate to severe tricuspid regurgitation, pulmonary hypertension, dilated cardiomyopathy, atrial or ventricular septal defect, and patients who had cardiac dysrhythmias. RESULTS: Out of 80 patients (64 men and 16 women) included in the study, 38 patients (47.5%) had TAPSE <1.7 cm, and 48 patients (60%) had RV longitudinal strain less negative than −19%.There was a statistically significant relationship between RV affection and anterior STEMI, left anterior descending artery as an infarct-related artery, duration of intensive care unit stay, impairment of LV global and regional systolic function, in-hospital complications, and 1-year mortality. CONCLUSION: RV dysfunction is not uncommon in acute LV STEMI when using the definition of TAPSE <17 cm and RV longitudinal strain less negative than −19%.There was a significant relationship between RV dysfunction and poor outcome in patients with acute LV STEMI.

scholarly journals Genome-wide identification and analysis of class III peroxidases in Betula pendula

BMC Genomics ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kewei Cai ◽  
Huixin Liu ◽  
Song Chen ◽  
Yi Liu ◽  
Xiyang Zhao ◽  
...  
Keyword(s):  
Stress Responses ◽  
Betula Pendula ◽  
Expression Patterns ◽  
Class Iii ◽  
Physiological Processes ◽  
Plant Life ◽  
Genome Wide ◽  
Plant Life Cycle ◽  
Class Iii Peroxidases ◽  
And Function

Abstract Background Class III peroxidases (POD) proteins are widely present in the plant kingdom that are involved in a broad range of physiological processes including stress responses and lignin polymerization throughout the plant life cycle. At present, POD genes have been studied in Arabidopsis, rice, poplar, maize and Chinese pear, but there are no reports on the identification and function of POD gene family in Betula pendula. Results We identified 90 nonredundant POD genes in Betula pendula. (designated BpPODs). According to phylogenetic relationships, these POD genes were classified into 12 groups. The BpPODs are distributed in different numbers on the 14 chromosomes, and some BpPODs were located sequentially in tandem on chromosomes. In addition, we analyzed the conserved domains of BpPOD proteins and found that they contain highly conserved motifs. We also investigated their expression patterns in different tissues, the results showed that some BpPODs might play an important role in xylem, leaf, root and flower. Furthermore, under low temperature conditions, some BpPODs showed different expression patterns at different times. Conclusions The research on the structure and function of the POD genes in Betula pendula plays a very important role in understanding the growth and development process and the molecular mechanism of stress resistance. These results lay the theoretical foundation for the genetic improvement of Betula pendula.

scholarly journals Dobutamine stress for evaluation of right ventricular reserve in pulmonary arterial hypertension

2014 ◽  
Vol 45 (3) ◽  
pp. 700-708 ◽  
Author(s):  
Tripura Sharma ◽  
Edmund M.T. Lau ◽  
Preeti Choudhary ◽  
Paul J. Torzillo ◽  
Phillip A. Munoz ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Systolic Function ◽  
Cardiopulmonary Exercise Testing ◽  
Dobutamine Stress ◽  
Contractile Reserve ◽  
Pulmonary Arterial

Right ventricular contractile response to pharmacological stress in pulmonary arterial hypertension (PAH) has not been characterised. We evaluated right ventricular contractile reserve in adults with PAH using dobutamine stress echocardiography.16 PAH patients and 18 age-matched controls underwent low-dose dobutamine stress echocardiography. Contractile reserve was assessed by the change (Δ; peak stress minus rest value) in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S′). A subgroup of 13 PAH patients underwent treadmill cardiopulmonary exercise testing for peak oxygen uptake (V′O2peak).At rest, TAPSE and S′ were reduced in the PAH group compared with controls (1.7±0.4 versus 2.4±0.2 cm and 9.7±2.6 versus 12.5±1.2 cm·s−1, respectively; p<0.05). Contractile reserve was markedly attenuated in PAH compared to controls (ΔTAPSE 0.1±0.2 versus 0.6±0.3 cm and ΔS′ 4.6±2.8 versus 11.2±3.6 cm·s−1; p<0.0001). In the sub-group of PAH patients with preserved right ventricular systolic function at rest, contractile reserve remained depressed compared to controls. V′O2peak was significantly correlated with ΔS′ (r=0.87, p=0.0003) and change in stroke volume (r=0.59, p=0.03).Dobutamine stress can reveal sub-clinical reduction in right ventricular contractile reserve in patients with PAH. A correlation with exercise capacity suggests potential clinical value beyond resting measurements.

scholarly journals Factors associated with right ventricular dilatation in coronary artery disease patients with prior Q-wave myocardial infarction

2015 ◽  
Vol 18 (1) ◽  
pp. 37
Author(s):  
V. A. Kuznetsov ◽  
Ye. I. Yaroslavskaya ◽  
G. S. Pushkarev ◽  
Ye. A. Gorbatenko
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Left Ventricular ◽  
Functional Class ◽  
Class Iii ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Factors Associated ◽  
Q Wave

Factors associated with right ventricular (RV) dilatation in patients with prior Q-wave myocardial infarction (MI) have been determined. Out of 16839 patients from Register of performed coronary angiography we selected those with prior Q-wave MI who had no congenital heart disease: 1263 patients without RV dilatation and 99 patients with RV dilatation. There were more males in the group with RV dilatation (97.0 vs 89.6%, p = 0.018). Mean body mass index (BMI) was higher in this group (31.05.1 vs 29.44.6 kg/m <sup>2</sup>, p = 0.003). Patients with RV dilatation more often had a higher New-York Heart Association (NYHA) functional class (III/IV - 50.5 vs 17.4%) and arrhythmias (45.5 vs 17.8%, both p<0.001). Mean left ventricular (LV) mass index determined by echocardiography was higher in patients with RV dilatation (168.444.5 vs 136.031.0 g/m <sup>2</sup>). This group often demonstrated a reduced LV systolic function (71.7 vs 32.9%) and significant mitral regurgitation (52.5 vs 12.4%, all p<0.001). There were less frequent lesions of the diagonal branch of the left circumflex artery in patients with dilated RV (5.1 vs 12.1%, p = 0.035). According to our mulrivariate analysis, RV dilatation was predominantly associated with male gender, increased BMI and parameters describing the severity of LV dysfunction and remodeling.

Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss

1995 ◽  
Vol 76 (16) ◽  
pp. 1194-1197 ◽  
Author(s):  
Martin A. Alpert ◽  
Charles R. Lambert ◽  
Hercules Panayiotou ◽  
Boyd E. Terry ◽  
Michael V. Cohen ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Weight Loss ◽  
Left Ventricular Mass ◽  
Systolic Function ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Ventricular Mass

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

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