Abstract 307: Poor Right Ventricular Systolic Function (lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and all Cause Mortality in Elderly Patients with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Gunjan Choudhary ◽  
Umashankar Lakshmanadoss ◽  
Hari Prasad ◽  
Zaruhi Babayan ◽  
Dwight Stapleton
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Elderly Patients ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
All Cause Mortality ◽  
Early Readmission ◽  
Rv Function

Background: Heart failure(HF) related early readmission (<30days) and mortality is higher in elderly patients. Right ventricular (RV) dysfunction is associated with worse prognosis in patients with HF with reduced ejection fraction (HFrEF). We evaluated effect of RV function (as measured by TAPSE - Tricuspid annular plane systolic excursion) and Pulmonary artery systolic pressure (PASP) on early HF readmission and mortality in elderly HF patients. Methods: This is single center observational study of elderly (≥65 years )patients with HFrEF. Patients with principal discharge diagnosis of HFrEF are included (n = 278, age 77 ± 9 years, 38% female, LVEF 29% ± 9%). Demographic and echocardiographic data are collected. TAPSE (as a marker of RV systolic dysfunction) and PASP are measured as per ASE guidelines. Prediction models are performed. Results: Among 278 patients, 62 patients ( 22.3%) had HF related early readmission and 123 patients (44%) died at the end of 5 year. On univariate analysis, older age, Hypertension, Diabetes, higher PASP , RV systolic dysfunction (TAPSE <16mm) and BMI< 25 are predictors of early readmission and mortality (P value <0.05). On multivariate logistic regression analysis, early HF readmission was predicted by TAPSE <16 mm (OR=23.6; p < 0.001; CI 10.23-54.60) and PASP >50 mmHg ( OR = 34; p < 0.001; 95 CI 14.08-82.81); five year all cause mortality was predicted by TAPSE < 16mm (OR = 1.85; p 0.023; 95 CI 1.08-3.16) and PASP >50 mmHg (OR = 2.11; p 0.009; 95 CI 1.19-3.72). Conclusion: TAPSE <16 mm and PASP >50 mmHg are strong predictors of early readmission and five year all cause mortality in elderly HF patients. The assessment of RV function through TAPSE and PASP, helps to risk-stratify elderly patients with HFrEF.

scholarly journals Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Aura Vijiiac ◽  
Sebastian Onciul ◽  
Silvia Deaconu ◽  
Radu Vatasescu ◽  
Claudia Guzu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Three Dimensional ◽  
Severe Heart Failure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Characteristic Analysis

Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.

P5581In patients with aortic valve regurgitation, left ventricular geometry and strain, more than pulmonary artery systolic pressure, affect right ventricular function

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Abdelgawad ◽  
M A Abdelhay ◽  
S Ashour ◽  
M Shehata ◽  
M Previato ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Sphericity Index ◽  
End Systolic Volume ◽  
Rv Function

Abstract Background Left ventricular (LV) overload due to aortic valve (AR) regurgitation may affect right ventricular (RV) function. Elevation of pulmonary artery pressures secondary to isolated AR is not common. Thus, the effects of chronic LV overload due to AR on RV function remains to be clarified. Purpose To assess the determinants of RV dysfunction in chronic AR. Methods We studied 36 patients with moderate or severe AR (53±18 years, 81% were men). We used 3D echocardiography to acquire multi-beat, full-volume data sets of LV and RV and to measure volumes and EF. RV fractional area change (FAC) was calculated. LV global longitudinal strain (GLS) and RV peak longitudinal strain (RVLS) were assessed by 2D speckle tracking echocardiography. Results RV EF and RV FAC were 40±6% and 34±9%. LV GLS and peak RVLS were reduced (Table). LV EDVi showed negative correlations with RV function (RV EF: r=−0.545, p<0.001; RV FAC: r=−0.816, p<0.001). LV sphericity index showed negative correlations with RV function (RVFAC: r=−0.608, P=0.001; RV EF: r=−0.469, P=0.004). Moreover, LV GLS and RVLS correlated positively with RV function (FAC: for GLS: r=0.475, p=0.003 and for RVLS: r=0.389, p=0.019) (RV EF: for GLS: r=0.526, p=0.001 and for RVLS: r=0.475, p=0.003). On multivariable linear regression analysis, LV EDVi, LV sphericity index, LV GLS and peak RVLS were found to be the only independent predictors of RV EF and FAC. Left and right ventricular volumes and function in patients with chronic aortic regurgitation AR (n=36) Control (n=25) p value LV end-diastolic volume (ml/m2) 106±36 56±8 <0.001 LV end-systolic volume (ml/m2) 50±28 22±4 <0.001 LV ejection fraction (%) 54±10 60±4 <0.001 LV sphericity index 0.53±0.11 0.38±0.08 <0.001 Pulmonary artery systolic pressure (mm Hg) 27±8 RV end-diastolic volume (ml/m2) 59±12 35±7 <0.001 RV end-systolic volume (ml/m2) 31±9 17±3 <0.001 RV ejection fraction (%) 40±6 50±4 <0.001 RV fractional area change (%) 34±9 44±6 <0.001 LV GLS (%) −18±3 21±1 <0.001 Peak RVLS (%) −26±5 −31±3 <0.001 Conclusions RV remodeling in chronic LV overload due to AR occurs independent on PASP values. LV size, shape and strain are the only independent predictors of RV function.

Abstract 3143: Reverse Hemodynamic Remodelling May Be Possible Over Time

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lynne W Stevenson ◽  
Yong K Cho ◽  
J. T Heywood ◽  
Robert C Bourge ◽  
William T Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Nyha Class ◽  
Systolic Pressure ◽  
Filling Pressure ◽  
Class Iii ◽  
One Year ◽  
Over Time

Introduction : Elevated filling pressures are a hallmark of chronic heart failure. They can be reduced acutely during HF hospitalization but the hemodynamic impact of ongoing therapy to maintain optivolemia has not been established. Methods and Results : After recent HF hospitalization, 274 NYHA Class III or IV HF patients were enrolled in the COMPASS-HF study at 28 experienced HF centers and received intense HF management (average 24.7 staff contacts/ 6 months) ± access to filling pressure information to adjust diuretics to maintain optivolemia, usually defined as estimated pulmonary artery diastolic (PAD) pressure of 12±4 mmHg. Filling pressure information was available for half the patients during the first 6 months (the Chronicle group, <Access), and for all patients during the next 6 months. Diuretics were adjusted 12.7 times per patient in the Chronicle group and 8.2 times per patient in the Control (-Access) group during the first 6 months (p = 0.0001). Compared to baseline, decreases in RV systolic pressure (RVSP) and ePAD were significant for the +Access patients by one year (p=0.0012 and p =.04, respectively). The Control patients exhibited a similar trend 6 months after crossing to +Access (figure ). Conclusions: Targeted therapeutic adjustments, based on continuous filling pressures along with intensification of HF management contacts, are associated with a reduction in chronic left-sided filling pressures and right ventricular load.

scholarly journals Immediate impact of percutaneous transvenous mitral commissurotomy on right ventricular function

2017 ◽  
Vol 14 (2) ◽  
pp. 19-24
Author(s):  
Bishal KC ◽  
Rabi Malla ◽  
Ram Kishore Shah ◽  
Anish Hirachan ◽  
Binay Kumar Rauniyar ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Clinical Symptoms ◽  
Longitudinal Velocity ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Tei Index ◽  
Long Term Outcome ◽  
Rv Function

Background and Aims: Abnormal Right Ventricular (RV) function affects the long term outcome and clinical symptoms in patients with mitral stenosis (MS). This study evaluates the immediate effect of Percutaneous Transmitral Commisurotomy (PTMC) on RV function.Methods: An observational, cross sectional study was done on 50 patients with rheumatic MS who underwent PTMC at Shahid Gangalal National Heart Center from Dec 2015 –Dec 2016. All underwent clinical evaluation and echocardiogram before and immediately after PTMC.Results: There was female preponderance with 66% being female. The mean age was 37.26 ± 10.63 years. There was immediate increase in the mitral valve area (MVA) from 0.87 ± 0.12cm2 to 1.54 ± 0.27cm2(p< 0.001). There was significant decrease in mean mitral diastolic gradient from 16.4 ± 8.8mmHg to 5 ± 1.5mmHg (p< 0.001), in the pulmonary artery systolic pressure 53.6 ± 21.83mmHg to 39.5 ± 14.67mmHg (p< 0.001), in the RV Tei index from 0.56 ± 0.08 to 0.40 ± 0.08 (p< 0.001). There was significant increase in TAPSE from 16.0 ± 1.50 to 18.6 ± 1.70 mm, (p<0.001) and the longitudinal velocity of excursion of the RV at the tricuspid annulus (RV S’) from 13.69 ± 3.33 cm/sec to 15.31 ± 3.07 cm/sec (p< 0.001)Conclusions: Successful PTMC can improve RV function as shown by the improvement in PASP, RV Tei index, TAPSE and RV S’. Further larger population studies are required to confirm the findings. Long term studies are important to determine the prognostic significance of improvement in RV function.Nepalese Heart Journal 2017; 14(2): 19-24

scholarly journals Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

2020 ◽  
Vol 25 (1) ◽  
pp. 39-45
Author(s):  
Z. D. Kobalava ◽  
O. I. Lukina ◽  
I. Meray ◽  
S. V. Villevalde
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Systolic Pressure ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Arterial Elastance ◽  
Increased Risk ◽  
All Cause Mortality

Aim. To assess ventricular-arterial coupling (VAC) parameters and their prognostic value in patients with decompensated heart failure (HF).Material and methods. VAC parameters were evaluated upon admission using two-dimensional echocardiography in 355 patients hospitalized with decompensated HF. VAC was expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees). The optimal VAC range was considered 0,6-1,2. Parameters of left ventricular (LV) efficacy were calculated using the appropriate formulas. Differences were considered significant at p<0,05.Results. The median values of Ea, Ees and VAC were 2,2 (1,7;2,9) mmHg/ml, 1,8 (1,0;3,0) mmHg/ml and 1,32 (0,75;2,21) respectively. In 63% of patients, VAC disorders were detected: 55% of patients had VAC >1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC <0,6 (all patients with HF with preserved ejection fraction (HFpEF)). Normal VAC was observed in 78%, 42%, and 1% of patients with HFpEF, HF with mid-range EF and HFrEF, respectively. There was significant correlation between Ea/Ees ratio and levels of NTproBNP (R=0,35), hematocrit (R=-0,29), hemoglobin (R=-0,26), pulmonary artery systolic pressure (PAPs) (R=0,18), dimensions of left atrium (R=0,32) and right ventricle (RV) (R=0,32). After 6 months, rehospitalization with decompensated HF was recorded in 72 (20,3%) patients, 42 (11,8%) patients died. Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg increased the risk of rehospitalization with decompensated HF and all-cause mortality 2,5 and 3,7 times, respectively.Conclusion. Impaired VAC was diagnosed in 63% of patients with decompensated HF. However, the increased risk of all-cause mortality and rehospitalization with decompensated HF over the 6 months was associated with Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg.

scholarly journals Prognostic Role of Subclinical Congestion in Heart Failure Outpatients: Focus on Right Ventricular Dysfunction

2021 ◽  
Vol 10 (22) ◽  
pp. 5423
Author(s):  
Andrea Lorenzo Vecchi ◽  
Silvia Muccioli ◽  
Jacopo Marazzato ◽  
Antonella Mancinelli ◽  
Attilio Iacovoni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Systolic Pressure ◽  
Right Ventricular Dysfunction ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
Prognostic Impact ◽  
Phone Calls ◽  
The Right

Background: subclinical pulmonary and peripheral congestion is an emerging concept in heart failure, correlated with a worse prognosis. Very few studies have evaluated its prognostic impact in an outpatient setting and its relationship with right-ventricular dysfunction. The study aims to investigate subclinical congestion in chronic heart failure outpatients, exploring the close relationship between the right heart-pulmonary unit and peripheral congestion. Materials and methods: in this observational study, 104 chronic HF outpatients were enrolled. The degree of congestion and signs of elevated filling pressures of the right ventricle were evaluated by physical examination and a transthoracic ultrasound to define multiparametric right ventricular dysfunction, estimate the right atrial pressure and the pulmonary artery systolic pressure. Outcome data were obtained by scheduled visits and phone calls. Results: ultrasound signs of congestion were found in 26% of patients and, among this cohort, half of them presented as subclinical, affecting their prognosis, revealing a linear correlation between right ventricular/arterial coupling, the right-chambers size and ultrasound congestion. Right ventricular dysfunction, TAPSE/PAPS ratio, clinical and ultrasound signs of congestion have been confirmed to be useful predictors of outcome. Conclusions: subclinical congestion is widespread in the heart failure outpatient population, significantly affecting prognosis, especially when right ventricular dysfunction also occurs, suggesting a strict correlation between the heart-pulmonary unit and volume overload.

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