Copeptin reliably reflects longitudinal right ventricular function

2021 ◽  
pp. 000456322198936
Author(s):  
Melissa Harbrücker ◽  
Michèle Natale ◽  
Seung-Hyun Kim ◽  
Julian Müller ◽  
Uzair Ansari ◽  
...  
Keyword(s):  
Regression Model ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Heart Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
The Novel ◽  
Right Heart ◽  
Right Heart Function

Background Data is limited evaluating novel biomarkers in right ventricular dysfunction. Normal right heart function improves the prognosis of patients with heart failure. Therefore, this study investigates the association between the novel biomarker copeptin and right heart function compared to NT-proBNP. Methods Patients undergoing routine echocardiography were enrolled prospectively. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE) and further right ventricular and atrial parameters. Exclusion criteria were age under 18 years, left ventricular ejection fraction < 50% and moderate to severe valvular heart disease. Blood samples were taken for biomarker measurements within 72 h of echocardiography. Results Ninety-one patients were included. Median values of copeptin increased significantly according to decreasing values of TAPSE ( P = 0.001; right heart function grade I: tricuspid annular plane systolic excursion; TAPSE > 24 mm: 5.20 pmol/L; grade II: TAPSE 18–24 mm: 8.10 pmol/L; grade III: TAPSE < 18 mm: 26.50 pmol/L). Copeptin concentrations were able to discriminate patients with decreased right heart function defined as TAPSE < 18 mm (area under the curves [AUC]: copeptin: 0.793; P = 0.001; NT-proBNP: 0.805; P = 0.0001). Within a multivariable linear regression model, copeptin was independently associated with TAPSE (copeptin: T: –4.43; P = 0.0001; NT-proBNP: T: –1.21; P = 0.23). Finally, copeptin concentrations were significantly associated with severely reduced right heart function (TAPSE < 18 mm) within a multivariate logistic regression model (copeptin: odds ratio: 0.94; 95% confidence interval: 0.911–0.975; P = 0.001). Conclusions This study demonstrates that the novel biomarker copeptin reflects longitudinal right heart function assessed by standardized transthoracic echocardiography compared with NT-proBNP.

Abstract 12422: Scoping Review of Early Transthoracic Echocardiography for Diagnosis and Prognosis After Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Linda Liu ◽  
Aris Karatasakis ◽  
Peter J Kudenchuk ◽  
james kirkpatrick ◽  
Michael R Sayre ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Diagnostic Accuracy ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Scoping Review ◽  
Right Ventricular Function ◽  
Transthoracic Echocardiography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Neurologic Outcomes

Introduction: Transthoracic echocardiography (TTE) is commonly performed early after resuscitation from cardiac arrest (CA). The ability of early TTE to differentiate cardiac from non-cardiac causes of CA or to inform patient outcomes has not been systematically reviewed. Methods: We reviewed MEDLINE, EMBASE, and CENTRAL databases from inception to December 2020 for studies that assessed adult recipients of TTE after resuscitation from non-traumatic CA. Studies were included if TTE was obtained early (<72 hours) after spontaneous return of circulation and reported either 1) their diagnostic accuracy for causes of the CA or 2) survival and neurologic outcomes. Diagnostic endpoints also included regional wall motion abnormalities (RWMA) to ascertain possible acute myocardial infarction (AMI) as the etiology of CA. Prognostic endpoints included TTE parameters and their association with survival to hospital discharge and neurologic outcomes. Results: Of 2518 articles screened, 12 (0.5%) studies met inclusion criteria, representing 1570 unique patients. Meta-analysis was not possible due to missing data and study heterogeneity. Five studies were included in diagnosis review and nine in the prognosis review. No studies reported the diagnostic accuracy of TTE for AMI, although in 3 of 5 studies RWMA were associated with AMI in 53-83% of patients. Reduced left ventricular ejection fraction was reported in 8 studies but was not associated with survival (Figure) or neurologic outcomes (n=4). Only high mitral inflow E/e’ ratio (n=1) and decreased right ventricular function (RVD; n=2) were associated with worse survival. Conclusion: This scoping review highlights the limited available data on the utility of early TTE after CA. Assessment of left and right ventricular function and other parameters by TTE is feasible, but further research is necessary to determine their diagnostic and prognostic value after CA.

Right ventricular function

2020 ◽  
pp. 119-132
Author(s):  
Michelle S. Chew
Keyword(s):  
Ventricular Function ◽  
Heart Function ◽  
Left Ventricular ◽  
Function Estimation ◽  
Right Heart ◽  
Right Heart Function ◽  
Disease States ◽  
Echocardiographic Examination ◽  
Systolic And Diastolic Function ◽  
The Right

The right ventricle (RV) has historically been given less importance than the left. There are important anatomical differences, including several intracardiac structures that may complicate echocardiographic assessments. The right heart is sensitive to changes in pressure and its function is affected by common interventions in critical care such as fluid loading and positive pressure ventilation. Right and left ventricular functions are inextricably linked, and both systolic and diastolic ventricular interdependence occur. The echocardiographic examination of the RV includes an assessment of size and dimensions, systolic and diastolic function, estimation of intracardiac and pulmonary pressures. These should be interpreted in the context of the clinical interventions that the patient was subjected to at the time of imaging, as well as left ventricular function. RV failure is associated with poorer outcomes in several disease states including congestive cardiac failure and acute myocardial infarction. In critically ill patients, acute respiratory distress syndrome (ARDS) has significant implications for right heart function, where there is a necessary balance between respiratory mechanics and haemodynamics.

The role of right ventricular function in paediatric idiopathic dilated cardiomyopathy

2012 ◽  
Vol 23 (3) ◽  
pp. 409-415 ◽  
Author(s):  
Abraham Groner ◽  
Jen Yau ◽  
Irene D. Lytrivi ◽  
H. Helen Ko ◽  
James C. Nielsen ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
P Value

AbstractIntroductionThe prevalence of right ventricular dysfunction in idiopathic dilated cardiomyopathy is incompletely studied in children. Furthermore, right ventricular function may signal worse outcomes. We evaluated recently published right ventricular function echocardiographic indices in identifying dysfunction in children with idiopathic dilated cardiomyopathy and the impact of right ventricular dysfunction on long-term prognosis.MethodsA retrospective database review of right ventricular function indices in 30 patients with idiopathic dilated cardiomyopathy was compared with 60 age- and sex-matched controls from January, 2001 until December, 2010. Right ventricular function was assessed by Doppler tissue peak systolic S′, early and late diastolic E′ and A′ waves and isovolumic acceleration at the tricuspid valve annulus; pulsed wave Doppler tricuspid valve inflow E and A waves; right ventricular myocardial performance index; tricuspid annular plane systolic excursion; right ventricular fractional area change.ResultsRight ventricular systolic and diastolic function in idiopathic dilated cardiomyopathy was significantly impaired. All measured indices except for isovolumic acceleration and fractional area change were significantly reduced, with a p-value less than 0.05. There was no right ventricular index predictive of death or transplantation. Patients with poor outcome were significantly more likely to need inotropic support (p-value equal to 0.018), be placed on a ventricular assist device (p equal to 0.005), and have a worse left ventricular ejection fraction z-score (p-value equal to 0.002).ConclusionRight ventricular dysfunction is under-recognised in children presenting with idiopathic dilated cardiomyopathy. The need for clinical circulatory support and left ventricular ejection fraction z-score less than minus 8 were primary determinants of outcome, independent of the degree of derangement in right ventricular function.

Clinical Evaluation Gf Right Ventricular Function in Patients with Left Ventricular Assist Device (Lvad)

1992 ◽  
Vol 15 (2) ◽  
pp. 109-113 ◽  
Author(s):  
G.B.W.E. Bennink ◽  
H. Noda ◽  
J.M. Duncan ◽  
O.H. Frazier
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Heart Function ◽  
Venous Pressure ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Stroke Work ◽  
Bridge To Transplant

Right ventricular function (RVF) during LVAD support can be a threat for patient survival. Despite extensive research, RVF and its interference with left heart function is unclear. This study examines RVF in a retrospective analysis of 14 patients. Hemodynamic data were collected, including heart rate (HR), central venous pressure (CVP), mean pulmonary artery pressure (mPAP), total cardiac output (CO), calculated stroke volume index (SVI) and right ventricular stroke work index (RVSWI). In all patients, CO increased gradually throughout the study period; CVP showed no significant decrease; mPAP and PCWP decreased significantly over the time period; SVI improved and RVSWI increased from the starting level prior to implantation of the LVAD. We conclude that the CO improved with a lowering of the right ventricular afterload combined with a decrease in total circulating volume. The improvement of RVF with LV assist makes this device an option as a bridge to transplant.

scholarly journals Prognostic Value of Echocardiographic Right Ventricular Function Parameters in the Presence of Severe Tricuspid Regurgitation

2021 ◽  
Vol 10 (11) ◽  
pp. 2266
Author(s):  
Matthias Schneider ◽  
Varius Dannenberg ◽  
Andreas König ◽  
Welf Geller ◽  
Thomas Binder ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Tricuspid Regurgitation ◽  
Right Ventricular Function ◽  
Prognostic Value ◽  
Large Scale ◽  
Systolic Function ◽  
Left Ventricular ◽  
Severe Tricuspid Regurgitation ◽  
Vena Contracta

Background: Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF. Methods: A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested. Results: The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52–79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15–22) and median FAC was 42% (30–52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396–1.421, p = 0.38) and 0.845 (95%CI 0.383–1.867, p = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296–0.886, p = 0.017) and 1.631 (95%CI 1.101–2.416, p = 0.015), respectively. Conclusions: This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.

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