Right Ventricular Function in Left Heart Disease

Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance. Research suggests that PHTN may not be the most important determinant of RV dysfunction. Both RV dysfunction and PHTN have independent prognostic significance. This review explores the unique anatomic and functional features of the RV and the pathophysiologic and prognostic implications of RV dysfunction in patients with MV disease in the perioperative period.

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Increased Brain Natriuretic Peptide as a Marker for Right Ventricular Dysfunction in Acute Pulmonary Embolism

Thrombosis and Haemostasis ◽

10.1055/s-0037-1616050 ◽

2001 ◽

Vol 86 (11) ◽

pp. 1193-1196 ◽

Cited By ~ 107

Author(s):

Igor Tulevski ◽

Alexander Hirsch ◽

Bernd-Jan Sanson ◽

Hans Romkes ◽

Ernst van der Wall ◽

...

Keyword(s):

Pulmonary Embolism ◽

Brain Natriuretic Peptide ◽

Right Ventricular ◽

Natriuretic Peptide ◽

Acute Pulmonary Embolism ◽

Prognostic Significance ◽

Systolic Pressure ◽

Clinical Importance ◽

Acute Pe ◽

Rv Function

SummaryRight ventricular (RV) function is of major prognostic significance in patients with acute pulmonary embolism (PE). The aim of the present study was to evaluate the role of neurohormone plasma brain natriuretic peptide (BNP) in assessing RV function in patients with acute PE.BNP levels were measured in 16 consecutive patients with acute PE as diagnosed by high probability lung scintigraphy or pulmonary angiography. Twelve healthy age-matched volunteers served as controls. All 16 patients underwent standard echocardiography and blood tests during the first hour of presentation. In the patient group, survival was studied for a period of 30 days. Plasma BNP levels in patients with acute PE were higher than in controls (7.2 [95% CI 0.4 to 144.6] versus 1.4[95% CI 0.4 to 4.6] pmol/L, p = 0.0008). Plasma BNP was significantly higher in 5 patients with RV dysfunction compared to 11 patients with normal RV function (40.2 [95% CI 7.5 to 214.9] versus 3.3 [95% CI 0.4 to 24.9] pmol/L, p = 0.0003). RV systolic pressure was not significantly correlated with BNP (r = 0.42, p = ns).In conclusion, plasma BNP neurohormone levels might be of clinical importance as a supplementary tool for assessment of RV function in patients with acute PE.

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Vas deferens invasion: A neglected issue in the sampling of radical prostatectomy materials

Canadian Urological Association Journal ◽

10.5489/cuaj.1802 ◽

2014 ◽

Vol 8 (7-8) ◽

pp. 554 ◽

Cited By ~ 3

Author(s):

Nuri Yigit ◽

Yildirim Karslioglu ◽

Bulent Kurt

Keyword(s):

Lymph Node ◽

Radical Prostatectomy ◽

Lymph Node Metastasis ◽

Vas Deferens ◽

Prognostic Significance ◽

Seminal Vesicles ◽

Node Metastasis ◽

Increased Risk ◽

Staging Systems ◽

Independent Prognostic Significance

A radical prostatectomy affects the prostate, bilateral seminal vesicles (SV), and the distal parts of the bilateral vasa deferentia (VD). SV invasion (SVI) is associated with an increased risk of lymph node metastasis and recurrence. However, the significance of VD invasion (VDI), either with or without the involvement of their surgical margins, has not been fully appreciated. We think VDI might have an independent prognostic significance, as does SVI, and should be incorporated into the pathology guidelines and the staging systems of prostatic adenocarcinoma. Our case illustrates this.

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Immediate impact of percutaneous transvenous mitral commissurotomy on right ventricular function

Nepalese Heart Journal ◽

10.3126/njh.v14i2.18498 ◽

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

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Abstract 15125: Percutaneous Transluminal Pulmonary Angioplasty Improves Hemodynamics and Right Ventricular Function in Patients with Chronic Thromboembolic Pulmonary Hypertension -One Year Follow-up Study

Circulation ◽

10.1161/circ.130.suppl_2.15125 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Masanobu Miura ◽

Koichiro Sugimura ◽

Kotaro Nochioka ◽

Tatsuo Aoki ◽

Shunsuke Tatebe ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Right Ventricular Function ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Pulmonary Hemodynamics ◽

Before And After ◽

Thromboembolic Pulmonary Hypertension ◽

Percutaneous Transluminal ◽

Rv Function

Objectives: Right ventricular function (RV) is an important prognostic indicator of pulmonary hypertension. Recent studies have demonstrated that percutaneous transluminal pulmonary angioplasty (PTPA) improves pulmonary hemodynamics in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). In this study, we examined whether PTPA also improves right ventricular dysfunction in those patients. Methods: We performed a total of 252 PTPA procedures (median 4 procedures per patient) for 56 consecutive patients with inoperable CTEPH, after stabilizing their condition using conventional pulmonary vasodilators. Among them, we enrolled 33 patients who had finished 1-year follow-up after final PTPA in the present study (female 81.8%, median age 60 yrs.). RV function was evaluated by tricuspid annular plane systolic excursion (TAPSE) on echocardiogram (42.4%, n=14) and RV ejection fraction (RVEF) on cardiac magnetic resonance imaging (39.4%, n=13) before and after PTPA. Results: No patient died during the PTPA procedure or during the 1-year follow-up period. Comparisons before and after PTPA showed marked improvement of WHO functional class III/IV (75.7 to 0%, P<0.001), 6-min walking distance (316 to 480 m, P<0.001), and brain natriuretic peptide level (93 to 23 pg/ml, P<0.001) and significant hemodynamic improvements for mean pulmonary artery pressure (42.3±10.7 to 24.4±5.7mmHg, P<0.001), cardiac index (2.2±0.6 to 2.7±0.6 L/min•m2, P<0.001) and pulmonary vascular resistance (786±384 to 265±93 dyn•sec•cm5, P<0.001). Furthermore, RV function was also significantly improved for both TAPSE (18.0±4.0 to 23.4±4.3mm, P<0.001) and RVEF (37.9±11.0 to 52.4±7.1%, P<0.001) (Figure). Conclusions: PTPA improves not only pulmonary hemodynamics but also RV function in patients with inoperable CTEPH.

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Abstract 17332: Prognostic Impact of Right Ventricular Function and Tricuspid Regurgitation in Functional Mitral Regurgitation: A Meta-Analysis

Circulation ◽

10.1161/circ.142.suppl_3.17332 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tam N Ngo ◽

Vien T Truong ◽

Hoang T Phan ◽

Thuy T Pham ◽

Tam T Quach ◽

...

Keyword(s):

Mitral Regurgitation ◽

Right Ventricular ◽

Tricuspid Regurgitation ◽

Meta Analysis ◽

Systemic Review ◽

Functional Mitral Regurgitation ◽

Prognostic Impact ◽

Increased Risk ◽

Prognostic Importance ◽

Rv Function

Introduction: Right ventricular dysfunction and tricuspid regurgitation grade are associated with cardiovascular mortality in the general population, primary MR, and other cardiovascular diseases. Hypothesis: The objective of this study was to investigate the prognostic importance of RVD, and TR in patients with functional mitral regurgitation (FMR) Methods: A systemic review and meta-analysis were performed using MEDLINE, Scopus, and Embase to assess the prognostic value of RVD and TR grade for mortality. RVD was defined as a TAPSE ≤ 16 mm or tissue Doppler-derived tricuspid lateral annular systolic velocity (S′TDI) < 10 cm/s.Hazard ratios were extracted from multivariate models reporting on the association of RVD and TR with mortality and described as pooled estimates with 95% confidence intervals. Data were pooled across studies using the DerSimonian-Laird random-effects model. Results: A total of 9 nonrandomized studies met the inclusion criteria with eight studies having at least 12 months follow-up. Among the above studies, a total of 1325 patients (74.1% being male) were eligible for being included in our meta-analysis with an overall survival of 68.2% (n = 903). Of the enrolled patients, RVD was present in 39.1% and moderate-severe TR in 32.8%. RVD was significantly associated with mortality compared to normal RV function (HR, 1.89, 95% CI, 1.51-2.38, p < 0.001, I2 =0). Additionally, patients with moderate-severe TR showed increased risk of mortality compared with those in the none-mild TR group (HR, 1.71. 95% CI, 1.36-2.15, p < 0.001, I2 =0) Conclusions: This meta-analysis demonstrates the prognostic importance of RVD and TR grade in predicting all-cause mortality in patients with FMR. RV function and TR parameters may therefore be useful in the risk stratification of patients with FMR.

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P1444 Occurrence and predictors of right ventricular dysfunction after pericardiocentesis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.872 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

H Matsutani ◽

M Amano ◽

C Izumi ◽

M Baba ◽

R Abe ◽

...

Keyword(s):

Right Ventricular ◽

Longitudinal Strain ◽

Linear Dimension ◽

Left Ventricular ◽

Lv Function ◽

P Value ◽

Free Wall ◽

Right Ventricular Free Wall ◽

Before And After ◽

Rv Function

Abstract Background—The changes in cardiac function that occur after pericardiocentesis are unclear.Purpose—This study was performed to assess right ventricular (RV) and left ventricular (LV) function with echocardiography before and after pericardiocentesis. Method and Results—In total, 19 consecutive patients who underwent pericardiocentesis for more than moderate pericardial effusion were prospectively enrolled from August 2015 to October 2017. Comprehensive transthoracic echocardiography was performed before, immediately after (within 3 hours), and 1 day after pericardiocentesis to investigate the changes in RV and LV function. RV dysfunction is defined as meeting three of the four criteria: a TAPSE of <17 mm, an S’ of <9.5 cm, an FAC of <35%, and an RV free wall longitudinal strain >−20%. The mean age of all patients was 72.6 ± 12.2 years. The changes of echocardiographic parameters related to RV function are shown in Table. After pericardiocentesis, RV inflow and outflow diameters increased and the parameters of RV function significantly decreased. These abnormal values or RV dysfunction remained at 1 day after pericardiocentesis. Conversely, no parameters of LV function parameters changed after pericardiocentesis. Of 19 patients, 13 patients showed RV dysfunction immediately after pericardiocentesis and 6 patients did not. RV free wall longitudinal strain before pericardiocentesis was higher in patients with post-procedural RV dysfunction (−18.9 ± 3.6%) than in those without (−28.4 ± 6.3%). ROC analysis revealed that a RV free wall longitudinal strain cut-off value of −23.0% had a sensitivity of 100% and a specificity of 83.3% for predicting the occurrence of RV dysfunction after pericardiocentesis (AUC = 0.910). Conclusions—The occurrence of RV dysfunction after pericardiocentesis should be given more attention. Pre-existing RV dysfunction maybe related to the occurrence of RV dysfunction after pericardiocentesis. Changes in RV function before and after Before Immediately after One day after P−value Basal right ventricular linear dimension (mm) 32.8 ± 5.0 37.1 ± 4.4† 33.6 ± 5.4 0.028 Mid-cavity right ventricular linear dimension (mm) 34.5 ± 4.6 38.8 ± 5.3† 37.0 ± 5.6 0.0504 Proximal right ventricular outflow diameter (mm) 30.2 ± 4.0 33.9 ± 3.5† 31.4 ± 3.9 0.014 TAPSE (mm) 20.0 ± 4.2 13.6 ± 4.3* 14.7 ± 3.9 <0.001 S" (cm/s) 12.6 ± 3.3 8.7 ± 2.4* 9.1 ± 2.4 <0.001 Fractional area change (%) 48.3 ± 5.9 37.8 ± 8.0* 40.0 ± 9.0 <0.001 Right ventricular free wall strain (%) −21.3 ± 6.3 −15.8 ± 6.7* −16.9 ± 5.2 0.036 Tricuspid regurgitation velocity peak (m/s) 2.41 ± 0.29 2.43 ± 0.25 2.34 ± 0.32 0.37

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An Echocardiographic Study of Right Ventricular Morphology and Function in Systemic Hypertension.

Nepalese Heart Journal ◽

10.3126/njh.v18i1.36783 ◽

2021 ◽

Vol 18 (1) ◽

pp. 39-44

Author(s):

Murari Prasad Barakoti ◽

Adhyashree Karki ◽

Manoj Kumar Chaulagain ◽

D B Karki

Keyword(s):

Right Ventricular ◽

Wall Thickness ◽

Medical Condition ◽

Prognostic Significance ◽

Systemic Hypertension ◽

Renal Diseases ◽

Basal Diameter ◽

Hypertensive Patients ◽

Increased Risk ◽

And Function

Background and Aims: Hypertension is a common medical condition that leads to increased risk of cardiovascular conditions including coronary artery disease, heart failure, stroke, renal diseases, blindness and cardiovascular death. Long term hypertension will affect left ventricle by hypertrophy and several functional derangements. Since heart works as a unit, right heart changes are expected. Right ventricular dysfunction has a strong prognostic significance and we aim to study right ventricular parameters in hypertensive patients. Methods: We studied 71 hypertensive subjects and 66 matched control without hypertension in echocardiography laboratory for chamber dimensions and right ventricular systolic and diastolic parameters. Results: The right ventricular free wall thickness (5.46±1.97mm vs 4.77±0.81mm; P=0.01) and interventricular septal thickness (11.62±2.64mm vs 9.10±1.16mm; P<0.01) were significantly higher among hypertensive patients. Right ventricular dimensions namely basal diameter (26.41±4.97mm vs 29.16±5.22mm; P<0.01), mid-ventricular diameter (25.83±4.40mmvs 27.44±5.05mm; P=0.05) and right ventricular long-axis length (69.54±7.08 mm vs 73.28±7.08mm; P<0.01) were significantly low among hypertensive patients. Tricuspid Annular Plane Systolic Excursion (TAPSE) was significantly lower among hypertensive patients (18.84±1.85mm vs control 20.54±2.65mm; P<0.01). A significant statistical correlation was found between mitral E/A ratio and tricuspid E/A ratio (R2 linear=0.78, P=0.01). Conclusion: The effect of hypertension in right ventricular structure and function are found to be subtle but definite as seen in diastolic wave velocities, right ventricular wall thickness, internal chamber dimensions and TAPSE. Assessment of hypertensive effect on heart will help to control hypertension in stringent way.

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Abstract 14130: Effect of Angiovac on Right Ventricular Function Following Removal of Right Atrial Masses in Patients With and Without Malignancy

Circulation ◽

10.1161/circ.142.suppl_3.14130 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Daniel P OBrien ◽

Tyler E Callese ◽

John Moriarty ◽

Eric Yang

Keyword(s):

Right Ventricular ◽

Left Ventricular ◽

Mean Difference ◽

Right Atrial ◽

Left Ventricular Ejection ◽

P Value ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

Rv Function

Introduction: The AngioVac thrombectomy system (AngioDynamics Inc, Queensbury, NY) is an FDA approved device for removal of thrombi and emboli. Prior studies have shown procedural success for removal of right atrial (RA) and caval masses. This study aims to assess the effect of AngioVac on right ventricular (RV) function in patients undergoing removal of RA masses. Methods: Retrospective institutional study of patients undergoing removal of RA masses with AngioVac at a single tertiary medical center were included. Right ventricular fractional change (RVFC) and tricuspid annular plane systolic excursion (TAPSE) values were collected from echocardiograms before and after AngioVac or obtained manually if not present in the report. Paired 2-sample t test was done to assess for a significant difference between the two values. Results: The mean difference in RVFC before and after AngioVac was 1.6%, with a p-value of 0.327. Ten of the 28 patients had active malignancy, with a mean difference in RVFC of 0.8% and a p value of 0.683. The mean difference in the TAPSE group was 0.07mm and a p value of 0.48. Eight of the 19 patients had active malignancy, with a mean difference in TAPSE of 0.2mm corresponding to a p-value of 0.24. There was no significant difference in left ventricular ejection fraction before and after AngioVac (mean difference of 2.5%, p-value of 0.11). Conclusions: These findings suggest that use of the AngioVac device for removal of RA masses does not cause significant derangements in RV function by echocardiographic assessment. It is a well-tolerated procedure in patients with preprocedural normal RV function. These findings also further assess the use of AngioVac in patients with both right sided cardiac masses and active malignancy.

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5200Incidental Ventricular Tachycardia: Short and Long-term Prognosis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0058 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Sajadieh ◽

A Sajadieh

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Risk Score ◽

Coronary Revascularization ◽

Prognostic Significance ◽

End Point ◽

Increased Risk ◽

Short And Long Term ◽

Long Term Prognosis

Abstract Background The prognostic significance of incidental non-sustained ventricular tachycardia (NSVT) in subjects without manifest heart disease is unknown. Aim We aimed to evaluate the short- and long-term prognosis of NSVT. Methods Data from 678 subjects from Copenhagen Holter study were analyzed. All had at least 48 hours of Holter recording. NSVT was defined as runs of at least three premature ventricular complexes. All were followed up to 16 years. The primary end-point was defined as a combination of cardiovascular mortality, acute myocardial infarction, coronary revascularization, or stroke. Results 72 (10.6%) had at least one event of VT. The primary end-point occurred more frequently in patients with NSVT: 38.3 versus 17.7 events per 1000 patient-years: HR and 95% CI: 2.06 (1.37–3.20) after relevant adjustments. In a shorter-term follow-up period of up to two-year there were few events: HR and 95% CI: 1.9 (0.69–5.24). The prognosis in subjects with NSVT was not dependent of the length of the VT (p for interaction 0.9), but of the background risk profile. Table 1. Results of the Cox proportional Hazard models showing risk of cardiovascular events in different groups of subjects with incidental ventricular tachycardia on ambulatory ECG recording Model 1 p Model 2 p Interaction All VT 2.02 (1.32–3.10) 0.001 1.95 (1.2–3.02) 0.003 VT (3 complexes) 1.79 (0.98–3.27) 0.057 1.84 (1.0–3.38) 0.04 0.91 VT (4–9 complexes) 1.94 (1.13–3.32) 0.016 1.78 (1.06–3.22) 0.029 VT and high risk score* 2.84 (1.79–4.49) <0.0001 2.35 (1.46–3.79) 0.0004 0.22 VT and low-risk score 0.70 (0.26–1.90) 0.49 0.93 (0.34–2.57) 0.88 Model 1: adjusted for sex and age. Model 2: adjusted for sex, age, smoking, diabetes mellitus, systolic blood pressure, LDL cholesterol and NT-proBNP. *Framingham riskscore ≥10 vs <10. Conclusions Incidental NSVT in subjects without manifest heart disease is associated with increased risk of mortality and CV-events, however the increased risk is not imminent but with a slow pace over time. Acknowledgement/Funding Danish Heart Foundation

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P614Comparison of echo parameters with cardiac MRI in the assessment of right ventricular function

European Heart Journal ◽

10.1093/eurheartj/ehz747.0223 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Agasthi ◽

N R Venepally ◽

F Mookadam ◽

C E Jokerst ◽

F Marcotte ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Cardiac Mri ◽

Prognostic Significance ◽

Systolic Pressure ◽

Study Cohort ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep ◽

Right Ventricular Strain ◽

Rv Function

Abstract Introduction Systolic right ventricular (RV) function has prognostic significance both in acquired and congenital heart diseases. However accurate assessment of RV ejection fraction (EF) with transthoracic echocardiography (TTE) remains challenging due to the complex geometric shape of the RV. Magnetic resonance imaging (MRI) remains the gold standard modality for assessment of RV function; however the cost and availability limits the regular use of MRI in clinical practice. The RV strain measured by speckle tracking (RVS) is a novel method of assessing RV EF. Purpose The purpose of the study was to assess the accuracy of RVS compared RV fractional area change (FAC%), tricuspid annular peak systolic excursion (TAPSE) and Doppler tissue imaging-derived isovolumic acceleration and peak systolic velocity (S') at the lateral tricuspid annulus in the assessment of impaired RV EF. Methods We retrospectively identified patients who had a cardiac MRI between 2012- 2017 and only included patients with a TTE within 1 month of the MRI for our final analysis. Baseline characteristics, TTE and MRI parameters were extracted from chart review. RV strain was measured retrospectively using ECHOINSIGHT software. Four TTE parameters including RVS, TAPSE, S' and FAC% were tested for accuracy to identify impaired RV EF (defined as EF<45%) using receiver operator curves. Results The study cohort included 500 patients with mean age 55 yr ± 18 and right ventricular systolic pressure 33.7±13.6 mmHg. The proportion of female gender, diabetes, hypertension and obstructive sleep apnea were 38%, 15.6%, 43% & 19.8% respectively. The area under ROC for TAPSE, S', FAC% and RVS were 0.58 (95% confidence interval [CI] 0.51–0.65, p=0.03), 0.59 (95% CI 0.52–0.66, p=0.03), 0.67 (95% CI 0.61–0.73, p=0.03) and 0.70 (0.64–0.76, p=0.03) for assessing RV EF <45%. Conclusion Right ventricular strain most accurately detected impaired right ventricular ejection fraction as obtained by MRI. Acknowledgement/Funding None

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