scholarly journals Echocardiographic assessment of the right heart in adults: a practical guideline from the British Society of Echocardiography

2020 ◽  
Vol 7 (1) ◽  
pp. G19-G41 ◽  
Author(s):  
Abbas Zaidi ◽  
Daniel S Knight ◽  
Daniel X Augustine ◽  
Allan Harkness ◽  
David Oxborough ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Response To Therapy ◽  
British Society ◽  
Right Heart ◽  
Functional Changes ◽  
Complex Anatomy ◽  
Clinical Scenarios ◽  
Wide Range ◽  
The Right ◽  
And Function

The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatomy of the right ventricle requires special considerations and echocardiographic techniques, which are set out in this document. The clinical relevance of right ventricular diastolic function is introduced, with practical guidance for its assessment. Finally, the relatively novel techniques of three-dimensional right ventricular echocardiography and right ventricular speckle tracking imaging are described. Despite these techniques holding considerable promise, issues relating to reproducibility and inter-vendor variation have limited their clinical utility to date.

scholarly journals Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

2020 ◽  
Vol 10 (1) ◽  
pp. 122
Author(s):  
Lilly-Ann Mohlkert ◽  
Jenny Hallberg ◽  
Olof Broberg ◽  
Gunnar Sjöberg ◽  
Annika Rydberg ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Ductus Arteriosus ◽  
Population Based ◽  
Right Heart ◽  
Functional Changes ◽  
Cardiac Phenotype ◽  
Extremely Preterm ◽  
Healthy Control ◽  
The Right ◽  
And Function

Preterm birth has been associated with altered cardiac phenotype in adults. Our aim was to test the hypothesis that children surviving extremely preterm birth have important structural or functional changes of the right heart or pulmonary circulation. We also examined relations between birth size, gestational age, neonatal diagnoses of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) with cardiac outcomes. We assessed a population-based cohort of children born in Sweden before 27 weeks of gestation with echocardiography at 6.5 years of age (n = 176). Each preterm child was matched to a healthy control child born at term. Children born preterm had significantly smaller right atria, right ventricles with smaller widths, higher relative wall thickness and higher estimated pulmonary vascular resistance (PVR) than controls. In preterm children, PVR and right ventricular myocardial performance index (RVmpi’) were significantly higher in those with a PDA as neonates than in those without PDA, but no such associations were found with BPD. In conclusion, children born extremely preterm exhibit higher estimated PVR, altered right heart structure and function compared with children born at term.

scholarly journals Genetic Analysis of Right Heart Structure and Function in 40,000 People

2021 ◽  
Author(s):  
James P. Pirruccello ◽  
Paolo Di Achille ◽  
Victor Nauffal ◽  
Mahan Nekoui ◽  
Samuel N. Friedman ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Deep Learning ◽  
Right Ventricular ◽  
Congenital Heart ◽  
Left Ventricular ◽  
Structure And Function ◽  
Right Heart ◽  
Heart Chamber ◽  
The Right ◽  
And Function

The heart evolved hundreds of millions of years ago. During mammalian evolution, the cardiovascular system developed with complete separation between pulmonary and systemic circulations incorporated into a single pump with chambers dedicated to each circulation. A lower pressure right heart chamber supplies deoxygenated blood to the lungs, while a high pressure left heart chamber supplies oxygenated blood to the rest of the body. Due to the complexity of morphogenic cardiac looping and septation required to form these two chambers, congenital heart diseases often involve maldevelopment of the evolutionarily recent right heart chamber. Additionally, some diseases predominantly affect structures of the right heart, including arrhythmogenic right ventricular cardiomyopathy (ARVC) and pulmonary hypertension. To gain insight into right heart structure and function, we fine-tuned deep learning models to recognize the right atrium, the right ventricle, and the pulmonary artery, and then used those models to measure right heart structures in over 40,000 individuals from the UK Biobank with magnetic resonance imaging. We found associations between these measurements and clinical disease including pulmonary hypertension and dilated cardiomyopathy. We then conducted genome-wide association studies, identifying 104 distinct loci associated with at least one right heart measurement. Several of these loci were found near genes previously linked with congenital heart disease, such as NKX2-5, TBX3, WNT9B, and GATA4. We also observed interesting commonalities and differences in association patterns at genetic loci linked with both right and left ventricular measurements. Finally, we found that a polygenic predictor of right ventricular end systolic volume was associated with incident dilated cardiomyopathy (HR 1.28 per standard deviation; P = 2.4E-10), and remained a significant predictor of disease even after accounting for a left ventricular polygenic score. Harnessing deep learning to perform large-scale cardiac phenotyping, our results yield insights into the genetic and clinical determinants of right heart structure and function.

scholarly journals Ethnic differences in right ventricular structure and function in urbanized hypertensive patients in the Gornaya Shoriya region

2022 ◽  
Author(s):  
Alexey N. Sumin ◽  
Nina S. Gomozova ◽  
Anna V. Shcheglova ◽  
Oleg G. Arkhipov
Keyword(s):  
Arterial Hypertension ◽  
Right Ventricular ◽  
Diastolic Dysfunction ◽  
Ethnic Differences ◽  
Structure And Function ◽  
Right Heart ◽  
Hypertensive Patients ◽  
Factors Associated ◽  
The Right ◽  
And Function

Abstract Objective of this study was to compare right ventricular echocardiography parameters in urbanized hypertensive patients of the Shor and non-indigenous ethnic groups in the Mountain Shoria region. Methods The study included patients with arterial hypertension: 58 Shors and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: Shors men (n = 20), Shors women (n = 38), non-indigenous men (n = 15) and non-indigenous women (n = 35). All underwent echocardiographic examination, and the right heart parameters were studied. Results Shor men with arterial hypertension had the lowest values ​​of the pulmonary artery index, the right atrium dimensions, and the highest values ​​of the blood flow velocity in the right ventricle, et' and st' in comparison with non-indigenous men. Shor women have the lowest values Et and Et/At ratios. RV diastolic dysfunction was detected mainly in women, somewhat more often in Shors. Ethnicity was one of the factors associated with the right ventricular diastolic dysfunction presence. Among the factors associated with the RV diastolic dysfunction were risk factors (smoking, obesity), blood pressure, gender, ethnicity, and left ventricular parameters (diastolic dysfunction and the myocardial mass increase). Conclusion Our study established the influence of ethnic differences on the right heart echocardiographic parameters in Shors and Caucasians with arterial hypertension. The revealed differences should improve the assessment of the right heart structure and function in patients with arterial hypertension from small ethnic groups, which will help to improve the diagnosis and treatment of such patients.

scholarly journals Existence Of Right Ventricular Structural And Functional Changes In Essential Hypertension And

2021 ◽  
Vol 17 (21) ◽  
pp. 1
Author(s):  
Ana Minashvili ◽  
Ann Rekhviashvili
Keyword(s):  
Essential Hypertension ◽  
Right Ventricle ◽  
Arterial Hypertension ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Structure And Function ◽  
Systemic Hypertension ◽  
Functional Changes ◽  
The Right ◽  
And Function

The structural and functional changes of left and right ventricles as well as the existence of ventricular interaction in patients with arterial hypertenison (AH) were discussed in many research papers. Therefore, published data regarding right ventricular changes under influence of AH are scarce, non-univocal, and sometimes contradictory. Furthermore, there is a significant lack of clinical trials addressing the influence of circadian BP profile on RV structure and function. The importance of right ventricular function in maintaining global cardiac performance was proven. However, the importance of the right ventricular structure and function for cardiovascular morbidity and mortality is still under debate. Despite the abundance of the study data and high vulnerability of the right ventricle under influence of AH, the world's leading contemporary guidelines of the AH management, right ventricular remodeling, its morphology, function, evaluation, predictive and prognostic value are neither discussed nor mentioned. Hence, we strongly believe that further investigations are needed to determine the exact clinical utility and prognostic value of right ventricular functional and morphological changes in patients with arterial hypertension. Moreover, standardization and improvement of diagnostic methodologies of the RV changes via echocardiography, computed tomography, and Magnetic Resonance Imaging are important, which might have a crucial meaning for professionals involved in AH management. The review article aims to discuss anatomic and physiologic aspects of the right ventricle and their discrepancies according to age, sex, and race, the prognostic meaning of RV remodeling, and review current publications regarding the influence of high blood pressure and its circadian profile on the prevalence of functional and structural changes of RV. Hence, we performed a literature search of the PUBMED database using the medical subject headings "arterial hypertension", "essential hypertension", "systemic hypertension", "circadian BP profile", "remodeling", "right ventricle", "morphology", "anatomy" and "function". A manual search for additional studies was performed using references cited in the original articles.

Transthoracic Right Heart Echocardiography for the Intensivist

2021 ◽  
pp. 088506662110034
Author(s):  
Maxwell A. Hockstein ◽  
Korbin Haycock ◽  
Matthew Wiepking ◽  
Skyler Lentz ◽  
Siddharth Dugar ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Heart Function ◽  
Salient Feature ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Right Heart ◽  
Clinical Scenarios ◽  
The Right ◽  
The Impact ◽  
Rv Function

Background: The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature. Main: RV dysfunction is heterogeneously defined across many domains and its diagnosis is not always clinically apparent. The RV is affected by conditions commonly seen in the ICU such as acute respiratory distress syndrome, pulmonary embolism, RV ischemia, and pulmonary hypertension. Basic ultrasonographic modalities such as 2D imaging, M-mode, tissue Doppler, pulsed-wave Doppler, and continuous Doppler provide clinicians with metrics to assess RV function and response to therapy. Conclusion: The right ventricle is impacted by various critical illnesses with substantial mortality and mortality. Focused bedside echocardiographic exams with attention to the right heart may provide intensivists insight into RV function and provide guidance for patient management.

CMR assessment of right ventricular remodeling after transcatheter therapy for severe tricuspid regurgitation

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
B Alushi ◽  
O Bisht ◽  
N Menck ◽  
V Mattea ◽  
Y Primet ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Short Axis ◽  
Right Heart ◽  
Severe Tricuspid Regurgitation ◽  
The Right ◽  
And Function

Abstract Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Helios Clinical Research Institute Background/Introduction Patients with severe tricuspid regurgitation (TR) are characterized from severe dilatation and negative remodeling of the right heart chambers causing functional right ventricular (RV) failure and increased mortality and morbidity. The transcatheter tricuspid edge-to-edge repair (TTVR) is a new treatment option associated with symptom improvement and reduced hospitalization. The cardiac magnetic resonance imaging (CMRI) remains the gold standard for evaluating the right ventricular morphology and function and could be a useful in assessing the RV reverse remodeling after TTVR.  The Tricuspid Regurgitation REgistry (TRuE) is an ongoing national prospective register of patients with severe TR that aims to identify morphofunctional parameters of the right heart chambers related to improve outcomes after TTVR. Purpose The present is a subanalysis of patients with serial CMRI examinations recruited in the ongoing prospective TRuE registry. Methods After excluding patients with intracardiac RV leads, seven patients (age 70 ±12 years) with completed thirty-day follow up were included in the present analysis. Retrospective gated steady state free precession cine images were acquired in the long and short-axis views covering the entirety of both ventricles. Aortic and pulmonary flow data were acquired with a flow-sensitive gradient echo sequence. Assessment of left ventricular (LV) and RV volumes was performed manually in the short-axis cine images (Circle Cardiovascular Imaging, Calgary, Alberta, Canada). The TR fraction was calculated as: ({total RV stroke volume (SV) – total pulmonary forward flow}/total RVSV) × 100. All volumes and flow measurements were indexed for body surface area and expressed in ml/m2. The ratio between the diameter of pulmonary artery (PA) and ascending aorta (AA) was used as indirect measurement of pulmonary arterial hypertension (PAH). CMRI parameters assessing TR quantification, RV morphology and function were analyzed at baseline and follow-up with Fisher´s test or paired t-test. Results At thirty days there was a significant reduction of the TR fraction (45% to 20%, p < 0.001), RV dilatation (RV-end diastolic volume (EDV): 106 ± 12ml/m2 to 86 ± 9.4ml/m2, p = 0.002, RV- end sistolic volume (ESV):55 ± 6.5 to 43 ± 6.6ml, p = 0.003) and improvement of function (RVEF: 47 ± 3.6 to 53 ± 2.4 %, p = 0.006). On the left heart side, there was an improvement of LV filling, with increased LVEDV and LVESV and of the LVSV (36 ± 5.3 to 41 ± 3.7ml/m2, p = 0.040), causing an improvement of the cardiac index (2.2 ± 0.9 l/min/m2 to 2.9 ± 0.7 l/min/m2; p = 0.019. Furthermore, the PA/AA ratio improved significantly (0.91 ± 0.15 to 0.81 ± 0.14, p = 0.006). Conclusion TTVR is associated with positive reverse remodeling of the RV with reduction of dilatation, PAH and function improvement.

scholarly journals EXPRESS: Chronic thromboembolic pulmonary hypertension following pulmonary embolism with a right ventricular thrombus: A report of two cases

2021 ◽  
pp. 204589402110136
Author(s):  
Tailong Zhang ◽  
Weitao Liang ◽  
Longrong Bian ◽  
Zhong Wu
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Imaging Features ◽  
Pulmonary Endarterectomy ◽  
Right Heart ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Right ◽  
Cardiac Masses

Right heart thrombus (RHT) accompanied by chronic thromboembolic pulmonary hypertension (CTEPH) is a rare entity. RHT may develop in the peripheral veins or in situ within the right heart chambers. The diagnosis of RHT is challenging, since its symptoms are typically non-specific and its imaging features resemble those of cardiac masses. Here, we report two cases of RHT with CTEPH that presented as right ventricular masses initially. Both patients underwent simultaneous pulmonary endarterectomy (PEA) and resection of the ventricular thrombi. Thus, when mass-like features are confirmed by imaging, RHT should be suspected in patients with CTEPH, and simultaneous RHT resection is required along with PEA.

scholarly journals Metastatic adenocarcinoma involving the right ventricle and pulmonary artery leading to right heart failure: case report

2017 ◽  
Vol 136 (3) ◽  
pp. 262-265 ◽  
Author(s):  
Turgut Karabag ◽  
Caner Arslan ◽  
Turab Yakisan ◽  
Aziz Vatan ◽  
Duygu Sak
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Right Heart Failure ◽  
Ventricular Outflow Tract ◽  
Right Heart ◽  
The Right

ABSTRACT CONTEXT: Obstruction of the right ventricular outflow tract due to metastatic disease is rare. Clinical recognition of cardiac metastatic tumors is rare and continues to present a diagnostic and therapeutic challenge. CASE REPORT: We present the case of a patient who had severe respiratory insufficiency and whose clinical examinations revealed a giant tumor mass extending from the right ventricle to the pulmonary artery. We discuss the diagnostic and therapeutic options. CONCLUSION: In patients presenting with acute right heart failure, right ventricular masses should be kept in mind. Transthoracic echocardiography appears to be the most easily available, noninvasive, cost-effective and useful technique in making the differential diagnosis.

Sign in / Sign up

Export Citation Format

Share Document