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

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.

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

Echo Research and Practice ◽

10.1530/erp-19-0051 ◽

2020 ◽

Vol 7 (1) ◽

pp. G19-G41 ◽

Cited By ~ 1

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.

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Preterm Delivery; Who Is at Risk?

Journal of Clinical Medicine ◽

10.3390/jcm10112279 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2279

Author(s):

Dvora Kluwgant ◽

Tamar Wainstock ◽

Eyal Sheiner ◽

Gali Pariente

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Prenatal Care ◽

Recurrent Pregnancy Loss ◽

Placental Abruption ◽

Placenta Previa ◽

Population Based ◽

Perinatal Morbidity ◽

Multiple Gestations ◽

Extremely Preterm

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%CI 17.00–24.96, p < 0.001) were the strongest risk factors for extreme PTB. In sub-populations (multiple gestations, women with previous PTB and indicated PTBs), risk factors included placental abruption and previa, lack of prenatal care, and recurrent pregnancy loss. Singleton extreme PTB risk factors included nulliparity, lack of prenatal care, and placental abruption. Placental abruption was the strongest risk factor for extreme preterm birth in all groups, and risk factors did not differ significantly between sub-populations.

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Right Heart Functional Changes in the Acute, Hypercapnic Exacerbations of COPD

BioMed Research International ◽

10.1155/2014/596051 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Claudio Terzano ◽

Sofia Romani ◽

Carlo Gaudio ◽

Francesco Pelliccia ◽

Mattia Serao ◽

...

Keyword(s):

Respiratory Failure ◽

Right Atrial ◽

Copd Exacerbation ◽

Blood Gas ◽

Right Heart ◽

Functional Changes ◽

Arterial Blood ◽

Copd Patients ◽

The Right ◽

Severe Copd

Objective. To investigate the correlation between respiratory failure and the pulmonary circulation. We focused on anatomical and functional changes of the right heart.Design. Clinical investigation.Methods. We evaluated 75 patients hospitalized in our respiratory ward for COPD exacerbation. All patients underwent transthoracic echocardiography and measurements of right heart chambers. Moreover all patients underwent blood tests, measurement of blood pressure, evaluation of body mass index (BMI), ECGs, pulmonary function tests, and the Saint George’s Respiratory Questionnaire (SGRQ).Results. Among 75 patients consecutively hospitalized, 56 patients with a COPD exacerbation were included in our study. We have emphasized the higher value of PAPs and the increased size of right atrial area in severe COPD patients. Significant correlation was observed between low values of PaO2and larger area of the right atrium. The measurement of TAPSE showed a right ventricular dysfunction in all patients but especially in severe COPD patients. We have obtained a significant correlation between TAPSE and arterial blood gas.Conclusions. In patients with chronic respiratory failure, blood gas parameters should be considered as negative prognostic factors of right heart failure. Respiratory failure shows a relationship with pulmonary hypertension and with the anatomy and function of the right heart sections.

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Timing of Pharmacological Treatment for Patent Ductus Arteriosus and Risk of Secondary Surgery, Death or Bronchopulmonary Dysplasia: A Population-Based Cohort Study of Extremely Preterm Infants

Neonatology ◽

10.1159/000367887 ◽

2014 ◽

Vol 107 (2) ◽

pp. 87-92 ◽

Cited By ~ 19

Author(s):

Anna Gudmundsdottir ◽

Stefan Johansson ◽

Stellan Håkansson ◽

Mikael Norman ◽

Karin Källen ◽

...

Keyword(s):

Cohort Study ◽

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Pharmacological Treatment ◽

Ductus Arteriosus ◽

Population Based ◽

Secondary Surgery ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Patent Ductus

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Pulmonary Atresia with Intact Ventricular Septum in a Neonate

Indonesian Journal of Cardiology ◽

10.30701/ijc.v38i4.787 ◽

2018 ◽

Vol 38 (4) ◽

pp. 218-225

Author(s):

Emir Yonas ◽

Raymond Pranata ◽

Nuvi Nusarintowati

Keyword(s):

Pulmonary Artery ◽

Right Ventricular ◽

Ductus Arteriosus ◽

Pulmonary Atresia ◽

Ventricular Septum ◽

Intact Ventricular Septum ◽

Right Heart ◽

Normal Limits ◽

The Right ◽

Patent Ductus

Introduction: Pulmonary atresia with an intact ventricular septum is a condition that is characterized by a complete obstruction to right ventricular outflow with varying degrees of right ventricular and tricuspid valve hypoplasia. This condition is uniformly fatal if untreated. In this case report, we present a case of a neonate with a pulmonary atresia with intact ventricular septum Case Presentation: A 2 days-old female Indonesian newborn was referred to our facility. The newborn was delivered from a G4P3A0 mother with a gestational age of 39 weeks (term delivery). Chest x-ray done at the referring facility is significant for a seemingly right heart hypertrophy, casting a “boot-shaped” appearance of the right heart border. Laboratory results done at the referring facility is significant for a neutrophilia of 82% and lymphocytopenia of 13% An episode of hypoglycemia was reported on referring facility with a blood sugar level of 50 mg/dl. Multiple episodes of cyanosis were reported at referring facility, CPAP was administered but the improvement was limited. Pulse oximetry averaged between 72-80% at the referring facility. Physical examination shows an actively moving neonate, with a strong cry. Perioral cyanosis was seen. Vital signs were as follows; heart rate 128 x / minute, temperature 37oC, respiratory rate 54 x / minute, pulse oximetry 74%, capillary refill time < 3 seconds. The rest of the physical examination was within normal limits. Laboratory result on admission at our facility is significant for low hematocrit, low erythrocyte count, leukopenia with neutrophilia and thrombocytopenia. Patient was admitted to NICU and given CPAP. Echocardiography 2 days upon arrival at our facility reveals a patent ductus arteriosus with the pressure of 4-5 mmHg and diameter of 0.3 cm, no forward flow from the right ventricle to the pulmonary artery, doppler mode demonstrated pulmonary artery filling from ductus arteriosus. The rest of the findings were within normal limits. Conclusion: Pulmonary atresia with an intact ventricular septum is a condition that relies on the patent ductus arteriosus for pulmonary blood supply, the patency of it is of paramount importance. Abstrak PENDAHULUAN: Atresia arteri pulmonalis dengan septum ventrikel yang utuh merupakan kondisi yang dikarakterisasikan dengan sumbatan total pada right ventricular outflow dengan berat hipoplasia ventrikel kanan dan trikuspid kanan yang beratnya bervariasi. Pada umumnya kondisi tersebut fatal apabila tidak ditangani. Pada laporan kasus ini, kami melaporkan suatu kasus neonates dengan atresia arteri pulmonalis dengan septum ventrikel yang utuh. PRESENTASI KASUS: Neonatus perempuan berumur 2 hari dirujuk ke rumah sakit kami. Bayi dilahirkan dari G4P3A0 usia kehamilan 39 minggu. Ronsen thoraks yang dilakukan oleh fasilitas kesehatan yang merujuk memperlihatkan hipertrofi jantung kanan serta bentuk “boot-shaped” pada batas jantung kanan. Hasil laboratorium pada fasilitas kesehatan tersebut menunjukan neutrofilia dan limfositopenia. Terdapat juga riwayat hipoglikemi. Episode sianosis berulang terjadi pada fasilitas kesehatan yang merujuk. Pemasangan CPAP kurang membuahkan hasil dengan saturasi O2 72-80% ketika tiba pada rumah sakit kami. Pemeriksaan fisik menunjukan tangis kuat dan gerak aktif dengan sianosis perioral. Detak jantung 128 kali/menit, suhu 37oC, laju naas 54 kali/menit, oksimetri nadi 74% dan waktu isi kapiler <3 detik. Pemeriksaan laboratorium saat pasien dating menunjukan hematocrit, hitung eritrosit, leukosit dan thrombosit yang rendah. Pasien dirawat di NICU dan diberikan CPAP. Ekokardiografi 2 hari kemudian menunjukan duktus arteriosus patent dengan tekanan 4-5 mmHg dan diameter 0.3 cm, tidak ada aliran maju dari ventrikel kanan kepada arteri pulmonalis, mode Doppler menunjukan pengisian arteri pulmonalis dari duktus arteriosus. Pemeriksaan lainnya dalam batas normal. KESIMPULAN: Atresia arteri pulmonalis dengan septum ventrikel yang utuh merupakan suatu kondisi dimana aliran darah menuju paru bergantung pada duktus arteriosus yang paten sehingga patensi daripada duktus tersebut sangatlah penting

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

10.1101/2021.02.05.429046 ◽

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.

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Differentiation of Cerebellum-Type and Parkinson-Type of Multiple System Atrophy by Using Multimodal MRI Parameters

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.687649 ◽

2021 ◽

Vol 13 ◽

Author(s):

Bin Cui ◽

Weimin Zheng ◽

Shan Ren ◽

Zhigang Chen ◽

Zhiqun Wang

Keyword(s):

Multiple System Atrophy ◽

Area Under The Curve ◽

Low Frequency ◽

Imaging Biomarker ◽

Functional Changes ◽

Clinical Variables ◽

Potential Biomarker ◽

Different Types ◽

The Right ◽

And Function

Recent studies have demonstrated the structural and functional changes in patients with multiple system atrophy (MSA). However, little is known about the different parameter changes of the most vulnerable regions in different types of MSA. In this study, we collected resting-state structure, perfusion, and patients with functional magnetic resonance imaging (fMRI) data of cerebellum-type of MSA (MSA-c) and Parkinson-type of MSA (MSA-p). First, by simultaneously using voxel-based morphology (VBM), arterial spin labeling (ASL), and amplitude of low-frequency fluctuation (ALFF), we analyzed the whole brain differences of structure, perfusion, and functional activation between patients with MSA-c and MSA-p. Second, we explored the relationships among structure, perfusion, function, and the clinical variables in patients with MSA. Finally, we extracted the MRI parameters of a specific region to separate the two groups and search for a sensitive imaging biomarker. As a result, compared with patients with MSA-p type, patients with MSA-c type showed decreased structure atrophy in several cerebella and vermis subregions, reduced perfusion in bilateral cerebellum_4_5 and vermis_4_5, and an decreased ALFF values in the right lingual gyrus (LG) and fusiform (FFG). Subsequent analyses revealed the close correlations among structure, perfusion, function, and clinical variables in both MSA-c and MSA-p. Finally, the receiver operating characteristic (ROC) analysis showed that the regional cerebral blood flow (rCBF) of bilateral cerebellum_4_5/vermis_4_5 could differentiate the two groups at a relatively high accuracy, yielding the sensitivity of 100%, specificity of 79.2%, and the area under the curve (AUC) value of 0.936. These findings have important implications for understanding the underlying neurobiology of different types of MSA and added the new evidence for the disrupted rCBF, structure, and function of MSA, which may provide the potential biomarker for accurately detecting different types of patients with MSA and new ideas for the treatment of different types of MSA in the future.

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The right-sided heart failure

Russian Pulmonology ◽

10.18093/0869-0189-2019-29-2-135-147 ◽

2019 ◽

Vol 29 (2) ◽

pp. 135-147

Author(s):

A. G. Chuchalin

Keyword(s):

Heart Failure ◽

Clinical Manifestations ◽

Clinical Syndrome ◽

Lv Function ◽

Right Heart ◽

Heart Abnormalities ◽

Lv Volume ◽

The Right ◽

And Function ◽

Heart Physiology

The right-sided heart failure (RSHF) is a complex clinical syndrome including different pathogenic mechanisms and processes resulted from the right ventricle (RV) dysfunction and manifested with signs of heart failure (HF). Recently, there is a growing scientific interest in the right-sided acute and chronic heart abnormalities; this is due to growing knowledge in this field and development of novel diagnostic, therapeutic and pharmacological approaches to treatment of pulmonary hypertension that is a common cause of RSHF. Cardiac embryogenesis, anatomic particularities, difference and interdependence of RV and the left ventricle (LV) are described in the article in order to improve the knowledge on structure and function of both the right heart and the left heart. Discussion on pathophysiology, causes and clinical manifestations of acute RSHF (aRSHF) and chronic RSHF (cRSHF) should consider the right heart physiology. Pharmacological treatment should be targeted to ventricle pre-load, myocardial contractility and RV post-load, correction of pulmonary circulation and LV volume resulting in post-load reduction and improvement in the LV function. Patients with biventricular dysfunction should be treated according to current clinical guidelines on therapy of chronic HF. Vasoactive agents and diuretics have an important role for the treatment of RSHF as this is the basic therapy of pulmonary congestion both in aRSHF and cRSHF. Step-by-step therapeutic algorithm is given in the article.

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Abstract P138: Alterations in Cardiac Structure and Function in Young Adults Born Extremely Preterm: Impact of Neonatal Bronchopulmonary Dysplasia

Hypertension ◽

10.1161/hyp.70.suppl_1.p138 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Muhammad Oneeb Rehman Mian ◽

Jean-Luc Bigras ◽

Rafael Fernandes ◽

Mariane Bertagnolli ◽

Li Feng Xie ◽

...

Keyword(s):

Young Adults ◽

Preterm Birth ◽

Cardiac Remodeling ◽

Structure And Function ◽

Cardiac Structure ◽

Lv Mass ◽

Extremely Preterm ◽

Cardiac Structure And Function ◽

And Function

Objective: Studies support a causal association between preterm birth and increased risk of cardiovascular diseases. Increased left and right ventricular mass and impaired systolic and diastolic function has been reported in young adults born preterm. However, the impact of extreme preterm birth and prematurity-specific complications on adult cardiac structure and function has not been evaluated. We assessed cardiac structure and function in young adults born extremely preterm (EPT) versus term, and correlated long term cardiac remodeling with neonatal bronchopulmonary dysplasia (BPD). Methods: Eighty five EPT (gest. age = 27.1±1.4 weeks) were recruited along with term-born controls matched for age, sex and socioeconomic status. Birth and neonatal data (gestational age, birth weight, BPD indicated by O 2 requirements at 36 weeks postmenstrual age) was collected. Ambulatory blood pressure (Spacelabs) and echocardiographic measurements (Phillips) were taken. Comparisons were performed using ANOVA or T-test. Results: EPT presented with increased systolic (119±9 vs 116±8 mmHg, P<0.05) and diastolic (68±5 vs 66±6 mmHg, P<0.05) blood pressures. EPT exhibited reduced septal thickness (IVS, 6.8±0.8 vs 7.1±1.1 mm, P<0.05), left ventricular internal dimension (LVID, 46±4 vs 48±5 mm, P<0.05), LV end-diastolic (98±20 vs 106±24 ml, P<0.05) and end-systolic (36±9 vs 40±11 ml, P<0.01) volumes, right ventricular internal dimension (RVID, 22±3 vs 24±4 mm, P<0.05), and LV mass (104±27 vs 115±30 g, P<0.05), but similar LV mass and volume indexes. EPT exhibited increased LV myocardial performance index (0.41±0.04 vs 0.39±0.04, P<0.01), reduced mitral lateral e’ (17.6±2.8 vs 19.1±2.6 cm/s, P<0.01), mitral s’ (10.7±2.3 vs 11.6±2.3 cm/s, P<0.01), tricuspid E’ (15.8±2.7 vs 16.8±2.1 cm/s, P<0.05), and tricuspid S’ (13.1±2.0 vs 14.0±2.0 cm/s, P<0.01) waves, and a trend in reduced mitral E wave (81±14 vs 85±15 cm/s, P=0.09). EPT with neonatal BPD exhibited greater reduction in IVS (6.5±0.8 mm, P<0.05 vs terms), LVID (45±4 mm, P<0.05), LV Mass (98±22 g, P<0.05), and RVID (20±3 mm, P<0.01). Conclusions: EPT exhibit cardiac structural and functional alterations compared to term-born individuals. Neonatal BPD in EPT is a key contributor to long term cardiac remodeling.

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