scholarly journals The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases

2021 ◽  
Vol 8 ◽  
Author(s):  
Marijana Tadic ◽  
Nicoleta Nita ◽  
Leonhard Schneider ◽  
Johannes Kersten ◽  
Dominik Buckert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Right Ventricular ◽  
Predictive Value ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Number Of Patients ◽  
Valvular Heart Diseases ◽  
Wide Range

Right ventricular (RV) systolic function has an important role in the prediction of adverse outcomes, including mortality, in a wide range of cardiovascular (CV) conditions. Because of complex RV geometry and load dependency of the RV functional parameters, conventional echocardiographic parameters such as RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), have limited prognostic power in a large number of patients. RV longitudinal strain overcame the majority of these limitations, as it is angle-independent, less load-dependent, highly reproducible, and measure regional myocardial deformation. It has a high predictive value in patients with pulmonary hypertension, heart failure, congenital heart disease, ischemic heart disease, pulmonary embolism, cardiomyopathies, and valvular disease. It enables detection of subclinical RV damage even when conventional parameters of RV systolic function are in the normal range. Even though cardiac magnetic resonance-derived RV longitudinal strain showed excellent predictive value, echocardiography-derived RV strain remains the method of choice for evaluation of RV mechanics primarily due to high availability. Despite a constantly growing body of evidence that support RV longitudinal strain evaluation in the majority of CV patients, its assessment has not become the part of the routine echocardiographic examination in the majority of echocardiographic laboratories. The aim of this clinical review was to summarize the current data about the predictive value of RV longitudinal strain in patients with pulmonary hypertension, heart failure and valvular heart diseases.

scholarly journals The pathophysiology of pulmonary hypertension in left heart disease

2015 ◽  
Vol 309 (9) ◽  
pp. L924-L941 ◽  
Author(s):  
Siegfried Breitling ◽  
Krishnan Ravindran ◽  
Neil M. Goldenberg ◽  
Wolfgang M. Kuebler
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Fluid Transport ◽  
Poor Response ◽  
Left Heart ◽  
Left Heart Disease ◽  
Wide Range ◽  
Pulmonary Arterial ◽  
Preclinical Animal Models

Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure leading to right-sided heart failure and can arise from a wide range of etiologies. The most common cause of PH, termed Group 2 PH, is left-sided heart failure and is commonly known as pulmonary hypertension with left heart disease (PH-LHD). Importantly, while sharing many clinical features with pulmonary arterial hypertension (PAH), PH-LHD differs significantly at the cellular and physiological levels. These fundamental pathophysiological differences largely account for the poor response to PAH therapies experienced by PH-LHD patients. The relatively high prevalence of this disease, coupled with its unique features compared with PAH, signal the importance of an in-depth understanding of the mechanistic details of PH-LHD. The present review will focus on the current state of knowledge regarding the pathomechanisms of PH-LHD, highlighting work carried out both in human trials and in preclinical animal models. Adaptive processes at the alveolocapillary barrier and in the pulmonary circulation, including alterations in alveolar fluid transport, endothelial junctional integrity, and vasoactive mediator secretion will be discussed in detail, highlighting the aspects that impact the response to, and development of, novel therapeutics.

P1511 Comparison between echocardiographic right ventricular-pulmonary arterial coupling and right ventricular longitudinal strain to identify pulmonary hypertension in heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Seidova ◽  
A Manouras ◽  
L H Lund ◽  
A Venkateshvaran
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Contractile Function ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Systolic Pulmonary Artery Pressure ◽  
Arterial Elastance ◽  
Coronary Syndrome

Abstract Background Both the ratio between tricuspid annular plane systolic excursion (TAPSE) and doppler estimated systolic pulmonary artery pressure (SPAP) and right ventricular longitudinal strain (RVSL) have been proposed as sensitive measures of RV contractile function and demonstrate important prognostic implications in heart failure (HF). However, a comparison between measurements to discern pulmonary hypertension (PH) in heart failure has not been adequately explored. Methods Consecutive subjects undergoing right heart catheterization (RHC) and simultaneous echocardiography to evaluate HF were enrolled. Subjects with atrial fibrillation, recent acute coronary syndrome and poor diagnostic images were excluded. RV-PA coupling was assessed based on the ratio between invasively derived RV elastance and arterial elastance (Ees/Ea) and correlated with TAPSE/RVSP and speckle-tracking derived RVSL. ROC analysis was performed to identify PH, defined as invasive PA mean pressure ≥25mmHg. Results 99 subjects were analysed (age: 59 ± 14; 49% female). Both TAPSE/RVSP (r = 0.47; p < 0.001) and RVSL (r = 0.48; p < 0.001) demonstrated significant associations with invasive Ees/Ea. TAPSE/RVSP was significantly lower in PH when compared with non-PH subjects (0.42 ± 0.27 vs 0.65 ± 0.34mm/mmHg; p < 0.001) and demonstrated strong differentiating ability (AUC = 0.80) for PH. RVSL, however, did not significantly differ between groups (p > 0.05). Conclusions Both TAPSE/RVSP and RVSL demonstrate significant association with invasive measures of RV-PA coupling. The stronger ability of TAPSE/RVSP to distinguish PH as compared with RVSL may be attributed to the lower load-dependency of this measure.

P6488Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Hinojar Baydes ◽  
A Garcia Martin ◽  
A Gonzalez-Gomez ◽  
M Martin-Plaza ◽  
M Sanroman-Guerrero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Valve Surgery ◽  
S Wave ◽  
Tricuspid Valve Surgery ◽  
Rv Function

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function that can allow detection of subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in stable patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (`S) and with STE derived peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure Results A total of 70 patients were included (mean age was 74±8 years, 71% females). 5 patients were excluded due to poor acoustic window. According to ethyology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean values of RV function parameters are shown in the table. During a median follow up of 18 months [IQR: 4–28], 37% of the patients reached the combined end point (n=15 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed impaired RV-GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes. Mean ± SD Mean ± SD Mean ± SD HR (95% confidence interval) P value in Cox regression analysis in all patients in patients with events in patients without events TAPSE 20±5 20±7 21±5 0.97 (0.9–1.06) 0.56 DTI S wave 10.5±2 11±3 10±2 1.08 (0.87–1.35) 0.49 FAC 44±7 43±6 45±8 1.04 (0.97–1.1) 0.22 FW longitudinal strain (FW-LS) 18±5 −16±5* −20±5 0.91 (0.84–0.98) 0.02 Global longitudinal strain (GLS) 19±4 −16±4* −21±4 0.87 (0.81–0.95) 0.001 Conclusion In patients with asymptomatic TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters may be included in the serial evaluation of these patients.

Prognostic value of right ventricular free wall longitudinal strain in a large cohort of outpatients with left-side heart disease

2019 ◽  
Vol 21 (9) ◽  
pp. 1013-1021 ◽  
Author(s):  
Mara Gavazzoni ◽  
Luigi P Badano ◽  
Enrico Vizzardi ◽  
Riccardo Raddino ◽  
Davide Genovese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Structural Heart Disease ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Heart Failure Hospitalization ◽  
Right Ventricular Free Wall ◽  
Echocardiographic Parameters

Abstract Aims Right ventricular free wall longitudinal strain (RVFWLS) has been proposed as an accurate and sensitive measure of right ventricular function that could integrate other conventional parameters such as tricuspid annulus plane systolic excursion (TAPSE) and fractional area change (FAC%). The aim of the present study was to evaluate the relationship between RVFWLS and outcomes in stable asymptomatic outpatients with left-sided structural heart disease. Methods and results We enrolled 458 asymptomatic patients with left-side heart diseases and any ejection fraction who were referred for echocardiography to two Italian centres. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome of this analysis. After a mean follow-up of 5.4 ± 1.2 years, 145 patients (31%) reached the combined endpoint. Most of echocardiographic parameters were related to outcomes, including right ventricular functional parameters. Mean value of RVFWLS in our cohort was −21 ± 8% and it was significantly related to the combined endpoint and in multivariable Cox-regression model; when tested with other echocardiographic parameters that were significantly related to outcome at univariate analysis, RVFWLS maintained its independent association with outcome (hazard ratio 0.963, 95% confidence interval 0.948–0.978; P = 0.0001). The best cut-off value of RVFWLS to predict outcome was −22% (area under the curve 0.677; P < 0.001; sensitivity 70%; 65% specificity). Conclusion RVFWLS may help clinicians to identify patients with left-sided structural heart disease at higher risk for first heart failure hospitalization and death for any cause.

scholarly journals RISK FACTORS OF DIASTOLIC HEART FAILURE

2006 ◽  
Vol 13 (03) ◽  
pp. 410-416
Author(s):  
LIAQAT ALI ◽  
MUHAMMAD AZHAR ◽  
ABDUL REHMAN ABID
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Diastolic Dysfunction ◽  
Systolic Function ◽  
Diastolic Heart Failure ◽  
Nyha Class ◽  
Ischemic Heart ◽  
Normal Systolic Function ◽  
Number Of Patients

Background and objective: Isolated diastolicdysfunction /heart failure is the cause of congestive heart failure in 50% of patients with normal systolic function. Severalfactors have been shown to be predisposing conditions associated with the development of diastolic dysfunction anddiastolic heart failure. This study was designed to study the common and important factors leading to diastolicdysfunction of the heart. Study design: This was a descriptive analytic study. Place & Duration: This study wasconducted at Cardiology Department of Mayo Hospital Lahore from January 1998 to September 1998. Material andmethods: One hundred patients of diastolic heart failure who fulfilled our inclusion criteria were studied when theypresented to echo room for echocardiography. Detailed Echocardiography examination of all patients included in thisstudy was done to measure Doppler parameters of diastolic dysfunction like deceleration time, isovolumic relaxationtime, S & D wave measurements on pulmonary vein. Detailed history was taken and physical examination wasperformed to evaluate the risk factor associated with diastolic dysfunction in each patient. Results Mean age of thestudy population was 511 18 years. Majority of patients 50(50%) had age range from 36 to 55 years. There were62(62%) male and 38(38%) female patients. Majority of patients 34(34%) had NYHA class I symptoms and 30(30%)patients were in NYHA class II. Ejection fraction was normal in 54(54%) of patients while it was less than 40% in 24%of patients. Majority of patients, 28(28%) had Ischemic heart disease while 24(24%) patients had hypertension and14(14%) had diabetes mellitus. Hypertension and Ischemic heart disease were present in 14(14%) patients.Conclusion Approximately 40% - 50% of patients with or without overt clinical features of heart failure have isolateddiastolic dysfunction / DHF with normal systolic function. Coronary artery disease, arterial hypertension and diabetesmellitus are the major factors associated with diastolic dysfunction and DHF. Obesity and aging also contributeindependently to the development of diastolic dysfunction in a reasonable number of patients.

Right ventricular systolic function in severe tricuspid regurgitation: prognostic relevance of longitudinal strain

2021 ◽  
Author(s):  
Francesco Ancona ◽  
Francesco Melillo ◽  
Francesco Calvo ◽  
Nadia Attalla El Halabieh ◽  
Stefano Stella ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Clinical Signs ◽  
Strain Analysis ◽  
Severe Tricuspid Regurgitation

Abstract Aims  The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42–56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.

scholarly journals Three-dimensional versus two-dimensional derived strain echocardiography for assessing right ventricular myocardial deformation in patients with chronic left ventricular heart failure: A proof-of-concept study

2020 ◽  
Author(s):  
Fei Gao ◽  
Chong Liu ◽  
Qiang Guo ◽  
Shuang-quan Jiang ◽  
Zhen-zhen Wang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Three Dimensional ◽  
Strain Analysis ◽  
Free Wall ◽  
Two Dimensional ◽  
Control Subjects ◽  
Dimensional Echocardiography

Abstract Background A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain. Methods Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV. Results 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p<0.001), and it correlated well with cardiac magnetic resonance-derived RVEF (r=0.74, p<0.001). On receiver operator characteristic analysis, a 3DE-derived RV-fwLS cutoff value of >-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p<0.05). Conclusion Assessment of RV myocardial function by 3DE-derived longitudinal strain is better than 2DE in identifying patients with impaired RV systolic function. 3DE-derived strain analysis for RV should be considered as a complementary tool for assessing RV systolic function in terms of accuracy.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

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