Evaluation of the right ventricle by echocardiography: particularities and major challenges
TL;DR: This review discusses the particular challenges and limits in obtaining accurate measurements of RV anatomical and functional parameters and focuses primarily on the difficulties in proper interpretation of the highly load dependent RV ECHO-parameters which complicates the use of this valuable diagnostic and surveillance technique.
Abstract: Introduction: Compared with the left ventricle (LV), the right ventricle (RV) is less suited for evaluation by echocardiography (ECHO). Nevertheless, RV ECHO-assessment has currently emerged as an ...
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Journal Article•
TL;DR: A study to characterize mortality in a multicenter prospective cohort of patients diagnosed with idiopathic, familial, or anorexigen-associated pulmonary arterial hypertension in the modern management era found that no new therapies have recently become available for pulmonary arterIAL hypertension.
Abstract: Background— Novel therapies have recently become available for pulmonary arterial hypertension. We conducted a study to characterize mortality in a multicenter prospective cohort of patients diagnosed with idiopathic, familial, or anorexigen-associated pulmonary arterial hypertension in the modern management era. Methods and Results— Between October 2002 and October 2003, 354 consecutive adult patients with idiopathic, familial, or anorexigen-associated pulmonary arterial hypertension (56 incident and 298 prevalent cases) were prospectively enrolled. Patients were followed up for 3 years, and survival rates were analyzed. For incident cases, estimated survival (95% confidence intervals [CIs]) at 1, 2, and 3 years was 85.7% (95% CI, 76.5 to 94.9), 69.6% (95% CI, 57.6 to 81.6), and 54.9% (95% CI, 41.8 to 68.0), respectively. In a combined analysis population (incident patients and prevalent patients diagnosed within 3 years before study entry; n=190), 1-, 2-, and 3-year survival estimates were 82.9% (95% CI...
170 citations
TL;DR: The increased use of bedside TTE focused on the right heart could facilitate more personalized management and treatment of hospitalized patients and can contribute towards reducing the high mortality associated with SARS-CoV-2 infection.
Abstract: Due to the SARS-CoV-2 infection-related severe pulmonary tissue damages associated with a relative specific widespread thrombotic microangiopathy, the pathophysiologic role of heart-lung interactions becomes crucial for the development and progression of right ventricular (RV) dysfunction. The high resistance in the pulmonary circulation, as a result of small vessel thrombosis and hypoxemia, is the major cause of right heart failure associated with a particularly high mortality in severe COVID-19. Timely identification of patients at high risk for RV failure, optimization of mechanical ventilation to limit its adverse effects on RV preload and afterload, avoidance of medication-related increase in the pulmonary vascular resistance, and the use of extracorporeal membrane oxygenation in refractory respiratory failure with hemodynamic instability, before RV failure develops, can improve patient survival. Since it was confirmed that the right-sided heart is particularly involved in the clinical deterioration of patients with COVID-19 and pressure overload-induced RV dysfunction plays a key role for patient outcome, transthoracic echocardiography (TTE) received increasing attention. Limited TTE focused on the right heart appears highly useful in hospitalized COVID-19 patients and particularly beneficial for monitoring of critically ill patients. In addition to detection of right-sided heart dilation and RV dysfunction, it enables assessment of RV-pulmonary arterial coupling and evaluation of RV adaptability to pressure loading which facilitate useful prognostic statements to be made. The increased use of bedside TTE focused on the right heart could facilitate more personalized management and treatment of hospitalized patients and can contribute towards reducing the high mortality associated with SARS-CoV-2 infection.
24 citations
Cites background from "Evaluation of the right ventricle b..."
...In PAH, the LAIRV can reach values of 25 even in patients with relevant RV dysfunction, suggesting that in the vast majority of PAH patients, the cause of RV failure is the excessive pressure overload and not a relevantly impaired RV contractility [77, 85, 92]....
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...This explains why RV failure is more likely and more faster reversible than LV failure of similar severity and also the reverse remodeling with normalization of RV function in the overwhelming majority of patients with pre-capillary PH-induced severe RV dysfunction, after they underwent lung transplantation [77, 85]....
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...Whereas optimal PEEP is beneficial by acting as a counterforce against superimposed pressure, thereby preventing atelectasis, and too low PEEP can induce atelectotrauma, high PEEP levels cause overinflation of the normal alveoli and compression of intraalveolar vessels, which lead to high PVR and 1 3 thereby to increased RV afterload [43, 51]....
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...Tidal forces and PEEP increase PVR in direct proportion to their effects on mean airway pressure [46]....
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...Because of the relevant impact of LV size and function on RV geometry and performance, the complex and different contraction-relaxation mechanism among the main segments of the RV, and the particularly high dependency of RV size, geometry, and function on RV loading conditions, even in the presence of unaltered myocardial contractility, collection of ECHO-data and especially their accurate interpretation is often a very challenging task [73, 77]....
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TL;DR: This review summarizes the available evidence on the usefulness and limitations of comprehensive evaluation of LV and RV systolic function by using all the currently available ECHO techniques.
14 citations
Journal Article•
TL;DR: In this article, the correlation between traditional (fractional shortening, s'RV, TAPSE) and innovative (strain) echocardiographic parameters and RV ejection fraction (RVEF) measured by CMR was explored.
Abstract: AIMS
Right ventricle fractional area change (RVFAC), tissue Doppler and M-mode measurements of tricuspid systolic motion [tricuspid Sm and tricuspid annular plane systolic excursion (TAPSE)], and 3D echocardiography are the current non-invasive methods for the quantification of RV systolic function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of RV performance. Using cardiac magnetic resonance (CMR) as the reference standard, this study aimed at exploring the correlation between the traditional (fractional shortening, s'RV, TAPSE) and innovative (strain) echocardiographic parameters and RV ejection fraction (RVEF) measured by CMR.
METHODS AND RESULTS
CMR and transthoracic echo-Doppler were performed in 63 patients referred for clinical assessment. Twenty-one presented the suspicion of myocarditis, 8 presented idiopathic dilated cardiomyopathy, 10 hypertrophic cardiomyopathy, 10 arrhythmogenic right ventricular dysplasia (ARVD), 5 infiltrative cardiomyopathy, and 9 other reasons. RVEF was measured by magnetic resonance imaging (MRI). RVFAC, tricuspid S', and TAPSE were calculated in all patients. RV longitudinal strain (RVLS) by STE was assessed by averaging RV free-wall segments (free-wall RVLS) and by averaging all segments (global RVLS). The ROC analysis was applied for the assessment of diagnostic accuracy. Good correlations were found for TAPSE, tricuspid S', and global RVLS with RVEF (r = 0.45, r = 0.52, and r = -0.71, respectively; P = 0.01 for all). Close correlations between free-wall RVLS and RVFAC with RVEF were found (r = -0.86 and r = 0.77, respectively; P < 0.0001 for both). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy [area under curve (AUC) 0.92] and good sensitivity and specificity of 96 and 93%, respectively, to predict reduced RVEF <45%, using a cut-off value of less than -17.0%.
CONCLUSION
In a heterogeneous group of patients referred to CMR evaluation, conventional (TAPSE, FAC, and tricuspid S') and novice (2D speckle-tracking-derived longitudinal strain) parameters of RV systolic function were compared and correlated with RVEF measured by MRI. All tested parameters were found to be independent predictors of reduced RVEF (<45%), but the strongest correlation was seen for the RV free-wall longitudinal strain.
11 citations
TL;DR: Proper assessment of RV function and its adaptability to hemodynamic overloading before LVAD implantation can predict post-implant RVF, thus helping to avoid complications generated by unforeseen RVF in LVAD recipients.
Abstract: Because end-stage heart failure (HF) often involves both ventricles even if its initial cause was left-sided heart disease, assessment of RV size, geometry and function before, during and after LVA...
10 citations
Cites methods from "Evaluation of the right ventricle b..."
...the diastolic pulmonary gradient (DPG), the pulmonary artery pulsatility index (PAPi) derived as (PAPs – PAPd)/CVP and the RHC-derived RV stroke work index (SWIRV) appeared more useful for assessment of RV function in LVAD candidates than individual hemodynamic variables [7,94,97]....
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References
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TL;DR: The Society of Echocardiography (SEDC) is an educational activity for cardiovascular physicians and cardiac sonographers with a knowledge base in the field of echo-cardiography as discussed by the authors.
Abstract: on Statement: Society of Echocardiography is accreditedby theAccreditationCouncil for edical Education to provide continuingmedical education for physicians. n Society of Echocardiography designates this educational activity for of 1.0 AMA PRA Category 1 Credits . Physicians should only claim credit te with the extent of their participation in the activity. CCI recognize ASE’s certificates and have agreed to honor the credit hours registry requirements for sonographers. Society of Echocardiography is committed to ensuring that its educational ll sponsored educational programs are not influencedby the special interests ation or individual, and itsmandate is to retain only those authors whose fists canbeeffectively resolved tomaintain thegoals andeducational integrity y. While a monetary or professional affiliation with a corporation does not fluence an author’s presentation, the Essential Areas and policies of the ire that any relationships that could possibly conflict with the educational activity be resolved prior to publication and disclosed to the audience. f faculty and commercial support relationships, if any, have been indicated. ience: is designed for all cardiovascular physicians and cardiac sonographers with erest and knowledge base in the field of echocardiography; in addition, reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
5,151 citations
01 Jan 2014
TL;DR: This activity is designed for all cardiovascular physicians and cardiac sonographers with arest and knowledge base in the field of echocardiography and reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
Abstract: on Statement: Society of Echocardiography is accredited by the Accreditation Council for edical Education to provide continuing medical education for physicians. n Society of Echocardiography designates this educational activity for of 1.0 AMA PRA Category 1 Credits . Physicians should only claim credit te with the extent of their participation in the activity. CCI recognize ASE’s certificates and have agreed to honor the credit hours registry requirements for sonographers. Society of Echocardiography is committed to ensuring that its educational ll sponsored educational programs are not influenced by the special interests ation or individual, and its mandate is to retain only those authors whose fists can be effectively resolved to maintain the goals andeducational integrity y. While a monetary or professional affiliation with a corporation does not fluence an author’s presentation, the Essential Areas and policies of the ire that any relationships that could possibly conflict with the educational activity be resolved prior to publication and disclosed to the audience. f faculty and commercial support relationships, if any, have been indicated. ience: is designed for all cardiovascular physicians and cardiac sonographers with erest and knowledge base in the field of echocardiography; in addition, reschers, clinicians, intensivists, and other medical professionals with a spein cardiac ultrasound will find this activity beneficial.
4,739 citations
Book•
18 Nov 1991
TL;DR: The Cardiovascular Disease and Disorders of other Organ Systems chapter discussesCardiovascular Disease in Special Populations, Disorders of the Heart, Pericardium and Pulmonary Vascular Bed, and Molecular Biology and Genetics.
Abstract: PART I General Considerations of Cardiovascular Disease PART II Examination of the Patient PART III Normal and Abnormal Cardiac Function: Heart Failure and Arrhythmias PART IV Hypertensive and Atherosclerotic Cardiovascular Disease PART V Diseases of the Heart, Pericardium and Pulmonary Vascular Bed PART VI Molecular Biology and Genetics PART VII Cardiovascular Disease in Special Populations PART VIII Cardiovascular Disease and Disorders of other Organ Systems
4,432 citations
University of Texas Health Science Center at Houston1, Virginia Commonwealth University2, Stony Brook University3, University of California, Los Angeles4, University of Pittsburgh5, University of Pennsylvania6, New York University7, University of Colorado Denver8, University of Illinois at Chicago9, Harvard University10, National Institutes of Health11, Cleveland Clinic12
TL;DR: Mortality was most closely associated with right ventricular hemodynamic function and can be characterized by means of an equation using three variables: mean pulmonary artery pressure, mean right atrial pressure, and cardiac index.
Abstract: Objective To characterize mortality in persons diagnosed with primary pulmonary hypertension and to investigate factors associated with survival. Design Registry with prospective follow-up. Setting Thirty-two clinical centers in the United States participating in the Patient Registry for the Characterization of Primary Pulmonary Hypertension supported by the National Heart, Lung, and Blood Institute. Patients Patients (194) diagnosed at clinical centers between 1 July 1981 and 31 December 1985 and followed through 8 August 1988. Measurements At diagnosis, measurements of hemodynamic variables, pulmonary function, and gas exchange variables were taken in addition to information on demographic variables, medical history, and life-style. Patients were followed for survival at 6-month intervals. Main results The estimated median survival of these patients was 2.8 years (95% Cl, 1.9 to 3.7 years). Estimated single-year survival rates were as follows: at 1 year, 68% (Cl, 61% to 75%); at 3 years, 48% (Cl, 41% to 55%); and at 5 years, 34% (Cl, 24% to 44%). Variables associated with poor survival included a New York Heart Association (NYHA) functional class of III or IV, presence of Raynaud phenomenon, elevated mean right atrial pressure, elevated mean pulmonary artery pressure, decreased cardiac index, and decreased diffusing capacity for carbon monoxide (DLCO). Drug therapy at entry or discharge was not associated with survival duration. Conclusions Mortality was most closely associated with right ventricular hemodynamic function and can be characterized by means of an equation using three variables: mean pulmonary artery pressure, mean right atrial pressure, and cardiac index. Such an equation, once validated prospectively, could be used as an adjunct in planning treatment strategies and allocating medical resources.
3,301 citations
01 Jan 2011
TL;DR: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2-Volume Set, 9th Edition Expert Consult Premium Edition €“ Enhanced Online Features - Libros de Medicina - Sistema Cardiovascular - 218,00
Abstract: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2-Volume Set, 9th Edition Expert Consult Premium Edition €“ Enhanced Online Features - Libros de Medicina - Sistema Cardiovascular - 218,00
1,538 citations