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ABSTRACT Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.
RESUMO A ecocardiografia do paciente grave tem se tornado fundamental na avaliação de pacientes em diferentes cenários e ambientes hospitalares. Entretanto, ao contrário de outras áreas relativas ao cuidado com esses pacientes, ainda não existem recomendações de sociedades médicas nacionais acerca do assunto. O objetivo deste documento foi organizar e disponibilizar opiniões de consenso de especialistas que possam auxiliar a melhor incorporação dessa técnica na avaliação de pacientes graves. Dessa forma, a Associação de Medicina Intensiva Brasileira, a Associação Brasileira de Medicina de Emergência e a Sociedade Brasileira de Medicina Hospitalar compuseram um grupo de 17 médicos para formular questões pertinentes ao tópico e debater a possibilidade de consenso de especialistas para cada uma delas. Todas as questões foram elaboradas no formato de escala Likert de cinco pontos. Consenso foi definido, a priori, como um somatório de, ao menos, 80% das respostas entre um e dois ou entre quatro e cinco. A apreciação das questões envolveu dois ciclos de votação e debate entre todos os participantes. As 27 questões elaboradas compõem o presente documento e estão divididas em 4 grandes áreas de avaliação: da função ventricular esquerda; da função ventricular direita; diagnóstica dos choques e hemodinâmica. Ao fim do processo, houve 17 consensos positivos (concordância) e 3 negativos (discordância); outras 7 questões persistiram sem consenso. Embora persistam áreas de incerteza, este documento reúne opiniões de consenso para diversas questões relativas à ecocardiografia do paciente grave e pode potencializar seu desenvolvimento no cenário nacional.
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Objective:To explore the changes of right ventricular myocardial perfusion in pulmonary arterial hypertension (PAH) pig models with a quantitative analysis technique based on dynamic SPECT myocardial perfusion imaging, and analyze the relationship between myocardial blood flow, hemodynamics and right ventricular function.Methods:Eleven Chinese miniature pigs (all males, 6-8 months old) weighing 25-30 kg were selected. The PAH models were established by ligating the main pulmonary artery and embolizing the right lower pulmonary artery. After the models were established, dynamic myocardial perfusion imaging with one-day resting/adenosine stress 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT was performed, and the quantitative parameters of left and right ventricles were obtained, including stress myocardial blood flow (SMBF), rest myocardial blood flow (RMBF) and myocardial flow reserve (MFR: the ratio of stress to rest myocardial blood flow). Right heart catheterization was performed to evaluate the mean pulmonary arterial pressure (mPAP), and the right heart function index tricuspid annular plane systolic excursion (TAPSE) was measured by transthoracic echocardiography. According to TAPSE, animals were divided into right heart function preserved group ( n=5, TAPSE≥17 mm) and right heart dysfunction group ( n=4, TAPSE<17 mm). Pearson correlation analysis and the independent-sample t test were used for data analysis. Results:Nine experimental pig models were established with increased mPAP of (38.1 ± 11.6 ) mmHg (1 mmHg=0.133 kPa). Myocardial perfusion imaging showed clear radiotracer uptake in the right heart and myocardial hypertrophy. There was a significant positive correlation between right ventricular myocardial RMBF ((0.71±0.13) ml·min -1·g -1) and mPAP ( r=0.94, P< 0.001). The SMBF in the decreased right ventricular function group was significantly lower than that in the preserved right ventricular function group ((1.66±0.35) vs (2.24±0.30) ml·min -1·g -1;t=2.68, P=0.032). Conclusion:SPECT myocardial blood flow quantification can be used to evaluate the right ventricular myocardial blood flow in pig models of PAH.
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Objective:To evaluate the right ventricular function in patients with dilated cardiomyopathy (DCM) by four-dimensional automatic right ventricular quantitative analysis (4D Auto RVQ), and compare with the right ventricular ejection fraction measured by cardiac magnetic resonance (CMR-RVEF), and to explore the clinical application value of 4D Auto RVQ technique in evaluating the right ventricular function of patients with DCM.Methods:A prospective study was conducted to select 52 patients with DCM who were treated in Fuwai Central China Cardiovascular Hospital of Zhengzhou University from March to October 2022 as DCM group, and 52 healthy volunteers were selected as the control group during the same period. The four-dimensional right ventricular ejection fraction (4D-RVEF), right ventricular stroke volume index (RVSVI), right ventricular end-diastolic volume index (RVEDVI), right ventricular end-systolic volume index (RVESVI), four-dimensional right ventricular basal diameter (4D-RVDd-base), four-dimensional right ventricular middle diameter (4D-RVDd-mid), four-dimensional right ventricular long axis diameter (4D-RVLd), four-dimensional tricuspid annular plane systolic excursion (4D-TAPSE) and four-dimensional right ventricular fractional area change (4D-RVFAC) were obtained by 4D Auto RVQ technique. The differences of the above parameters between DCM group and control group were compared.Pearson linear correlation analysis was used to evaluate the correlation between echocardiographic parameters and CMR-RVEF. The ROC curve was used to find the most sensitive parameters for evaluating right ventricular function, and the area under the ROC curve ( AUC ) was calculated and compared.Results:Compared with the control group, RVEDVI, RVESVI, 4D-RVDd-base and 4D-RVDd-mid in the DCM group were increased, and the absolute values of 4D-RVEF, 4D-TAPSE, 4D-RVFAC, right ventricular global longitudinal strain(RVGLS) and right ventricular free wall longitudinal strain(RVFWLS) were decreased (all P<0.05). Correlation analysis showed that 4D-RVEF was positively correlated with CMR-RVEF ( r=0.711, P<0.05). ROC curve analysis showed that 4D-RVEF was superior to other parameters in evaluating right ventricular function in DCM patients (AUC: 0.916). Conclusions:4D Auto RVQ technique can quantitatively evaluate right ventricular function in DCM patients. 4D-RVEF has a significant correlation with CMR-RVEF, and 4D-RVEF has the best efficacy in evaluating right ventricular function in DCM patients.
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Objective:To evaluate the effect of cinacalcet on right ventricular function in rats with MCT-induced arterial pulmonary hypertension by echocardiography.Methods:Thirty male SD rats were randomly divided into control group, PAH group, and cinacalcet group, with 10 rats in each group. Rats in the cinacalcet group were given intraperitoneal injection of cinacalcet hydrochloride with 30 mg/kg, and the control group and the PAH group were given equal-volume of solvent. Echocardiographic parameters: right ventricular wall thickness (RVWT), right ventricular basal dimension (RVD), left ventricular eccentricity index (EI), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tricuspid lateral annular systolic velocity (s′), right ventricular global longitudinal strain (RV4CSL), and right ventricular free wall longitudinal strain (RVFWSL), etc. Histopathological parameters: pulmonary arteriole wall thickness (WT), right ventricular cardiomyocyte mean diameter (RV cell-D), collagen volume fraction (CVF) and right ventricular hypertrophy index (RVI). Echocardiographic and pathological parameters were compared among three groups, and the correlation between right ventricular pathological changes and strain parameters was analyzed.Results:①Compared with the control group, WT, RV cell-D, CVF and RVI in PAH group were increased (all P<0.01), the size of right ventricle and thickness of RV wall were increased (all P<0.05), and the right ventricular longitudinal strain was reduced ( P<0.01). ②Compared with the PAH group, rats in the cinacalcet group showed reduced WT, RV cell-D, CVF and RVI (all P<0.01), as well as improved structure and function of the right ventricle (all P<0.05). There was no statistical difference of the above parameters between cinacalcet and control group (all P>0.05). ③Correlation analysis: the right chamber remodeling parameters CVF and RV cell-D were positively correlated with WT ( rs=0.706 3, 0.629 4; both P<0.05); and RVFWSL correlated well with CVF, RV cell-D ( rs=-0.685 3, r=-0.767 2; both P<0.05). Conclusions:The right ventricular inverse remodeling of PAH rats with the intervention of cinacalcet was retained, suggesting that cinacalcet had a protective effect on the structure and function of the right ventricle in rats with PAH.
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Objective:To observe the feasibility of evaluating right ventricular (RV) function by the method based on left ventricle (LV) pressure-strain ring (PSL) technique in patients with systemic lupus erythematosus (SLE), and to evaluate the efficacy of non-invasive PSL in the diagnosis of dysfunction of both LV and RV.Methods:Thirty-nine patients were enrolled with SLE who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from March 2020 to September 2021 and 57 sex- and age-matched healthy controls underwent assessment by conventional echocardiography, two-dimensional speckle tracking imaging (2D-STI) and myocardial work (MW). The echocardiographic parameters were compared between the groups. The correlations between RVMW parameters and conventional echocardiographic parameters, and between MW parameters and SLEDAI-2K score were analyzed by Spearman correlation analysis.Results:①The two groups did not show any difference at the conventional echocardiographic parameters of the LV systolic function ( P>0.05). In the SLE group, tricuspid regurgitation maximal velocity (TR V max) and right ventricular index of myocardial performance (RIMP) increased, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular S′ (S′ tv) decreased (all P<0.05), and others did not show statistical difference (all P>0.05). ②The 2D-STI parameters: There were no significant differences in left ventricular global longitudinal strain (LV GLS) ( P>0.05), however RVGLS decreased ( P<0.05). ③The MW parameters of LV and RV: including global constructive work (GCW), global work index (GWI), global wasted work (GWW), and global work efficiency (GWE). In SLE group, LV GWE, RV GWE decreased and LV GWW, RV GWW increased ( P<0.05), others were no significant differences ( P>0.05). ④The correlation analysis: RV GWI positively correlated with TR V max ( rs=0.481). RV GCW positively correlated with TR V max ( rs=0.587). RV GWW positively correlated with right atrial area (RAA) and TR V max ( rs=0.429, 0.610), negatively correlated with S′ tv ( rs=-0.342). RV GWE positively correlated with S′ tv ( rs=0.326) and negatively correlated with RAA ( rs=-0.462) (all P<0.05). SLEDAI-2K score was negatively correlated with LV GLS ( rs=-0.333) and LV GWI ( rs=-0.326) ( P<0.05). Conclusions:The study has shown the impaired systolic function of both LV and RV in patients with SLE. PSL technique, especially RVMV based on LV PSL technique might emerged as a novel measure to evaluate systolic dysfunction in SLE patients.
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Objective:To investigate the alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation(PAF) and concomitant heart failure with preserved ejection fraction (HFpEF).Methods:The prospective observational study was performed in patients with HFpEF-PAF and undergoing first-time radiofrequency ablation procedures in the First Affiliated Hospital of Nanjing University between May to December 2019. Right ventricular functional parameters were measured before and 5 days, 1, 3, 6 and 12 months after the ablation by transthoracic echocardiography, respectively, including the right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion(TAPSE), tricuspid annular diameter (TVAD), tricuspid annular peak systolic speed(TDI-S′) and longitudinal strain of right ventricular free wall (RVFLS). Meanwhile, routine ECG and Holter recordings were performed at each follow-up time point.Results:In this study, atrial fibrillation (AF) recurrence occurred in 4 patients at the 3rd month after ablation, and 7 patients failed to follow up due to the Covid-19. Finally, 19 patients were followed up for the evaluation of cardiac function after catheter ablation. Compared with pre-ablation, right ventricular structural and functional paramters(RVFAC, TAPSE, TVAD, TDI-S′, RVFLS) improved significantly at all stages of follow-up( all P<0.05). Patients with atrial fibrillation recurrence had lower RVFLS and TDI-S′ at the baseline( P=0.039, P=0.019). Conclusions:Right ventricular function could improve in HFpEF-PAF patients who maintain sinus rhythm after radiofrequency ablation.
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Objective:To explore the application value of right modified myocardial work index (Mod-RMPI) in assessing fetal right ventricular function in assisted reproductive technology (ART).Methods:Sixty-four fetuses conceived by assisted reproduction (ART group) and 80 fetuses with spontaneously conceived (SC) pregnancies (control group) from November 2021 to February 2022 underwent echocardiography in the Third Affiliated Hospital of Zhengzhou University were enrolled, gestational ranges from 20 to 28 weeks. The differences of Mod-RMPI, tricuspid valve E/A ratio (TV-E/A) were compared between the ART group and the control group; The correlation between maternal age, body mass index (BMI), pregnancy, and delivery and Mod-RMPI in the ART group was analyzed by applying multiple linear regression analysis; The receiver operating characteristic (ROC) curves were used to test the predictive efficacy of Mod-RMPI for adverse pregnancy outcomes.Results:①Compared with the control group, Mod-RMPI, isovolumetric relaxation time(IRT), isovolumetric contraction time(ICT) and BMI were increased in ART group with statistically significant difference, ventricular ejection time (ET) were decreased, the difference was (all P<0.05). But there were no significant differences in total spent time (TST) and TV-E/A compared with the control group ( P>0.05). ②There were no correlations between maternal age, BMI, gravidity, and times of bearing birth and Mod-RMPI ( P>0.05). ③The ROC curve analysis showed the area under the curve of Mod-RMPI for predicting adverse pregnancy outcome was 0.748, the optimal cut-off value was 0.465, the sensitivity was 0.778, and the specificity was 0.608. Conclusions:ART can affect fetal right ventricular function.Mod-RMPI has good consistency and repeatability, and has certain value in predicting adverse pregnancy outcome.
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Objective:To investigate the effect of preoperative pulmonary hypertension (PH) on right ventricular function in patients with heart transplantation(HTx) one year after surgery.Methods:A total of 120 patients who underwent HTx in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2017 to January 2020 were retrospectively recruited.According to the mean pulmonary arterial pressure (mPAP) obtained by preoperative right heart catheterization, the research subjects were divided into the pulmonary hypertension group (PH group, n=81) and without pulmonary hypertension group (NPH group, n=39). Conventional echocardiographic indices of right ventricular function such as right ventricular area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid lateral annular systolic velocity (S′), and two-dimensional speckle tracking imaging (2D-STI) strain parameters including right ventricular global longitudinal strain (RV-GLS), right ventricular free wall longitudinal strain (RV-FWLS) were obtained to assess the right ventricular function of grafted hearts. The echocardiographic parameters one year after the operation of the two groups were analyzed to compare the differences in right ventricular function and their correlation with preoperative mPAP. Results:The grafted heart RV-GLS and RV-FWLS were significantly decreased in the PH group (all P<0.01), while RV-FAC, TAPSE, and S′ were similar between the two groups (all P>0.05). RV-FWLS and RV-GLS correlated with preoperative hemodynamic parameter mPAP( rs=-0.46, -0.54; all P<0.05)while RV-FAC, TAPSE, and S′ were not significantly correlated with mPAP (all P>0.05). Conclusions:Preoperative PH correlates with right ventricular function in HTx patients 1 year after the operation. The absolute values of RV-FWLS and RV-GLS in HTx patients with preoperative PH decrease 1 year after the operation. 2D-STI is more sensitive than conventional echocardiography to monitor the changes in right ventricular function in HTx patients after the operation.
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Resumo Fundamento A ressonância magnética cardíaca (RMC) é o método de escolha para avaliar as dimensões e a função do ventrículo direito (VD), e a insuficiência pulmonar (IP). Objetivos Avaliar a acurácia da ecocardiografia bidimensional (ECO 2D) em estimar a função e as dimensões do VD e o grau de IP, e comparar os resultados obtidos pela ECO 2D com os da RMC. Métodos Comparamos os relatórios de ECO e RMC de pacientes cuja indicação para RMC havia sido para avaliar VD e IP. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados Incluímos 51 pacientes com cardiopatia congênita com idade mediana de 9,3 anos (7-13,3 anos). Observou-se uma baixa concordância entre ECO 2D e RMC quanto à classificação da dimensão (Kappa 0,19; IC 95% 0,05 a 0,33, p 0,004) e da função do VD (Kappa 0,16; IC 95% -0,01 a +0,34; p 0,034). O tamanho do VD foi subestimado pela ECO 2D em 43% dos casos, e a função do VD foi superestimada pela ECO 2D em 29% dos casos. O grau de concordância entre os métodos quanto à classificação da IP não foi significativo (Kappa 0,014; IC 95% -0,03 a +0,06; p 0,27). Houve uma tendência de a ECO 2D superestimar o grau da IP. Conclusões A ECO 2D mostrou baixa concordância com a RMC quanto às dimensões e função do VD, e grau de IP. Em geral, a ECO subestimou as dimensões do VD e superestimou a função do VD e o grau de IP quando comparada à RMC.
Abstract Background Cardiac magnetic resonance (CMR) is the method of choice for assessing right ventricular (RV) dimensions and function, and pulmonary insufficiency (PI). Objectives To assess the accuracy of two-dimensional echocardiography (2D ECHO) in estimating RV function and dimensions, and the degree of PI, and compare the 2D ECHO and CMR findings. Methods We compared ECHO and CMR reports of patients whose indication for CMR had been to assess RV and PI. A p-value < 0.05 was considered statistically significant. Results We included 51 congenital heart disease patients, with a median age of 9.3 years (7-13.3 years). There was poor agreement between 2D ECHO and CMR for classification of the RV dimension (Kappa 0.19; 95% CI 0.05 to 0.33, p 0.004) and function (Kappa 0.16; 95% CI -0.01 to +0.34; p 0.034). The RV was undersized by 2D ECHO in 43% of the cases, and RV function was overestimated by ECHO in 29% of the cases. The degree of agreement between the methods in the classification of PI was not significant (Kappa 0.014; 95% CI -0.03 to +0.06, p 0.27). 2D ECHO tended to overestimate the degree of PI. Conclusions The 2D ECHO showed a low agreement with CMR regarding the RV dimensions and function, and degree of PI. In general, ECHO underestimated the dimensions of the RV and overestimated the function of the RV and the degree of PI as compared with CMR.
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Humans , Child , Ventricular Dysfunction, Right/diagnostic imaging , Echocardiography, Three-Dimensional , Heart Defects, Congenital , Stroke Volume , Echocardiography , Magnetic Resonance Spectroscopy , Reproducibility of Results , Ventricular Function, Right , Magnetic Resonance Imaging, Cine , Heart Ventricles/diagnostic imagingABSTRACT
Resumo Fundamento A nova doença por coronavírus (COVID-19) pode levar a uma enfermidade grave e causar a morte. Sabe-se que a COVID-19 afeta o sistema cardiovascular. A detecção precoce da progressão para um estágio grave da doença que afeta o sistema cardiovascular pode desempenhar um papel crítico no tratamento da COVID-19. Objetivos Explorar a possível relação entre a pneumonia por COVID-19 e os achados de strain do ventrículo direito no eletrocardiograma (ECG). Métodos Foi realizado um estudo retrospectivo de 141 pacientes hospitalizados com COVID-19. A correlação de Spearman e as análises de regressão logística foram aplicadas para avaliar as relações entre as manifestações de strain ventricular direito na ECG e os níveis de biomarcadores e outros achados laboratoriais e de imagem do tórax. O nível de significância foi considerado estabelecido como p < 0,05. Resultados Os sinais de ECG de estresse ventricular direito foram significativamente mais frequentes e os níveis de fibrinogênio, PCR e ferritina foram significativamente mais elevados em pacientes com COVID-19 com níveis elevados de hs-cTnI, procalcitonina e dímero-D. A análise univariada mostrou que existem relações significativas entre a presença de pneumonia bilateral, a maioria dos sinais eletrocardiográficos de strain ventricular direito e lesão cardíaca e biomarcadores inflamatórios e trombóticos. A análise multivariada revelou que o supradesnivelamento do segmento ST em V1 e padrão S1Q3T3 são preditores independentes de lesão cardíaca ( odds ratio =0,23; IC95%, 0,06 a 0,90; p=0,035) e níveis elevados de procalcitonina ( odds ratio =0,19; IC 95%, 0,06 a 0,62; p=0,006), respectivamente. Conclusão Os achados do presente estudo sugerem que a dano cardíaco direito é prevalente na COVID-19. Além disso, nosso estudo demonstra o valor clínico do ECG na avaliação e monitoramento de pacientes com pneumonia por COVID-19.
Abstract Background The novel coronavirus disease (COVID-19) may lead to severe disease that can cause death. COVID-19 is known to affect the cardiovascular system. Early detection of the progression to the severe disease stage that affects the cardiovascular system may play a critical role in the treatment of COVID-19. Objectives To explore the possible relationship between the COVID-19 pneumonia and right ventricular strain findings on electrocardiography (ECG). Methods We conducted a retrospective study of 141 hospitalized patients with COVID-19. Spearman's correlation and logistic regression analyses were applied to assess relationships between ECG manifestations of right ventricular strain and levels of biomarkers and other laboratory and chest imaging findings. The significance level was considered as < 0.05. Results The ECG signs of right ventricular stress were significantly more frequent and the levels of fibrinogen, CRP, and ferritin were significantly higher in COVID-19 patients with elevated levels of hs-cTnI, procalcitonin and D-dimer. The univariate analysis showed there are significant relations between the presence of bilateral pneumonia, most of the ECG signs of right ventricular strain and cardiac injury and inflammatory and thrombotic biomarkers. The multivariate analysis revealed that ST-segment elevation in V1and the S1Q3T3pattern are independent predictors of cardiac damage (odds ratio=0.23; 95% CI, 0.06 to 0.90; p=0.035) and elevated procalcitonin levels (odds ratio=0.19; 95% CI, 0.06 to 0.62; p=0.006), respectively. Conclusion The findings of the present study suggest that right heart damage is prevalent in COVID-19. In addition, our study shows the clinical value of ECG in evaluating and monitoring the patients with COVID-19 pneumonia.
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Humans , Pneumonia , COVID-19 , Biomarkers , Retrospective Studies , Electrocardiography , SARS-CoV-2ABSTRACT
Objective:To evaluate the feasibility of a new ultrasonic parameter to assess right ventricular-pulmonary artery (RV-PA) coupling in patients with acute pulmonary embolism (APE).Methods:A retrospective analysis was performed in 140 patients with APE diagnosed by computed tomography pulmonary angiography (CTPA) in the Second Affiliated Hospital of Harbin Medical University from August 2017 to June 2020. According to the tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio cutoff value 0.40 mm/mmHg reported by the European Society of Cardiology in 2020, the patients were divided into the coupling group ( n=99) and the uncoupling group ( n=41). The conventional ultrasonic parameters of the 2 groups were measured, and then several ultrasonic parameter ratios were obtained. The new ultrasonic parameter, which can replace the TAPSE/PASP ratio, was screened out by Spearman correlation analysis, and ROC curve was plotted to calculate the diagnostic efficacy of this parameter. Results:①Compared with the coupling group, patients in the uncoupling group were older and more likely to be accompanied by dyspnea and venous thrombosis in the lower extremities (all P<0.05), but there was no significant difference in other general data(all P>0.05); ②Compared with the coupling group, tricuspid regurgitation velocity (TRV), tricuspid regurgitation pressure gradient(TRPG), PASP, right ventricle end-diastolic transverse diameter(RVTD), inferior vena cava(IVC) diameter and the ratio of early diastolic tricuspid inflow to tricuspid lateral annular velocity(E/e′), in the uncoupling group increased significantly (all P<0.05), and TAPSE, peak systolic velocity of tricuspid annulus(s′), TAPSE/PASP ratio, TAPSE/TRPG ratio, TAPSE/RVTD ratio and s′/TRPG ratio decreased significantly (all P<0.05); ③The TAPSE/TRPG ratio was highly correlated with TAPSE/PASP ratio ( rs=0.970, P<0.001); The TAPSE/TRPG ratio was still highly correlated with TAPSE/PASP ratio in the uncoupling and coupling groups ( rs=0.966, 0.922; all P<0.001). ④ROC analysis showed that the area under curve for TAPSE/TRPG in diagnosing RV-PA coupling was 0.992. At the cutoff of TAPSE/TRPG <0.625 mm/mmHg for indicating RV-PA coupling, the sensitivity and specificity were 97.6% and 92.9%, respectively. Conclusions:TAPSE/TRPG ratio can be used as a new ultrasonic parameter to reflect RV-PA coupling, which is helpful for clinical identification of APE patients with high risk and poor prognosis.
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Objective:To explore the feasibility, accuracy and reproducibility of a novel, fully automated three-dimensional echocardiography right ventricular(RV) quantification software(3D Anto RV) to evaluate the RV volume and RV ejection fraction (RVEF) using artificial intelligence in patients after heart transplantation (HT) comparing with the gold reference-cardiac magnetic resonance (CMR).Methods:Forty-six patients after HT who were scheduled for echocardiogram at their routine follow-up examinations and also agreed to undergo CMR examination within the following 24 hours in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2018 to June 2019 were prospectively included. The right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume (RVESV), right ventricular stroke volume (RVSV) and RVEF of HT patients were measured by CMR 3D Auto RV and conventional semi-automated three-dimensional echocardiography RV quantification software (Tomtec 4D RV function 2.0). The results of the 3D Auto RV and conventional semi-automated Tomtec were respectively compared with CMR using paired two-tailed student′s t-tests, Pearson correlation coefficients and Bland-Altman analyses. Results:The feasibility of the 3D Auto RV was 87%.The fully automated analysis realized in 27 (59%) patients by 3D Auto RV and the analysis time required only (12±1)s. The results of the remaining 19 (41%) patients needed manual adjustment and the mean analysis time in manual adjustment was also <2 min that was shorter than the conventional semi-automated three-dimensional echocardiography RV quantification software[(108±15)s vs (160±34)s, P<0.001]. For the results of RV volumes: There were good correlations between the 3D Auto RV and CMR, conventional semi-automated Tomtec and CMR for the measurements of RVEDV, RVESV and RVSV ( r=0.77-0.84, all P<0.001). In addition, compared with CMR, although there were significantly underestimated RV volumes by the 3D Auto RV and conventional semi-automated Tomtec, the negative bias was smaller in the 3D Auto RV than the conventional semi-automated Tomtec. For the results of RVEF: the corresponding RVEF derived from 3D Auto RV and CMR showed an excellent correlation and consistency ( r=0.84, P<0.001; bias=-1.1%, Limit of agreement=-8.1%-6.0%). In addition, the correlations between the manual adjustment by 3D Auto RV and the CMR ( r=0.63-0.72, all P<0.001) was lower than the correlations between the 3D Auto RV and the CMR ( r=0.76-0.82, all P<0.001) for RV volumes and RVEF.Finally, 3D Auto RV had a good reproducibility. Conclusions:The new fully 3D Auto RV quantification software underestimate RV volumes that less than the conventional semi-automated Tomtec. And the 3D Auto RV quantification software can accurately evaluate the RVEF in patients after HT with rapid analysis and higher reproducibility, which may also support the routine adoption of this method during follow-ups of HT patients in the daily clinical workflow.
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Abstract Constrictive pericarditis is a disease where loss of pericardial elasticity and restriction of filling of the cardiac chambers occurs. It is most often seen as an associated symptom of heart failure. Pericardiectomy provides effective treatment for patients with symptomatic constrictive pericarditis, although high rates of morbidity and mortality are related to the procedure. We present a case with extensive calcification, massive caseous necrosis and an important impairment of right ventricular function successfully operated in our institution.
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Humans , Pericarditis, Constrictive/surgery , Pericarditis, Constrictive/etiology , Pericarditis, Constrictive/diagnostic imaging , Vascular Calcification/complications , Heart Failure , Pericardium/surgery , Pericardium/diagnostic imaging , Pericardiectomy , NecrosisABSTRACT
Objective: To explore the value of quantitative parameters of CT pulmonary angiography in evaluating right heart function and prognosis of patients with central pulmonary embolism. Methods: Clinical data of 200 patients with central pulmonary embolism were retrospectively analyzed, including 35 cases died (death group) and 165 cases survived (survival group) during hospitalization. The quantitative parameters of CT pulmonary angiography and right heart function were compared between 2 groups. Results: Compared with the survival group, the pulmonary artery occlusion index, right ventricular short axis maximum diameter (RVSAMD), RVSAMD/left ventricular short axis maximum diameter (LVSAMD), pulmonary artery diameter in the death group all increased (all P< 0.001). There was no significant difference of LVSAMD between 2 groups (P=0.131). Multivariate Logistic regression analysis showed that CT pulmonary artery occlusion index, RVSAMD, RVSAMD/LVSAMD and increase of pulmonary artery diameter were the risk factors of death in patients with central pulmonary embolism (all P< 0.05). Pearson linear regression analysis showed that CT pulmonary artery occlusion index, RVSAMD/LVSAMD and pulmonary artery diameter were all positively correlated with RVSAMD (all P< 0.05). Conclusion: The quantitative parameters of CT pulmonary angiography have certain value in predicting right heart function and prognosis of patients with central pulmonary embolism.
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Objective: To evaluate changes of right ventricular (RV) function in severe single vessel coronary artery disease patients before and after percutaneous coronary intervention (PCI) using three-dimensional speckle tracking imaging (3D-STI). Methods: Totally 25 patients with severe single vessel coronary artery disease but not myocardia infarction who underwent successful PCI were included in case group, while 42 patients without obvious coronary artery stenosis were selected as the controls(control group). Two-dimensional and three-dimensional (3D) ultrasonic images were collected before and 1 and 3 months after PCI. RV common parameters, right ventricular myocardial performance index (RVMPI), right ventricular fractional area change (RVFAC-3D), tricuspid annular plane systolic excursion (TAPSE-3D), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVEF-3D), right ventricular free wall longitudinal strain (FW-RVLS) and right ventricular septum longitudinal strain (Sep-RVLS) were measured. Results: In case group, RVMPI significantly increased compared with control group, TAPSE-3D (P0.05). FW-RVLS was lower in patients with right coronary artery (RCA) stenosis than other conditions (P0.05). RV function were significantly improved 1 month and 3 months after PCI (both P<0.05)in case group. Conclusion: The damage of RV function can be caused by severe single coronary artery lesion, especially in patients with RCA lesion. FW-RVLS3D-STI has good value for indicating damage of RV function, which might be improved after PCI.
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The incidence and mortality of heart failure with preserved ejection fraction (HFpEF) are increasing year by year. Right ventricle dysfunction (RVD) is an independent predictor of poor prognosis of HFpEF patients. Early evaluation of right heart structures and degrees of RVD are of great significance to the treatment and prognosis of HFpEF patients. The progresses of echocardiography in evaluation of the right heart structure and function in HFpEF were reviewed in this article.
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Objective: To explore the application value of right ventricular longitudinal shortening fraction (LSF) obtained with XPLANE technique for evaluation on changes of right ventricular function in patients with atrial septal defect (ASD) before and after percutaneous intervention (PI), and to analyze relative impact factors. Methods: Totally 68 patients with ultrasound-diagnosed ASD who accepted PI were collected. All patients underwent echocardiography before PI, 1 month and 3 months after PI, respectively. Then LSF of apical plane of 2-chamber (LSFAP2) and apical plane of 4-chamber (LSFAP4) images and the mean value of LSFAP2 and LSFAP4 (LSFAPM), tricuspid annular plane systolic excursion (TAPSE), pulmonary hypertension (PH) grading, as well as right ventricle end-diastolic diameter/left ventricle end-diastolic diameter (RVEDD/LVEDD) grading before and after PI were measured and compared. The correlation of LSFAP2, LSFAP4, LSFAPM and TAPSE, and the impact factors of LSFAPM were analyzed. Results: RVEDD/LVEDD (H=76.07, 77.74) and PH (H=42.02, 49.83) grading 1 month and 3 months after PI were lower than those before PI (all P0.05). There were statistical differences of remaining LSFAP2, LSFAP4, LSFAPM and TAPSE before and after PI (all P<0.05). LSF parameters before and after PI were positively correlated with TAPSE (all P<0.05).Age and preoperative PH grading were the common impact factors of LSFAPM before and after PI. Conclusion: XPLANE technique can be used to effectively observe the changes of right ventricular function in patients with ASD before and after PI. The morphology and function of right ventricle in patients can be improved with PI, and the variation trend of LSF parameters and TAPSE before and after PI are basically similar. Age and preoperative PH grading are impact factors of right heart function before and after PI.
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End-stage heart failure (HF) is a clinical syndrome in various heart diseases developed to end-stage with high morbidity and mortality. Heart transplantation is deemed as the only valid method for sufferers with end-stage HF, but implantation of left ventricular assist device (LVAD) has become an important treatment for HF patients at the end-stage for the critical shortage of cardiac donors. Right ventricular failure frequently occurred after LVAD implantation. Early identifying right ventricular failure after LVAD implanted has been an important clinical problem. The research progresses of echocardiography for evaluation on right ventricular function perioperative LVAD implantation were reviewed in this article.
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Objective: To evaluate the right ventricular (RV) function with 2D speckle tracking imaging (2D-STI) in patients with heart failure (HF). Methods Echocardiography was performed in 31 HF patients with reduced ejection fraction (HFREF group), 41 HF patients with preserved ejection fraction (HFPEF group) and 26 healthy volunteers (control group). Conventional ultrasonic parameters were obtained on apical four-chamber images, including RV wall thickness, RV basal diameter (RVD1), RV end systolic area (RVESA), RV end diastolic area (RVEDA), RV fractional area change (RVFAC), peak systolic velocity (S'), myocardial performance index (MPI), tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fraction (LVEF). 2D-STI was performed to observe strain parameters, including basal, middle, apical and the whole longitudinal peak systolic strain of RV free wall respectively (RVLSbas, RVLSmid, RVLSapi and RVLSfw). Then 2D strain parameters were compared among the three groups, and the correlation of 2D strain parameters and conventional ultrasonic parameters were analyzed. Results RV wall thickness, RVD1, MPI, RVFAC, TAPSE and LVEF were all significantly different among three groups (all P<0.01). RVLSbas, RVLSmid and RVLSfw gradually reduced in control group, HFPEF group and HFREF group (all P<0.05). RVLSfw had strong correlation with LVEF, TAPSE, MPI and RV wall thickness (r=-0.68, -0.53, 0.52, 0.51, all P<0.01) and had weak correlation with RVD1, FAC and S' (r=0.42, -0.46, -0.39, all P<0.01). Conclusion: 2D strain parameters can be used to assess RV function in patients with HF.