Determinants of Right Ventricular Failure in Patients Admitted With Acute Left Heart Failure (original) (raw)
Related papers
Assessment of right ventricular function by echocardiography in patients with chronic heart failure
The Egyptian Heart Journal, 2018
Background: The main focus of most of the studies in heart failure (HF) is the assessment of the left ventricular functions, while the right ventricle was much less studied. Much of this neglect is due to the complexity of anatomy and physiology of the right ventricle which are considered challenges during assessment of RV. Objective: [1] To review the alterations of right ventricular dimensions & function associated with chronic heart failure. [2] To predict the prevalence of right ventricular systolic dysfunction in patients with chronic heart failure, based on echocardiographic parameters. Methods: 100 chronic left sided heart failure patients with LVEF less than 40% were evaluated in Ain Shams University hospitals from April 2015 to March 2016. All patients were subjected to full history taking & clinical evaluation. ECG was done mainly to exclude presence of ischemic heart disease. Complete trans-thoracic echocardiography study was done for assessment of [B] Left ventricular dimensions, systolic and diastolic functions [B] Assessment of the right side of the heart: [1] Measurement of the right ventricular dimensions [basal-mid cavity and the longitudinal diameters]. [2] Right ventricular area and calculation of the fractional area change (FAC). [3] Tricuspid annular plane systolic excursion (TAPSE). [4] Tissue Doppler derived tricuspid lateral annular systolic velocity (S 0 wave velocity). [5] Tissue Doppler derived Myocardial Performance Index (MPI) (Tei index). [6] Grading of tricuspid regurgitation severity, and assessment of right ventricular systolic pressure. Results: Right ventricle was dilated at the basal level in 36% of the studied patients & at the mid cavity level in 23% of the patients. Longitudinal RV diameter was enlarged in 20% of the patients. Right ventricular systolic dysfunction was found in 36% of patients with DCM in the current study. Patients who had right ventricular systolic dysfunction had significantly higher incidence of elevated JVP, significantly lower EF and significantly higher grade of LV Diastolic dysfunction. They showed significantly larger RV dimensions at different levels, significantly worse degree of TR and significantly higher mean value of RVSP. Conclusions: The occurrence of right ventricular systolic dysfunction in patients with DCM is common [Approaching 40% in this study] and is independent of age and sex, and is proportionate to the degree of LV dilatation, and EF impairment.
Cardiovascular Ultrasound, 2007
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Echocardiography represents the "gold standard" in the assessment of LV systolic dysfunction and in the recognition of systolic heart failure, since dilatation of the LV results in alteration of intracardiac geometry and hemodynamics leading to increased morbidity and mortality.
European Heart Journal, 2007
Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF . 50% and an LV end-diastolic volume index (LVEDVI) ,97 mL/m 2 . Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure .16 mmHg or mean pulmonary capillary wedge pressure .12 mmHg) or non-invasively by tissue Doppler (TD) (E/E 0 . 15). If TD yields an E/E 0 ratio suggestive of diastolic LV dysfunction (15 . E/E 0 . 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion.
International Journal of Cardiology, 2005
Background: The presence of right ventricular systolic dysfunction is known to significantly worsen prognosis of patients with heart failure. However, the prognostic impact of right ventricular diastolic dysfunction and of its combination with right ventricular systolic dysfunction and with other prognostic markers has not yet been systematically studied. The aim of this study was to assess the prognostic impact of combined right ventricular systolic and diastolic dysfunction in patients with symptomatic heart failure due to ischemic or idiopathic dilated cardiomyopathy. Methods: The study included 177 consecutive patients with symptomatic heart failure (mean left ventricular ejection fraction of 23%). All patients underwent clinical and laboratory examination, standard echocardiography completed by Doppler tissue imaging of the tricuspid annular motion, and right-sided heart catheterization. They were followed up for a mean period of 16 months (range, 1-48 months). Results: During the follow-up, there were 28 cardiac-related deaths and 35 non-fatal cardiac events (31 hospitalizations for heart failure decompensation and 4 hospitalizations for malignant arrhythmias requiring the implantation of a cardioverter-defibrillator). The multivariate stepwise Cox regression modeling revealed the right ventricular systolic (represented by the peak systolic tricuspid annular velocity-Sa) and diastolic (represented by the peak early diastolic tricuspid annular velocity-Ea) function to be the independent predictors of event-free survival or survival ( pb0.01). The Sa separated better between patients with and without the risk of cardiac events ( pb0.05), while the Ea appeared to further distinguish patients with increased risk (those at risk of late event from those at risk of early non-fatal event and early death). The strongest predictive information was obtained by the combination of Sa and Ea creating the Sa/Ea categories. The Sa/Ea I category of patients (Saz10.8 cm s À1 and Eaz8.9 cm s À1 ) had excellent prognosis. On the other hand, the Sa/Ea IV category (Sab10.8 cm s À1 and Eab8.9 cm s À1 ) was found to be at a very high risk of cardiac events ( pb0.001 vs. Sa/Ea I). Imbalanced categories of patients (Sa/Ea II and III) with only one component (Sa or Ea) pathologically decreased were at medium risk when assessing event-free survival. However, a significantly better survival ( pb0.05) was found in patients with Eaz8.9 cm s À1 (Sa/Ea I and III categories) as compared with those having Eab8.9 cm s À1 (Sa/Ea II and IV categories). Thus, in contrast to event-free survival, the survival pattern was determined mainly by the Ea value with only little additional contribution of Sa. Conclusions: The assessment of right ventricular systolic and diastolic function provides complementary information with a very high power to stratify prognosis of patients with heart failure. The combination of right ventricular systolic and diastolic dysfunction identifies those with a very poor prognosis. D
The American Journal of Cardiology, 2007
It is unknown whether right ventricular (RV) tissue Doppler (TD) predicts outcome in patients with left ventricular (LV) heart failure (HF) independently of contemporary echocardiographic Doppler variables of LV diastolic function. Comprehensive echocardiographic Doppler examination was performed before discharge in 107 patients hospitalized with LV HF. The primary end point was cardiac death or rehospitalization for HF. Follow-up was complete for 100 of 107 patients a mean of 527 days after hospital discharge. There were no significant differences in baseline clinical variables (mean age 58 ؎ 12 years, 46% women, 77% hypertensive, 48% diabetic, 41% current smokers, and 23% known coronary artery disease) in prediction of the primary end point. Compared with patients without an event, patients with an event had a larger left atrial volume index (42 ؎ 16 vs 33 ؎ 13 ml/m 2 , p ؍ 0.001), lower LV ejection fraction (35 ؎ 19% vs 46 ؎ 22%, p ؍ 0.01), higher mitral peak early diastolic flow velocity/TD early diastolic velocity (19 ؎ 7 vs 14 ؎ 7, p ؍ 0.001), lower RV fractional area change (39 ؎ 11% vs 43 ؎ 10%, p ؍ 0.04), and lower RV TD systolic velocity (8 ؎ 2 vs 10 ؎ 3 cm/s, p ؍ 0.005). On Cox proportional hazards multivariate analysis, left atrial volume index (p ؍ 0.01), mitral peak early diastolic flow velocity/TD early diastolic velocity (p ؍ 0.03), and RV TD systolic velocity (p ؍ 0.04) were independent predictors of outcome. Even when contemporary echocardiographic Doppler measures of LV diastolic function are considered, RV TD systolic velocity is an independent predictor of cardiac death or rehospitalization for HF in patients hospitalized with HF and appears to be superior to conventional 2-dimensional parameters of RV function.
European Journal of Heart Failure, 2007
Background: The prognostic importance of right ventricular (RV) dysfunction in heart failure (HF) has been suggested in patients with severe systolic heart failure. Tricuspid annular plane systolic excursion (TAPSE) is a simple echocardiographic measure of RV ejection fraction, but may be affected by co-existing chronic obstructive pulmonary disease (COPD). Aims: To examine the prognostic information from TAPSE adjusted for the potential confounding effects of co-existing cardiovascular and COPD in a large series of patients admitted for new onset or worsening HF. Methods and results: Eight hundred and seventeen patients screened for participation in a large clinical trial by trans-thoracic echocardiography, including measurement of TAPSE, were followed for a median of 4.1 years (maximum 5.5 years). Decreased TAPSE as well as presence of COPD were independently associated with adverse short-and long-term survival, hazard ratio was 0.74 (p = 0.004) for every doubling of TAPSE; and 2.4 ( p < 0.0001) for the presence of COPD. Conclusion: Decreased RV systolic function as estimated by TAPSE is associated with increased mortality in patients admitted for HF, and is independent of other risk factors in HF including left ventricular function. The co-existence of COPD is also associated with an adverse prognosis independent of the RV systolic function.
Journal of Echocardiography, 2008
Background. Little is known of the pathophysiologic characteristics of a common disease cohort with congestive heart failure (CHF) and preserved left ventricular (LV) systolic function. The objective of this retrospective study was to determine the differences in the echocardiographic features in patients with or without previous evidence of newonset CHF in the outpatient setting using a selected common disease cohort. Methods and Results. We selected 72 consecutive outpatients, including 37 patients with hypertension, 16 with diabetes, 30 with hyperlipidemia, and/or 10 with coronary artery disease with no significant stenosis, having an early diastolic to atrial systolic transmitral flow velocity ratio (E/A) 1, and an LV ejection fraction 50%. The patients were divided into 2 groups according to the presence or absence of previous evidence of new-onset CHF: CHF group (n=7) and control group (n=65). Of the 72 patients, previous CHF was certified in 7 patients (9.7%). The LV mass index and maximal left atrial dimension were significantly greater (P < 0.05 and P < 0.005, respectively), and the systolic and early diastolic strain rates of the LV walls were significantly lower (both P < 0.05) in the CHF group than in the control group. There were no significant differences in peak systolic and early diastolic mitral annular motion velocities (Sw and Ew, respectively) and E/Ew between the 2 groups. Conclusions. Left atrial enlargement, LV hypertrophy, and LV systolic myocardial dysfunction are important in the development of CHF in patients with impaired LV relaxation and preserved LV pump function.