Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy (original) (raw)
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European journal of heart failure, 2016
To evaluate whether the clinical and echocardiographic correlates and the prognostic significance of right ventricular (RV) dysfunction are different in heart failure patients with reduced (HFrEF), mid-range (HFmrEF), or preserved (HFpEF) left ventricular ejection fraction. The study included 1663 patients with heart failure caused by ischaemic or hypertensive heart disease or by idiopathic cardiomyopathy. Left ventricular ejection fraction was <40% in 1123 patients (HFrEF), 40-49% in 156 patients (HFmrEF) and ≥50% in 384 patients (HFpEF). Imaging of the right ventricle was performed by echocardiography; RV function was defined on the basis of tricuspid annular plane systolic excursion (TAPSE) and its normalization for pulmonary artery systolic pressure (PASP). All-cause mortality was the endpoint of survival analysis. Non-sinus rhythm, high heart rate, ischaemic aetiology and E-wave deceleration time <140 ms were associated with a reduced TAPSE in HFrEF patients, whereas PASP...
The Egyptian Heart Journal, 2014
Background: Right ventricular (RV) dysfunction is associated with poor prognosis in patients with heart failure (HF). Several RV echocardiographic parameters have been proposed as sensitive markers to detect patients at risk. Objective: The aim is to compare the predictive value of several RV systolic echocardiographic parameters for adverse outcome in patients with chronic systolic HF. Methods: We assessed 117 patients with chronic systolic HF and left ventricular ejection fraction (LVEF) <40% for the following: (i) RV fractional area change (RVFAC), (ii) tricuspid annular plane systolic excursion (TAPSE), (iii) integral of the systolic wave (ISW tdi), and (iv) peak systolic velocity (Sa tdi). ISW tdi and Sa tdi were measured using tissue Doppler imaging at the tricuspid annulus. The primary endpoint was death, urgent transplantation, or acute HF episode requiring hospital admission. The follow-up extended for one year. Results: Fifty-two patients reached the primary endpoint. The cutoff thresholds for RVFAC, TAPSE, Sa tdi , and ISW tdi defined using receiver-operating characteristic curves were 30%, 15.5 mm, 10.0 cm/s, and 2.4 cm, respectively. The area under the curve and the 95% confidence interval for RVFAC, TAPSE, Sa tdi , and ISW tdi were 0.71(0.65-0.85), 0.66(0.55-0.76), 0.85(0.70-0.96), and 0.75(0.64-0.86), respectively. NYHA > 2, and Sa tdi were found to be independent predictors of adverse outcome. Conclusion: Sa tdi is an independent predictor of adverse outcome in HF at a threshold value of 10.0 cm/s and appears to be superior to other RV systolic echocardiographic parameters.
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.
Right Ventricular Function and Prognosis in Stable Heart Failure Patients
Journal of Cardiac Failure, 2014
Background: Right ventricular ejection fraction (RVEF) is a mortality predictor in heart failure (HF) patients. There are controversial results regarding the influence of RVEF on other important prognostic variables. The purpose of this study was to investigate the effect of RVEF on exercise parameters obtained during cardiopulmonary exercise testing (CPET), creatinine and B-type natriuretic peptide (BNP) levels, and a composite outcome of death, heart transplantation, or ventricular assist device implantation in ambulatory HF patients. Methods and Results: This retrospective cohort study included 246 ambulatory HF patients with CPETand RVEF evaluated with the use of first-pass radionuclide angiography. We analyzed the impact of RVEF on other prognostic factors with the use of multivariable linear regression. The mean age was 49 6 12 years. The mean peak VO 2 was 16.4 6 5.7 mL kg À1 min À1 , mean peak VE/VCO 2 34.1 6 9.1, mean creatinine 1.17 6 0.40 mg/dL, and median BNP 158 pg/mL (interquartile range 374 pg/mL). The mean left ventricular ejection fraction was 35 6 12% and the mean RVEF 38 6 10%. For every 10% decrease in RVEF, peak VO 2 decreased 0.97 mL kg À1 min À1 (P ! .05), creatinine increased 0.12 mg/dL (P ! .01), and log BNP increased 0.26 (P ! .05). Conclusions: We found an independent association between RVEF and prognostic markers in HF patients. Worsening RV function may exert its negative effect on prognosis through increasing congestion (elevated BNP), affecting renal blood flow (increased creatinine) and limiting left ventricular preload, thereby reducing exercise tolerance. (J Cardiac Fail 2014;20:343e349)
AJP: Heart and Circulatory Physiology, 2013
Background: Transient left ventricular dysfunction can occur under conditions of extreme emotional or physiological stress. There is little data on right ventricular function in such situations. Methods: One hundred twenty patients admitted to an ICU with a noncardiac illness were studied. Those with documented coronary disease, ejection fraction <40%, sepsis, or intracranial hemorrhage were excluded. Echocardiograms were performed within 24 hours of admission. Tricuspid annular plane systolic excursion (TAPSE) was measured to assess right ventricular systolic function. Plasma catecholamines (norepinephrine, epinephrine, dopamine) were measured on admission. Clinical and demographic data were collected, along with data on ICU length of stay (LOS), hospital LOS, and in-hospital and long-term mortality. TAPSE was tested for correlation with adverse outcomes and length of stay. Results: Mean TAPSE for the group was 2.05 AE 0.66 cm. Based on area under the ROC curve analysis, TAPSE <2.4 cm was the best cutoff for predicting in-hospital and long-term mortality. There were 13 in-hospital deaths, 12 in the group with TAPSE <2.4 cm and one among those with TAPSE ≥2.4 cm. On multivariate analysis, TAPSE <2.4 cm was a significant predictor of in-hospital mortality (v 2 = 4.6, P = 0.03). When tested against hospital LOS, an inverse correlation was found (P = 0.04). No association was found between TAPSE and catecholamine levels. Conclusions: Right ventricular systolic function, as assessed by TAPSE, has important prognostic value in critically ill patients. Mean values were lower in patients who died inhospital versus those who survived to discharge. In addition, patients with TAPSE <2.4 cm had a longer hospital length of stay. (Echocardiography 2015;00:1-6)
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.
Circulation Journal, 2011
Background: Right ventricular (RV) systolic function has been recognized as a prognostic factor in endstage heart failure (HF) patients and in the present study we evaluated the effect of this dysfunction on prognosis in patients with newly-diagnosed systolic HF. Methods and Results: We enrolled 180 consecutive patients with newly diagnosed systolic HF (ischemic or dilated cardiomyopathy). Echocardiographic evaluation was performed to assess biventricular function. Pulse-wave tissue Doppler imaging (TDI) readings were obtained from the lateral tricuspid annulus and the peak systolic annular velocity (Stv) was recorded. Patients were followed for a 2-year period and events (death or HF hospitalization) were recorded. During the follow-up, 79 patients (44%) had an adverse event. An inverse relationship was observed between the height of Stv and the probability of an event (odds ratio (OR) 0.716, 95% confidence interval (CI) 0.583-0.880, P=0.001), after controlling for potential confounders. Furthermore, creatinine clearance (CrCl) was inversely associated with the outcome: a 1-unit increase in CrCl was associated with a 0.98-times lower likelihood of having an event. When the analysis was stratified by CrCl <60 ml/min or ≥60 ml/min, Stv predicted adverse events in both groups (CrCl <60 ml/min: OR 0.62, 95%CI 0.39-0.98, P=0.04; CrCl ≥60 ml/min: OR 0.78, 95%CI 0.61-1.01, P=0.06). Conclusions: Pulse-wave TDI readings of peak systolic velocity at the lateral tricuspid annulus, reflecting RV systolic function, has prognostic significance in newly-diagnosed systolic HF patients.
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.