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Background: We aimed to evaluate the correlation and agreement between the Systemic Coronary Risk Estimation 2 (SCORE2) and Predicting Risk of CVD EVENTs (PREVENT) 10-year ASCVD risk scores by incorporating computed tomographic (CT) data to assess differences between the scoring systems. Methods: The PREVENT risk score was calculated for 171 patients, while the SCORE2 and SCORE2 Older Persons (OP) risk scores were calculated for 113 patients. Coronary artery calcium (CAC) scores were calculated, and the grading of coronary artery disease (CAD) was assessed according to these scores. Results: According to the PREVENT risk category, 79 patients (46.2%) were in the low-risk category, 32 (18.7%) were in the borderline-risk category, and 51 (29.8%) were in the intermediate-risk category. In contrast, the SCORE2 systems placed 32 patients (28.3%) in the low- to moderate-risk categories. Only 9 patients (5.3%) were classified as being at high risk by PREVENT, while SCORE2 categorized 39 patients (34.5%) as being at high risk and 42 patients (37.2%) as being at very high risk. There was a strong correlation between the scores (r = 85, p < 0.001), with a Bland–Altman plot analysis showing a bias of −3.71 points and the limits of agreement ranging from −16.06 to 8.64. The total CAC score and CAD grading were significantly different across the PREVENT risk groups (p < 0.001 for all) but were similar across the SCORE2 groups (p = 0.3 and p = 0.051, respectively). Conclusions: There is a strong correlation and agreement between the two risk scores. However, SCORE2 tends to categorize more patients as high-risk than PREVENT does. Additionally, the PREVENT risk categories are more effective than SCORE2 in determining the likelihood of CAD based on CT results. [ABSTRACT FROM AUTHOR]

Aims: Right ventricular (RV) failure is one of the leading causes of death in patients with pulmonary hypertension (PH). Conventional echocardiographic parameters are not included in risk stratification and follow‐up for prognostic assessment due to PH's diverse nature and the RV's complex geometry. RV outflow tract velocity time integral (RVOT VTI) is a simple, non‐invasive estimate of pulmonary flow and an echocardiographic surrogate of RV stroke volume. In this study, we aimed to define the prognostic value of RVOT VTI in PH patients. Methods: Sixty‐three subjects with idiopathic PAH (IPAH) (n = 23), connective tissue disease‐associated PAH (CTD‐associated PAH) (n = 19) and chronic thromboembolic pulmonary hypertension (CTEPH) (n = 21) were retrospectively included. A comprehensive two‐dimensional echocardiographic evaluation, including RVOT‐VTI measurement, was performed during the follow‐up and the New York Heart Association functional class (NYHA FC), 6 min walk distance (6MWD) and brain natriuretic peptide (BNP) levels were recorded. Results: The median age of the whole cohort was 63 years (52–68), and 47 (74.6%) of the patients were women. The median follow‐up period was 20 months (11–33), and 20 (31.7%) patients died in this period. BNP values were higher [317 (210–641) vs 161 (47–466), P = 0.02], and 6MWD values were lower [197.5 ± 89.5 vs 339 ± 146.3, P < 0.0001] in the non‐survivor group, and the non‐survivor group had a worse NYHA‐FC (P = 0.02). Among echocardiographic data, tricuspid annular plane systolic excursion (TAPSE) (15.4 ± 4.8 vs 18.6 ± 4.2, P = 0.01) and RVOT VTI (11.9 ± 4.1 vs 17.2 ± 4.3, P < 0.0001) values were lower whereas right atrial area (RAA) (26.9 ± 10.1 vs 22.2 ± 7.1, P = 0.04) values were higher in the non‐survivor group. The area under curve of the RVOT VTI for predicting mortality was 0.82 [95% confidence interval (CI) 0.715–0.940, P < 0.0001], and the best cut‐off value was 14.7 cm with a sensitivity of 80% and specificity of 77%. Survival was significantly lower in subjects with RVOT VTI ≤ 14.7 cm (log‐rank P < 0.0001). Survival rates for patients with RVOT VTI ≤ 14.7 cm were 70% at 1 year, 50% at 2 years, %29 at 3 years and 21% at 5 years. The univariate determinants of all‐cause mortality were BNP [hazard ratio (HR) 1.001 (1.001–1.002), P = 0.001], 6MWD [HR 0.994 (0.990–0.999), P = 0.012] and NYHA‐FC III–IV [HR 3.335 (1.103–10.083), P = 0.03], TAPSE [HR 0.838 (0.775–0.929), P = 0.001], RAA [HR 1.072 (1.013–1.135), P = 0.016] and RVOT VTI [HR 0.819 (0.740–0.906), P < 0.0001]. RVOT VTI was found to be the only independent determinant of mortality [HR 0.857 (0.766–0.960), P = 0.008]. Conclusions: The decreased RVOT VTI predicts mortality in patients with PH and each 1 mm decrease in RVOT VTI increases the risk of mortality by 14.3%. This parameter might serve as an additional parameter in the follow‐up of these patients especially when 6MWD and NYHA‐FC could not be determined. [ABSTRACT FROM AUTHOR]

Aims Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients. Methods and results Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 ± 8.7%) and MWI (403.2 ± 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69–0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage. Conclusion Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage. [ABSTRACT FROM AUTHOR]

Aims: Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients., Methods and Results: Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 ± 8.7%) and MWI (403.2 ± 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69-0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage., Conclusion: Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Obstructive sleep apnea syndrome (OSAS) leads to right ventricular (RV) dysfunction and pulmonary hypertension (PH) in the later stages. Early determination of these conditions is very important., Objectives: We aimed to evaluate the correlations of pulmonary artery distensibility, right pulmonary artery fractional shortening (RPA-FS), and pulmonary artery stiffness (PAS) with PH among newly diagnosed OSAS patients., Methods: We prospectively evaluated 34 newly diagnosed OSAS patients and 28 controls. The study subgroups were determined according to the apnea-hypopnea index (AHI). All patients underwent a transthoracic echocardiographic examination. Conventional RV parameters, PAS, and RPA-FS parameters were measured., Results: RPA-FS was significantly lower in the OSAS group (p < 0.001) and positively correlated with tricuspid annular systolic excursion (TAPSE) (p = 0.047) and pulmonary acceleration time (PAT) (p = 0.006), and inversely correlated with systolic pulmonary artery pressure (sPAP) (p = 0.013), and PAS (p < 0.001). Consistent with this result, PAS was significantly worse in the patients with OSAS compared to the controls (27.1 ± 3.5 to 15.8 ± 2.7, p < 0.001), and inversely correlated with RPA-FS (p < 0.001), PAT (p = 0.001), and TAPSE (p = 0.035). PAS was positively correlated with sPAP (p = 0.001). There were statistically significant differences for both PAS and RPA-FS among the OSAS subgroups with regards to the severity of disease (p < 0.001). The correlation analyses showed a significantly positive correlation between RPA-FS and mean O2 saturation. RPA-FS was also inversely correlated with AHI. Similarly, PAS was positively correlated with AHI and arousal index., Conclusions: PAS and RPA-FS are worsened in patients with OSAS, and are correlated with PH and severity of OSAS.

Background: A possible relationship between an obstructive prosthesis and suboptimal hemodynamic recovery, as reflected by unsatisfactory regression in systolic pulmonary artery pressure (sPAP) and functional tricuspid regurgitation (FTR) following mitral valve replacement (MVR), was investigated. A delineating effective orifice area index (EOAI) value was sought in order to define a patient-prosthesis mismatch., Methods: A total of 128 patients undergoing isolated mechanical MVR were followed up for a mean of 46 ± 9 months. Patients were allocated to two groups. Group I comprised 83 patients (65%) exhibiting a satisfactory (≥30%) regression in sPAP and FTR, while group II comprised 45 patients with a <30% (suboptimal) decrease in these parameters. A cutoff value for the prosthetic mitral valve in-vivo EAOI was explored as a predictor of postoperative hemodynamic recovery., Results: The mean in-vivo EOAI differed significantly between the groups (1.23 cm2/m2 in group I versus 1.11 cm2/m2 in group II; p <0.0001). The consequent receiver operating characteristic curve analysis revealed an EOAI of 1.19 cm2/m2 as the cut-off value, below which a suboptimal postoperative regression in pulmonary hypertension and FTR is predicted., Conclusions: An in-vivo EOAI <1.19 cm2/m2 strongly suggests a suboptimal hemodynamic recovery following MVR with the bileaflet mechanical prosthesis used in the present study. Although no direct relationship between prosthesis size and in vivo EOAI was demonstrated, the logical approach is to implant a prosthesis of the largest possible size.