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(1) Background: Left ventricular assist devices (LVADs) represent mechanical support in end-stage congestive heart failure and are characterized by satisfactory long-term results. Uric acid (UA) represents one of the early heart failure markers whose usefulness was postulated in clinical practice. (2) Methods: Twenty-nine male patients with a median age of 58 (51–62) years were referred for LVAD implantation due to end-stage congestive heart failure in the mean (SD) New York Heart Association (NYHA) status class 3.3 (0.6). Preoperative and postoperative right ventricular (RV) characteristics were compared with serum uric acid concentration within 12 (8–15) months following the implantation. (3) Results: Significant correlations between postoperative uric acid concentration and right ventricular dimension (r = 0.604, p = 0.005), tricuspid annulus plane systolic excursion (TAPSE) (r = −0.496, p = 0.022), left ventricular ejection fraction (r = −0.463, p = 0.046), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) (r = 0.505, p = 0.041) were noted. (4) Conclusions: The analysis shows the association between the postoperative RV diameter and TAPSE results in LVAD patients and uric acid concentration. Serum uric acid can be regarded as a possible right ventricular dysfunction marker in LVAD patients. [ABSTRACT FROM AUTHOR]

Background: Asthma is the most prevalent chronic airway condition in children. It is characterised by hyperresponsiveness of the small airways leading to airway narrowing, which is usually reversible, with or without treatment. Asthma is known to cause right ventricular dysfunction, but not much is known of this effect among children with highest burden of asthma. The aim of this study is to compare the right ventricular functions of children with asthma, aged 6– ≤ 13 years, with those of their age and sex-matched apparently healthy control using transthoracic echocardiography. The systolic and global right ventricular functions were assessed using Tricuspid Annular Plane Systolic Function (TAPSE) and Tei index, respectively. Results: Seventy cases and 68 controls were included in the final analysis of the results. The male-to-female ratios are 1.9:1 and 2:1 for the cases and controls, respectively, and their mean age were 8.82 (± 2.28) and 9.05 (2.50) years. There was no statistically significant difference between their sex ( X 2 /P = 0.810/0.85) and their mean age (P = 0.554). The mean TAPSE of the cases (20.16 ± 2.15 mm) and the controls (20.28 ± 2.71 mm) did not differ significantly (P = 0.74), but the mean Tei index of the cases (0.56 ± 0.16) was significantly higher than that of the control (0.50 ± 0.10) (P = 0.007). Among the asthmatics, 17.1% (12/70) and 2.9% (2/70) had global and systolic RV dysfunctions, respectively; 2.9% (2/70) of the controls had RV global dysfunctions, but none had RV systolic dysfunction. The global dysfunction among the asthmatics was significantly associated with their age range and frequency of hospitalisation ( X 2 /p of 6.051/0.014 and 7.209/0.021, respectively), and significantly correlates with their Body Mass Index, and peripheral oxygen saturation (r/P of −0.236/0.049 and − 2.490/0.038, respectively). None of the participants had right ventricular systolic dysfunction. Conclusion: This study shows that asthmatic patients have global RV dysfunction, and it is suggested that better control of asthma would preserve cardiac function. [ABSTRACT FROM AUTHOR]

Tricuspid annular plane systolic excursion (TAPSE) is usually measured with M‐mode using sector line, however, this may not align with the anatomical shortening of the right ventricular (RV). In this study, we compared the different methods to measure TAPSE using three different reference lines (sector line, anatomical line, and apico‐annular line). We included 148 patients diagnosed with pulmonary arterial hypertension (PAH) who underwent TTE and right heart catheterization within 2 weeks of each other. TAPSE was measured by M‐mode (sector, anatomical), 2D (sector, anatomical), or as tricuspid apico‐annular displacement (TAAD). Agreement between measures was assessed using coefficient of variation (COV), Spearman's correlation, and Bland–Altman analysis. Receiver–operating characteristics and Kaplan–Meier analysis were used to explore associations with the combined outcome of death or lung transplantation at 5 years. There was a good concordance between anatomical and sector M‐mode with a COV of 15.5 ± 1.6% and a bias of −0.6 ± 3.2 mm. In contrast, anatomical M‐mode TAPSE and TAAD differed significantly with the mean difference of 3.3 ± 3.8 mm (COV 30.5 ± 6.1%; p < 0.0001). Among the different 2D methods, anatomical 2D agreed well with anatomical M‐mode TAPSE (COV of 11.8 ± 2.0%; r = 0.89; p < 0.0001). Among the five methods, TADD had the strongest association with the combined endpoint of death or transplantation at 5 years (C‐statistic 0.64, 95% confidence interval [CI] 0.57–0.71). We concluded that different measures of TAPSE are not interchangeable. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the feasibility and reliability of tricuspid and mitral annular plane systolic excursion measurements (TAPSE and MAPSE) applying M-mode spatiotemporal image correlation (STIC) technology in low-risk pregnancies. An initial retrospective pilot study was carried out to assess repeatability, followed by a larger mixed cross-sectional and prospective longitudinal study, both evaluating low-risk singleton pregnancies between 22+6 and 39+1 weeks. As only annuli capture was necessary, STIC acquisition parameters were set to the minimum volume angle of 15° and acquisition time of 7.5 s. A total of 330 volumes were analysed offline applying STIC M-mode. Acquisition rates were 96.9 % for TAPSE and 93.7 % MAPSE in the pilot study (n=32) and 98.0 % for both in the longitudinal study (n=102). Both study designs revealed good repeatability for both sides of the heart, with higher intraclass correlation coefficients (ICCs) for TAPSE (0.84–0.94) compared to MAPSE (0.80–0.88). Good repeatability was demonstrated for both sides of the heart, more so for TAPSE than MAPSE, with ICCs for TAPSE 0.84–0.91 and MAPSE 0.75–0.76, comparable to prior ICCs for STIC repeatability. Modified STIC acquisition settings specifically tailored for capturing the longitudinal annular displacement may improve STIC TAPSE and MAPSE acquisition rates, optimising image quality for precise measurement and potentially bringing these modalities closer to clinical application. [ABSTRACT FROM AUTHOR]

IntroductionReduced TAPSE/sPAP ratio has recently emerged as a predictive parameter risk factor for PH, however its role in SSc has been poorly investigated. The aim of the study was to investigate the prognostic value of the TAPSE/sPAP ratio for the prediction of mortality and cardiovascular events in patients with SSc complicated by PH. A comparison between SSc patients with PAH (SSc-PAH) and those with PH and significant ILD (SSc-PH) was also carried out.Materials and methodsA retrospective single-center study in which all patients having SSc—complicated by PH—referring to the Scleroderma-Unit of the AOU Policlinico of Modena, from October 2013 to October 2023 were evaluated. All SSc patients underwent recurrent clinical examination, routine blood chemistry analysis, functional, instrumental evaluation.Results61 SSc patients (F/M 52/9) were enrolled. During the follow-up, 60.1% of patients experienced at least one cardiovascular event and 62% died. The main causes of death were PH (39.4%) and other heart-related events (39.4%). The TAPSE/sPAP ratio was significantly lower in deceased patients compared to survivors (mm/mmHg 0.3 ± 0.12SD vs. 0.48 ± 0.17SD, p

Background: Congenital heart diseases (CHD) account for one third of all congenital anomalies. Doppler and Tissue Doppler evaluate cardiac performance and diagnose CHD. Study aim: evaluation ventricular functions in congenital heart diseases using tricuspid plane systolic excursion TAPSI and tissue Doppler-derived left ventricular myocardial performance index MPI. Methods: The study was performed at Pediatric Cardiology Unit of Zagazig University Hospitals on 70 age and sex matched children classified into case group included 35 patients with CHD and control group included 35 healthy children underwent complete history, conventional echocardiographic and tissue Doppler examination. Results: There was increase in cases regarding interventricular septum (IVS) and decrease in left ventricular diameter at end diastole (LVDd), left ventricular diameter at end systole (LVDs), right pulmonary artery diameter (RPA) and left atrium diameter more than control group with no difference in between regarding: posterior wall diameter (PW), fractional shortening (FS), main pulmonary artery diameter, left pulmonary artery diameter (LPA) and aorta diameter. There was a highly significant decrease in TAPSE in case more than control group and significant decrease in ejection time (ET) with no significant difference between case and control group regarding LV MPI. Conclusions: TAPSE is lower in cases compared with control group indicating longitudinal RV dysfunction. The value of LV MPI was slightly higher than that of control that need further studies with a larger number of patients.LV FS did not show any abnormality in cases pointing out ability of tissue Doppler echocardiography to measure segmental LV dysfunction compared to conventional echocardiography. [ABSTRACT FROM AUTHOR]

Background: A deep Y descent in the jugular venous pulse (JVP) is associated with diseases such as a decrease in right ventricular (RV) preload reserve. The present study investigated the relationship between RV-pulmonary arterial (PA) coupling and a deep Y descent, examined risk factors for a deep Y descent and clarified whether a deep Y descent was an independent risk factor for cardiac events irrespective of RV-PA coupling in patients with heart failure (HF). Methods: We enrolled 350 patients with HF who underwent echocardiography and JVP examination. A deep Y descent was identified by a deeper ‘Y’ descent than ‘X’ descent in the JVP waveform. We defined cardiac events of HF as follows: sudden death, death from HF, the emergent infusion of loop diuretics, or hospitalization for decompensated HF. Results and Conclusions: A deep Y descent and cardiac events were observed in 129 and 83 patients, respectively. The prevalence of a deep Y descent increased with decreases in the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio. Not only the TAPSE/SPAP ratio (odds ratio,0.756 per0.1 mm/mmHg, 95 %confidence interval [CI], 0.660–0.866, p

Abstract Tricuspid annular plane systolic excursion (TAPSE) is usually measured with M‐mode using sector line, however, this may not align with the anatomical shortening of the right ventricular (RV). In this study, we compared the different methods to measure TAPSE using three different reference lines (sector line, anatomical line, and apico‐annular line). We included 148 patients diagnosed with pulmonary arterial hypertension (PAH) who underwent TTE and right heart catheterization within 2 weeks of each other. TAPSE was measured by M‐mode (sector, anatomical), 2D (sector, anatomical), or as tricuspid apico‐annular displacement (TAAD). Agreement between measures was assessed using coefficient of variation (COV), Spearman's correlation, and Bland–Altman analysis. Receiver–operating characteristics and Kaplan–Meier analysis were used to explore associations with the combined outcome of death or lung transplantation at 5 years. There was a good concordance between anatomical and sector M‐mode with a COV of 15.5 ± 1.6% and a bias of −0.6 ± 3.2 mm. In contrast, anatomical M‐mode TAPSE and TAAD differed significantly with the mean difference of 3.3 ± 3.8 mm (COV 30.5 ± 6.1%; p

Abstract Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. Methods We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (

Background: Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV-PA coupling) using a simplified ratio of tricuspid annular plane systolic excursion (TAPSE)/ tricuspid regurgitant velocity (TRV) could help to identify RV decompensation and improve risk stratification in critically ill patients. This is the first study to explore the distribution of TAPSE/TRV ratio and its prognostic relevance in a large general critical care cohort. Methods: We undertook retrospective analysis of echocardiographic, clinical, and mortality data of intensive care unit (ICU) patients between January 2012 and May 2017. A total of 1077 patients were included and stratified into tertile groups based on TAPSE/TRV ratio: low (< 5.9 mm.(m/s)−1), middle (≥ 5.9–8.02 mm.(m/s)−1), and high (≥ 8.03 mm.(m/s)−1). The distribution of the TAPSE/TRV ratio across ventricular function subtypes of normal, isolated left ventricular (LV), isolated RV, and biventricular dysfunction was explored. The overall prognostic relevance of the TAPSE/TRV ratio was tested, including distribution across septic, cardiovascular, respiratory, and neurological subgroups. Results: Higher proportions of ventricular dysfunctions were seen in low TAPSE/TRV tertiles. TAPSE/TRV ratio is impacted by LV systolic function but to a lesser extent than RV dysfunction or biventricular dysfunction. There was a strong inverse relationship between TAPSE/TRV ratio and survival. After multivariate analysis, higher TAPSE/TRV ratios (indicating better RV-PA coupling) were independently associated with lower risk of death in ICU (HR 0.927 [0.872–0.985], p < 0.05). Kaplan–Meier analysis demonstrated higher overall survival in middle and high tertiles compared to low tertiles (log rank p < 0.0001). The prognostic relevance of TAPSE/TRV ratio was strongest in respiratory and sepsis subgroups. Patients with TAPSE/TRV < 5.9 mm (m/s)−1 had a significantly worse prognosis than those with higher TAPSE/TRV ratios. Conclusion: The TAPSE/TRV ratio has prognostic relevance in critically ill patients. The prognostic power may be stronger in respiratory and septic subgroups. Larger prospective studies are needed to investigate the role of TAPSE/TRV in pre-specified subgroups including its role in clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: SGLT2 inhibitors have been shown to reduce hospitalisation in patients with chronic heart failure (CHF). The cardioprotective mechanisms of gliflozins however have not been fully elucidated. The aim of this study was therefore to evaluate the effect of SGLT2 inhibitors on right and left ventricular function in patients with diabetes and HF. Methods: Seventy‐eight patients with diabetes and CHF were enroled in the study and followed up; 38 started treatment with SGLT2i, while the remaining 40 continued their previous antidiabetic therapy. All patients underwent conventional, TDI and strain echocardiography in an ambulatory setting, at the beginning and after 3 months of therapy with SGLT2i. Results: After 3 months of therapy with SGLT2i, echocardiographic parameters assessing both left and right ventricular dimensions and function were found as significantly improved in patients switching to SGLT2i than control group: LVEF (45 ± 9% vs. 40 ± 8%, p < 0.001), LVEDD (54 ± 6.5 vs. 56 ± 6.5 mm, p < 0.01), GLS (−13 ± 4% vs. −10 ± 3%, p < 0.001), TAPSE (21 ± 3 vs. 19 ± 3 mm, p < 0.001), RV S' (12.9 ± 2.5 vs 11.0 ± 1.9 cm/sec, p < 0.001) and PAsP (24 ± 8 vs. 31 ± 9 mmHg, p < 0.001). Also mitral (1.0 ± 0.5 vs. 1.3 ± 0.5, p < 0.01) and tricuspid regurgitation (1.0 ± 0.5 vs. 1.3 ± 0.5, p < 0.01) improved after SGLT2i therapy. Changes were not statistically significant in patients not treated with SGLT2i (p n.s. in all cases). Conclusions: In a real‐world scenario, treatment with SGLT2i in patients with CHF and diabetes is associated with an improvement in both left and right ventricular function assessed at echocardiography. These data may explain potential anti‐remodelling effects of gliflozins. [ABSTRACT FROM AUTHOR]

To compare transesophageal echocardiography-guided 2-dimensional and M-mode tricuspid annular plane systolic excursion (TAPSE) to transthoracic echocardiography (TTE)-guided M-mode TAPSE in terms of accuracy, interobserver, and intra-observer variability. A prospective, observational study. Adult and pediatric operating rooms. Adult and pediatric patients (42 each) undergoing cardiac surgeries. None. Modified midesophageal (Mod-ME), deep transgastric, and transgastric TAPSEs were analyzed for reliability and were compared to TTE TAPSE in both adult and pediatric groups. Modified ME TAPSE showed good method agreement with TTE TAPSE (bias = −0.97, p = 0.08 (adult); bias = 0.17, p = 0.71 [pediatric]), and showed a moderate correlation with right ventricular (RV) fractional area change (FAC) (r = 0.41, p = 0.006, [adult]; r = 0.57, p < 0.001, [pediatric]), with acceptable interobserver variability (percentage error =10.56 [adult]; 4.42 [pediatric]) and intraobserver variability (percentage error = 13.1 [adults]; 12.24 [pediatric]). Transgastric TAPSE poorly agreed with TTE TAPSE and had higher interobserver and intraobserver variability. Deep transgastric TAPSE had good method agreement with TTE TAPSE and had acceptable interobserver and intra-observer variability. Modified ME TAPSE is a reliable and reproducible measure of RV function before pericardiotomy in both adult and pediatric cardiac surgery. Right ventricular FAC values reflected the RV systolic function better than TAPSE after pericardiotomy. Deep transgastric TAPSE is reliable and reproducible but is less accurate than Mod-ME TAPSE. [ABSTRACT FROM AUTHOR]

Objective: To compare the cardiac functions of fetuses with preterm premature rupture of membranes (PPROM) between their control groups and investigate its relationship with perinatal outcomes. Methods: This prospective study was conducted with 102 pregnant women. Pregnant women with PPROM were divided into two subgroups Group A, between 26 and 30 weeks, and Group B, between 30 and 34 weeks. A control group was formed by randomly including one healthy pregnant woman for each study patient. Sociodemographic, obstetric data, tissue Doppler imaging, and M‐mode imaging results were compared. The relationship between echocardiographic parameters and perinatal outcomes was also investigated. Results: Tricuspid annular plane systolic excursion (TAPSE), S′, and ET′ of systolic cardiac parameters were shortened in both groups compared with their controls. Diastolic function indicator E′/A′, and global function indicator myocardial performance index' increased in both groups. Isovolumetric contraction time' did not change between groups. A correlation was found between myocardial performance index', and the length of neonatal intensive care unit stay in Group A and TAPSE and duration of respiratory support and length of neonatal intensive care unit stay in Group B. Conclusions: The fetal cardiac function seems to be affected by PPROM, and these changes are associated with neonatal outcomes. Therefore, administering fetal cardiac function evaluation in pregnancies complicated by PPROM may help physicians establish more appropriate clinical management protocols in this special population. [ABSTRACT FROM AUTHOR]

Pendahuluan. Angka kejadian penyakit gagal jantung masih terus meningkat di tingkat global. Dalam mendiagnosis dan mengevaluasi penyakit gagal jantung, terdapat beberapa modalitas yang dapat diandalkan, salah satunya adalah ekokardiografi. Metode pemeriksaan ekokardiografi berguna dalam banyak aspek termasuk penilaian fungsi dan diameter jantung, yang secara klinis menjadi landasan dalam pilihan pengobatan dan prognosis penderita gagal jantung. Tujuan. Tujuan penelitian ini adalah untuk mengetahui gambaran hasil pemeriksaan ekokardiografi pasien gagal jantung di RSUP H. Adam Malik Medan pada tahun 2021. Metode. Penelitian ini memiliki desain deskriptif retrospektif dengan pendekatan potong lintang (cross sectional). Hasil. Mayoritas penderita berasal dari kalangan usia produktif. 73,62% pasien berjenis kelamin laki-laki. Etiologi terbanyak pada penelitian ini adalah penyakit iskemik. Ditemukan 49,08% sampel mengalami hipertrofi eksentrik, 46,63% mengalami hipertrofi konsentrik, 1,84% mengalami remodelling konsentrik, dan 2,45% memiliki geometri LV yang normal. Rata rata LVEF adalah 44,70% dengan HFpEF yang paling mendominasi. 77,30% memiliki TAPSE normal dan dari 121 data yang tersedia, 46,63% mengalami disfungsi diastolik grade I, 14,72% mengalami disfungsi diastolik grade III, dan sisanya, 12,88% mengalami disfungsi diastolik grade II. Kesimpulan. Kebanyakan pasien gagal jantung di RSUP H. Adam Malik Medan pada tahun 2021 berasal dari kalangan usia produktif. Etiologi tersering adalah penyakit iskemik. Dimensi dan volume LV mayoritas pasien hipertrofi eksentrik. HFpEF mendominasi dan TAPSE kebanyakan normal. Dari 121 data mengenai disfungsi diastolik LV, disfungsi grade I merupakan yang terbanyak. Kata Kunci: gagal jantung, ekokardiografi, LVEF, TAPSE, gambaran

(1) Background: Left ventricular assist devices (LVADs) represent mechanical support in end-stage congestive heart failure and are characterized by satisfactory long-term results. Uric acid (UA) represents one of the early heart failure markers whose usefulness was postulated in clinical practice. (2) Methods: Twenty-nine male patients with a median age of 58 (51–62) years were referred for LVAD implantation due to end-stage congestive heart failure in the mean (SD) New York Heart Association (NYHA) status class 3.3 (0.6). Preoperative and postoperative right ventricular (RV) characteristics were compared with serum uric acid concentration within 12 (8–15) months following the implantation. (3) Results: Significant correlations between postoperative uric acid concentration and right ventricular dimension (r = 0.604, p = 0.005), tricuspid annulus plane systolic excursion (TAPSE) (r = −0.496, p = 0.022), left ventricular ejection fraction (r = −0.463, p = 0.046), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) (r = 0.505, p = 0.041) were noted. (4) Conclusions: The analysis shows the association between the postoperative RV diameter and TAPSE results in LVAD patients and uric acid concentration. Serum uric acid can be regarded as a possible right ventricular dysfunction marker in LVAD patients.

Right ventricular (RV) dysfunction is associated with poor prognosis in acute respiratory failure (ARF). Our study evaluates the efficacy of RV strain in detecting RV dysfunction in ARF patients requiring invasive mechanical ventilation (IMV) compared to tricuspid annular plane systolic excursion (TAPSE). In this retrospective study involving 376 patients diagnosed with ARF and requiring IMV, we extracted clinical and outcome data from patient records. RV global longitudinal strain (RVGLS), free wall longitudinal strain (FWLS), and TAPSE were measured retrospectively using speckle tracking echocardiography (STE) and traditional echocardiography, respectively. We divided the cohort into three groups: TTE during IMV (TTE-IMV, 223 patients), before IMV (TTE-bIMV, 68 patients), and after IMV (TTE-aIMV, 85 patients). Multivariable regression analysis, adjusted for covariates, revealed significantly higher RVGLS and FWLS in the groups not on IMV at the time of TTE compared to the TTE-IMV group. Specifically, the TTE-bIMV group showed higher RVGLS (β = 7.28, 95% CI 5.07, 9.48) and FWLS (β = 5.83, 95% CI 3.36, 8.31), while the TTE-aIMV group exhibited higher RVGLS (β = 9.39, 95% CI 6.10, 12.69) and FWLS (β = 7.54, 95% CI 4.83, 10.24). TAPSE did not reveal any significant differences across the groups. Our study suggests an association between IMV and lower RVGLS and FWLS in ARF patients, indicating that IMV itself may contribute to RV dysfunction. RVGLS and FWLS appear to be more sensitive than TAPSE in detecting changes in RV function that were previously subclinical in patients on IMV. Prospective studies with TTE before, during, and after IMV are necessary to assess the primary driver of RV dysfunction and to prognosticate STE-detected RV dysfunction in this population.

The study examines global and regional systolic shortening of the left (LV) and right ventricle (RV) in 1266 individuals without evidence of heart disease in the third wave of the HUNT study. Regional mitral annular systolic displacement (mitral annular plane systolic excursion [MAPSE]) was 1.5 cm in the septum and anterior walls, 1.6 cm in the lateral wall and 1.7 cm in the inferior wall, global mean 1.6 cm. Peak systolic velocity S' was 8.0, 8.3, 8.8 and 8.6 cm/s in the same walls (global mean 8.7 cm/s). All measures of LV longitudinal shortening correlated, mean MAPSE and S' also correlated with stroke volume (SV) and ejection fraction (EF). Global longitudinal strain by either method correlated with MAPSE, S' and EF, but not with SV, reflecting a systematic difference. S' and MAPSE correlated with early annular diastolic velocity (e'), reflecting that e' is the recoil from systole. Mean displacement was 2.8 (0.5) cm in the tricuspid annulus (tricuspid annular plane systolic excursion [TAPSE]). Normal values by age and sex are provided. Both TAPSE and S' were lower in women, where body size explained the sex difference. Normalisation of MAPSE and S' for wall length reduced intra‐individual variation of displacement and velocity by 80%–90%, showing regional MAPSE to be related to LV wall length, and that longitudinal wall strain was relatively uniform. Displacement and S' were lowest in the septum and highest in the left and right free walls, shows systolic bending of the AV‐plane into a U‐shape, relating to the total cardiac volume changes during the heart cycle. [ABSTRACT FROM AUTHOR]

Background: Traditional transvenous pacemakers are associated with worsening tricuspid valve function due to lead‐related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from chronic right ventricular (RV) pacing. The association of leadless pacing with ventricular and valvular function has not been well established. We aimed to assess the association of leadless pacemaker placement with changes in valvular regurgitation and ventricular function. Methods and Results: Echocardiographic features before and after leadless pacemaker implant were analyzed in consecutive patients who received a leadless pacemaker with pre‐ and postprocedure echocardiography at Duke University Hospital between November 2014 and November 2019. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Among 54 patients, the mean age was mean age was 70.1 ± 14.3 years, 24 (44%) were women, and the most frequent primary pacing indication was complete heart block in 24 (44%). The median RV pacing burden was 45.4 (interquartile range [IQR] 3.5–97.0). On echocardiogram performed 8.9 months (IQR 4.5–14.5) after implant, there was no change in the average severity of tricuspid regurgitation (mean change 0.07 ± 1.15, p =.64) from pre‐procedure echocardiogram. We observed a decrease in the average left ventricular ejection fraction (LVEF) (52.3 ± 9.3 to 47.9 ± 12.1, p =.0019) and tricuspid annular plane systolic excursion (TAPSE) (1.8 ± 0.6 to 1.6 ± 0.4, p =.0437). Thirteen patients (24%) had absolute drop in LVEF of ≥10%. Conclusion: We did not observe short term worsening valvular function in patients with leadless pacemakers. However, consistent with the pathophysiologic impact of RV pacing, leadless pacing was associated with a reduction in biventricular function. [ABSTRACT FROM AUTHOR]

Cardiac involvement from amyloidosis is of growing interest in the overall literature. Despite cardiac amyloidosis (CA) has been considered for a long time a rare disease, the diagnostic awareness is increasing mainly thanks to the improvement of diagnostic softwares and of imaging techniques such as cardiac magnetic resonance (CMR). Some authors have observed an increase of prevalence rate of CA; moreover it's often underestimated because clinical manifestations are aspecific. The interstitial infiltration of the left ventricle has been extensively studied, while the involvement of the right ventricle (RV) has been less investigated. Involvement of the RV, even in the absence of pulmonary hypertension or clearly left ventricle infiltration, plays an important role as prognostic factor and is useful to achieve an early diagnosis. Therefore, the use of fast and low-cost diagnostic methods such as ultrasound strain of the right ventricle could be used to recognize cardiac amyloidosis early. Herein the importance of evaluating the right ventricular involvement, which can predict the most severe course of the disease also without overt clinical manifestations. The role of imaging, in particular of echocardiography, CMR, and scintigraphy is here reported. [ABSTRACT FROM AUTHOR]

Background: Although measures of longitudinal displacement of the tricuspid annulus measured by M‐mode as tricuspid annular systolic plane excursion (TAPSE) and systolic velocity by tissue Doppler imaging (TA TDI s) are routinely used for assessment of right ventricular (RV) systolic function; these measures describe different phenomena and should not be used interchangeably. Methods: Previously published data was used to determine the individual relationship between TAPSE and TA TDI s with increasing pulmonary artery systolic pressures (PASP). Results: In this retrospective analysis, 488 patients were divided into 2 groups based on TAPSE (Group 1: <1.8 cm and Group 2: ≥1.8 cm). A robust correlation (R =.79) between TAPSE and TA TDI s noted for the entire population. However, a statistically lower correlation (R =.43) was seen between Group 1 and Group 2 (R =.65; p <.0047). With increasing pulmonary pressures, only PASP (p <.0001) and TA TDI s (p <.0001) discriminated between low and normal TAPSE/PASP values. Suggesting that a TA TDI s/PASP ratio would be most useful than TAPSE/PASP with a specificity of 80%. Conclusions: Significant differences exist between TAPSE and TA TDI s, particularly at low TAPSE values with increased PASP, were uncoupling occurs. Our data seems to suggest that TA TDI s/PASP would be most useful than TAPSE/PASP ratio. Future studies should address, if abnormalities in the material properties along the RV free wall account for these differences seen between TAPSE and TA TDI s. [ABSTRACT FROM AUTHOR]

Introduction: Tricuspid regurgitation in patients with mitral valve disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity. The objective was to access if modified De Vega Annuloplasty (mDA) using pericardial patch offered significant surgical, functional and economical benefits over RA done for Mitral valve replacement with severe functional tricuspid regurgitation in a predominant rheumatic population. Methods: This retrospective study analyzed data from 50 patient who were eligible for this study and underwent mitral valve replacement surgery for severe mitral valve stenosis with functional tricuspid valve disease (30 AR and 20 mDA) between the period of January 2015 and December 2019 at Kem Hospital, Mumbai. Post-operatively all patients has routine TTE (transthoracic echocardiography) before discharge and subsequently at 6 months and 1 year. Severity of TR (Tricuspid Regurgitation), LVEF (Left Ventricular Ejection Fraction), TAPSE (Tricuspid Annular Plane Systolic Excursion) and PASP (Pulmonary Artery Systolic Pressure) were used for determining functional status of the patient. Results: There was no statistically significant difference in residual TR. There was significant improvement in NYHA (Newyork Heart Association) stage. Statistically significant difference was seen in the cost, with mDA demonstrating economic benefits for the patient. Conclusions: Similar functional outcomes were seen with both techniques. Only incremental economic benefit was seen with mDA in the form of lower cost for the patient. However, this is just the early outcome and long term study is ongoing to ascertain outcome. Resumen: Introducción: La regurgitación tricuspídea en pacientes con valvulopatía mitral se asocia a un mal resultado y predice una mala supervivencia, insuficiencia cardíaca y una menor capacidad funcional. El objetivo fue acceder a si la anuloplastia de De Vega modificada (mDA) mediante parche pericárdico ofrecía beneficios quirúrgicos, funcionales y económicos significativos sobre la RA realizada para la sustitución de la válvula mitral con regurgitación tricúspide funcional grave en una población predominantemente reumática. Métodos: Este estudio retrospectivo analizó datos de 50 pacientes que fueron elegibles para este estudio y se sometieron a cirugía de reemplazo de válvula mitral por estenosis severa de válvula mitral con enfermedad de válvula tricúspide funcional (30 AR y 20 mDA) entre el período comprendido entre enero del 2015 y diciembre del 2019 en el Hospital Kem, Bombay. Después de la operación, todos los pacientes tienen ETT (ecocardiografía transtorácica) de rutina antes del alta y posteriormente a los 6 meses y a un año. La gravedad de la TR (regurgitación tricuspídea), FEVI (fracción de eyección del ventrículo izquierdo), TAPSE(excursión sistólica del plano anular tricúspide y PASP (presión sistólica de la arteria pulmonar) se utilizaron para determinar el estado funcional del paciente. Resultados: No hubo diferencia estadísticamente significativa en la TR residual. Hubo una mejora significativa en el estadio de la NYHA (New York Heart Association). Se observó una diferencia estadísticamente significativa en el costo, demostrando la mDA beneficios económicos para el paciente. Conclusiones: Se observaron resultados funcionales similares con ambas técnicas. Sólo se observó un beneficio económico incremental con la mDA en forma de menor coste para el paciente. Sin embargo, este es solo el resultado inicial y se está llevando a cabo un estudio a largo plazo para determinar los resultados.

Background: This study aimed to define the normal ranges of echocardiographic parameters that are used to evaluate right ventricular systolic functions. Methods: A total of 607 children within the age range of 0 - 18 years without any cardiac pathology or chronic disorders were included in the study. The study population was categorized into different age groups and underwent transthoracic echocardiography. In this study, tricuspid annular plane systolic excursion (TAPSE), tricuspid annular peak systolic velocity (TAPSV), and right ventricular myocardial performance index (RVMPI) values were measured. Results: There was no statistically significant difference between the mean TAPSE and TAPSV values of male and female subjects. The mean RVMPI was higher in females than in males. The study population was categorized into nine groups according to their age. The TAPSE, TAPSV, and RVMPI values were calculated for each group. Additionally, the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, and ± 2 standard deviation (SD) and ± 3 SD values of TAPSE measurements were calculated for each age group. The study population was divided into eight groups according to their body surface area (BSA). Moreover, the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of TAPSE measurements were calculated. There was a strong positive correlation between TAPSE and BSA. The TAPSE was also positively correlated with TAPSV but not with RVMPI. Conclusions: This study determined the normal values for TAPSV and RVMPI. It is important to have knowledge of the normal ranges of these parameters to recognize right ventricular dysfunction early in various cardiac disorders. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is one of the most prevalent types of cancers among women in Egypt with incidence rates of 48.8 per 100.000 women. Anthracyclines are the drugs of choice for adjuvant chemotherapy in high-risk patients, however, their use is limited due to their cardiotoxicity. In animal models treated with anthracyclines, right ventricle (RV) dysfunction is thought to be an independent prognostic factor and it's possible that it could be an early indicator of subclinical left ventricle (LV) dysfunction. Therefore, further research is required to study the cardiotoxic effect of anthracycline drugs on the RV using different 2D echocardiographic modalities. Subjects and Methods: A total number of 40 newly diagnosed breast cancer patients who were planned to receive doxorubicin therapy for 37 of them and epirubicin for 3 patients were prospectively recruited. Serial 2 D echocardiograms including speckle-tracking were done at baseline, 3 months later, and 6 months later. Results: RV dysfunction was detected more by right ventricle global longitudinal strain (RVGLS) after six months of anthracycline-based chemotherapy (-22.85±1.31 vs. -19.30±2.30, P value 0.001). ROC curve revealed a total anthracycline cumulative dose of 416 mg/m2 with the highest sensitivity and specificity of RV dysfunction. Conclusion: RVGLS surpassed other traditional 2D metrics in identifying subclinical RV disease, and the total anthracycline cumulative dose is strongly linked to the incidence of chemotherapy related cardiotoxicity to the right ventricle. 2D speckle-tracking is noninvasive and feasible modality that can be used to detect early anthracycline-induced cardiotoxicity. [ABSTRACT FROM AUTHOR]

Tricuspid annular plane systolic excursion (TAPSE) is important in the noninvasive echocardiographic assessment of right heart function. This retrospective observational study shows correlations of TAPSE with invasive right heart catheterization parameters after pediatric heart transplantation (HTx). The study included patients after pediatric HTx with cardiac catheterizations in 2018/2019 and measurement of TAPSE (n = 52 patients with 57 examinations; 50.9% adults, 52.6% female, median age: 18.54 years). TAPSE was compared with normal values. Stepwise, linear and multiple regression were used to show influencing variables on TAPSE. Mean TAPSE z‐score was −3.48 (SD: 2.25) and 68.4% of HTx‐recipients showed abnormally reduced TAPSE (z‐score ←2) compared to normal values. Multiple regression (p‐value <0.001; corrected R2 = 0.338) showed significant correlations of time since HTx (p‐value <0.001) and mPAP (p‐value: 0.008) with TAPSE z‐scores. Divided into subgroups (time since HTx <10 and ≥10 years), TAPSE and mPAP correlated only ≥10 years after HTx (p‐value = 0.002). This study provides data of TAPSE even ≥10 years after pediatric HTx. Most patients showed a decreased TAPSE early after HTx, which improved over time. TAPSE z‐scores correlated significantly with time since HTx and mPAP, especially ≥10 years post‐HTx. Therefore, TAPSE must be used carefully in the early follow‐up. [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension and right ventricular (RV) dysfunction are drivers of adverse outcomes; however, modifiable risk factors for RV dysfunction are not well described. We investigated the association between clinical markers of metabolic syndrome and echocardiographic RV function in a large referral population. Methods and Results Using electronic health record data, we performed a retrospective cohort study of patients aged ≥18 years referred for transthoracic echocardiography between 2010 and 2020 with RV systolic pressure (RVSP) or tricuspid annular plane systolic excursion (TAPSE) values. Pulmonary hypertension was defined by RVSP >33 mm Hg and RV dysfunction by TAPSE ≤1.8 cm. Our sample included 37 203 patients of whom 19 495 (52%) were women, 29 752 (83%) were White, with a median age of 63 years (interquartile range, 51–73). Median (interquartile range) RVSP was 30.0 mm Hg (24.0–38.7), and median TAPSE was 2.1 cm (1.7–2.4). Within our sample, 40% had recorded RVSP >33 mm Hg, and 32% with TAPSE 39 mm Hg) was associated with lower low‐density lipoprotein and high‐density lipoprotein, and higher hemoglobin A1c and body mass index (P1.8 cm, TAPSE 1.5–1.8 cm, and TAPSE

IntroductionThe imaging standard for evaluation of acute pulmonary embolism (PE) includes a computed tomography pulmonary angiogram. Ultrasonography has shown promise in obtaining the tricuspid annular plane systolic excursion (TAPSE) measurements, which may be of clinical importance in patients with acute PE. The objective of this study is to evaluate the diagnostic capability of TAPSE measurements for patients with suspicion for acute PE.MethodsWe prospectively enrolled patients who came to the emergency department with suspicion of acute PE. Each patient underwent a point-of-care sonogram where a TAPSE measurement was obtained, followed by computed tomography pulmonary angiogram. Based on the computed tomography pulmonary angiogram findings, patients were grouped into 3 categories: no acute PE, clinically insignificant acute PE, or clinically significant acute PE.ResultsWe enrolled 87 patients in this study. Twenty-three (26.4%) of these patients were diagnosed with PE. Of patients with PE, 15 (65%) were found to have a clinically significant acute PE. Analysis of mean TAPSE measurements between patients with clinically significant acute PE and those with insignificant or no PE was 15.2 mm and 22.7 mm, respectively (P ≤ .0001). Following receiver operating characteristic curve analysis, optimum TAPSE measurement to identify clinically significant acute PE is 18.2 mm. A cutoff TAPSE measurement of 15.2 mm shows a sensitivity of 53.3% (95% confidence interval, 26.7%-80%) and a specificity of 100% (95% confidence interval, 100%-100%) for the diagnosis of a clinically significant PE.ConclusionsOur data suggest that TAPSE measurements less than 15.2 mm have a high specificity for identifying clinically significant acute PE.

Background: Lung hyperinflation and systemic inflammation are currently believed to be the most important causes of right heart alterations in chronic obstructive pulmonary disease (COPD) patients. A multicentre observational study was performed to assess the morphological and functional parameters of right ventricle (RV) in COPD subjects, as well as to evaluate the potential prognostic impact on the development of major cardiovascular adverse events (MACEs). Methods: For this retrospective study, from 1 January 2010 to 31 December 2021, we enrolled COPD patients on the basis of their airflow limitation. In particular, we selected subjects spanning across GOLD 1 and 2 functional stages. Clinical, laboratory and functional parameters were collected at baseline. Echocardiography was routinely performed in all COPD patients. RV dysfunction was defined on the basis of tricuspid annular plane systolic excursion (TAPSE) values. MACE occurrence (non‐fatal ischemic stroke, non‐fatal myocardial infarction, cardiac revascularization or coronary bypass surgery and cardiovascular death) was evaluated during a median follow‐up of 55 (36–72) months. Results: Among the 749 enrolled patients, 408 subjects had a TAPSE value ≥20 mm, while the remaining 341 had a TAPSE value <20 mm. In patients with TAPSE ≥20 mm the observed MACEs were 1.9 events/100 patient‐year, while in the group with a worse right heart function there were 4.2 events/100 patient‐year (p <.0001). The multivariate analysis model confirmed the association between RV dysfunction and MACE. Indeed, a 1‐mm increase in TAPSE value and the intake of long‐acting β2‐receptor agonists (LABA)/long‐acting muscarinic antagonist (LAMA) inhaled therapy were protective factors for the onset of MACE, while the presence of diabetes mellitus and high values of both uric acid (UA) and systolic pulmonary arterial pressure (S‐PAP) enhanced the risk of MACE in study participants. Conclusions: The results of this study showed that in patients with mild COPD there is an association between right heart dysfunction and the risk of MACE during follow‐up. [ABSTRACT FROM AUTHOR]

Background: The main cause of death globally is acute myocardial infarction (AMI), specifically acute coronary syndrome (ACS). In the setting of acute myocardial infarction, right ventricular (RV) infarction has a greater risk of adverse outcomes. Objective: The goal of this study was to evaluate the right ventricular function in patients with an acute anterior myocardial infarction. Patients and Methods: This case control study included 60 participants who were divided into two groups; group 1 included 30 patients with acute anterior myocardial infarction (first attack and within 1-12 hours of symptoms onset), and group 2 (control group) included 30 age and gender matched group with no MI. All patients with acute anterior MI were managed by primary percutaneous coronary intervention (PCI). Results: Compared to control group, we found that the mean RIMP was significantly higher in the MI group (0.50 ± 0.081 vs 0.28 ± 0.043, p < 0.001), mean TAPSE was significantly lower in the MI group (1.76 ± 0.391 cm vs 2.38 ± 0.420 cm, p < 0.001), mean fractional area change was significantly lower in the MI group (32.34 ± 3.625 % vs 48.00 ± 5.350 %, p < 0.001), mean DTI-derived tricuspid lateral annular systolic velocity was significantly lower in the MI group (11.091 ± 2.0334 cm/s vs 13.077 ± 3.0285 cm/s, p= 0.014), and mean right ventricle strain was significantly lower in the MI group (-16.47 ± 3.246 vs -26.83 ± 2.276, p < 0.001). Conclusion: Echocardiographic RV function parameters are significantly lower in the setting of acute anterior MI compared to controls denoting more RV dysfunction among this group of patients. [ABSTRACT FROM AUTHOR]

Background: Tricuspid annular plane systolic excursion (TAPSE) connected to pulmonary artery systolic pressure (PASP) may enhance prognosis in heart failure with an adequate ejection fraction. Objective: The aim of the current study is to evaluate the applicability of TAPSE in cases with heart failure and preserved ejection fraction (HFpEF), which is indexed to PASP. Patients and methods: The present study included 75 patients with HFpEF. They were divided into 2 groups depend on the results of 6-minute walking test. Group I included 49 patients with good exercise tolerance and Group II included 36 patients with reduced exercise tolerance. Results: The TAPSE/PASP ratio has a sensitivity of 83.5% and a specificity of 79.3% for detecting individuals with reduced exercise intolerance, with an area under the curve (AUC) of 0.834 (95%CI: 0.753-0.916, P <0.001). Conclusion: A relevant clinical indicator of the length/force relation may be the correlation between longitudinal RV fibre shortening (TAPSE) and developed pressure (PASP), and the ratio of 2 variables may be more reliable than either of the two measures alone in predicting the severity of disease. [ABSTRACT FROM AUTHOR]

Background: Objective right ventricular (RV) systolic function assessment is attained using a series of well‐described and validated echo‐Doppler measurements. However, how left ventricular (LV) systolic function influences these RV functional measurements has not been previously studied. Consequently, we conducted a retrospective proof‐of‐concept analysis to answer this important question. Methods: A total of 100 echocardiographic studies were included and patients were divided into two groups according to their LV ejection fraction (LVEF). The following RV variables were acquired including, tricuspid annular systolic plane excursion (TAPSE), velocity of the systolic motion (TA TDI s'), RV outflow tract velocity time integral (VTI), pulmonary vascular resistance (PVR), and the TAPSE to pulmonary artery systolic pressure (PASP) ratio. Results: Not only TAPSE, TA DI s', RVOT VTI, PVR, and TAPSE/PASP were all significantly different between patients with normal versus abnormal LVEF; but most importantly, RVOT VTI (p <.0001) was the best discriminatory variable in assessing normal versus abnormal LVEF followed by TAPSE (p =.0001). Using receiver operating characteristic curve analysis, an RVOT VTI value > 11 identified patients with a normal LVEF with a sensitivity of 90% and specificity of 76%. Conclusion: Based on our results, reduced LVEF affects the RV, likely mediated by mechanisms of interventricular dependence. Therefore, RV analysis cannot be performed in isolation as it not only reflects intrinsic RV systolic function but also, is dependent on LV systolic function. In cases of reduced LVEF, additional measures of RV assessment should be used to provide better objective assessments. [ABSTRACT FROM AUTHOR]

Aim:TAPSE and pPTT are new echocardiographic parameters recommended in the evaluation of right ventricular function. Examine the echocardiographic parameters of patients diagnosed with acute pulmonary thromboembolism and determine the predictive of mortality.Materials and Methods:The study was prospectively. Patients diagnosed with pulmonary thromboembolism (PTE) in the emergency department between 06.12.2019-31.05.2020 were included [86 patients (42 case - 44 control)] in the study.Results:pPTT mean scores of the case and control groups were 91.88 ms and 127,09 ms (p

خلفية البحث وهدفه: يعد فرط التوتر الشرياني الرئوي شكاية شائعة مرافقة لأمراض القلب الخلقية عند الأطفال. وتحدث معظم الحالات عند مرضى الآفات القلبية الخلقية المترافقة مع شنت أيسر أيمن (جهازي-رئوي)، ولاسيما غير الخاضعين للإصلاح الجراحي في الوقت المناسب. ويعرف فرط التوتر الشرياني الرئوي بأنه ارتفاع بالضغط الوسطي للشريان الرئوي(MPAP) أكثر من 25 ملم ز أثناء الراحة، وأكثر من 30 ملم ز أثناء الجهد مقاساً بالقثطرة القلبية، أو ارتفاع بالضغط الانقباضي للشريان الرئوي(SPAP) أكثر من 40 ملم ز مقاساً بإيكو القلب دوبلر. هدف البحث إلى دراسة العلاقة بين شدة ارتفاع التوتر الشرياني الرئوي الثانوي لآفات القلب الخلقية المترافقة مع تحويلة (يسرى- يمنى) والوظيفة الانقباضية للبطين الأيمن باستخدام تخطيط الصدى القلبي. وكذلك دراسة وظيفة البطين الأيمن في حالات فرط التوتر الشرياني الرئوي الثانوي لآفات القلب الخلقية المترافقة مع تحويلة (يسرى- يمنى) مما يفيد في تحديد خطة العلاج والإنذار. مواد البحث وطرائقه: دراسة حشدية مستقبلية تمت في مشفى الأطفال الجامعي بدمشق (شعبة الأمراض القلبية) بالفترة الممتدة من 1/3/2020 وحتى 1/3/2021. وقد شملت الدراسة 60 طفلاً مشخصاً لهم فرط توتر رئوي ثانوي لآفات القلب الخلقية المترافقة مع تحويلة يسرى-يمنى (VSD، ASD، PDA، CAVC) بعد مرحلة الوليد. النتائج: وجود علاقة مهمة إحصائياً بين متوسط قيم الضغط الرئوي وقيم TAPSE ، وبين متوسط قيم الضغط الرئوي وقيم سرعة الموجة الانقباضية S' المقاسة بدوبلر الأنسجة TDI، كما تبين وجود علاقة سلبية (تناسب عكسي) بين قيم الضغط الرئوي من جهة وقيم TAPSE وTDI(S') من جهة أخرى. الاستنتاج: وجود تناسب عكسي بين الوظيفة الانقباضية للبطين الأيمن وبين وشدة ومدة ارتفاع الضغط الشرياني الرئوي. كما تبين أن تقييم وظيفة البطين الأيمن باستخدام TAPSE وTDI(S') وسيلة مهمة وموضوعية في سياق دراسة فرط التوتر الشرياني الرئوي الثانوي لآفات القلب الخلقية المترافقة مع شنت أيسر أيمن عند الأطفال.

BackgroundEarly detection of subclinical cardiotoxicity of immune checkpoint inhibitor (ICI) therapy can be challenging.ObjectiveTo evaluate subclinical cardiac dysfunction using two-dimensional speckle tracking imaging (2D-STI) and three-dimensional echocardiography in Chinese patients.MethodsFifty-five consecutive patients with malignant tumors treated by immunotherapy were included. They were examined by echocardiography before immunotherapy and after immunotherapy. Left ventricular ejection fraction (LVEF) was calculated in three-dimensional imaging. Moreover, left ventricular global longitudinal peak systolic strain (LVGLS), left ventricular global circumferential peak systolic strain (LVGCS), right ventricular global longitudinal systolic strain (RVGLS), right ventricular free wall longitudinal peak systolic strain (RVFWLS), and tricuspid annular plane systolic excursion (TAPSE) were evaluated. Clinical and laboratory parameters were recorded. Cardiac toxicity events were defined as the presence of heart failure symptoms, LVEF reduction, and increase in troponin. Subclinical cardiac toxicity was defined as cardiac dysfunction associated with ICI treatment, with absent or delayed ICI-associated cardiotoxicity clinical symptoms.ResultsCompared with baseline, the LVGLS, TAPSE, and RVGLS significantly deteriorated after ICI treatment [(–18.63 ± 2.53)% vs. (–17.35 ± 2.58)%, P = 0.000; 18.29 ± 6.23 vs. 14.57 ± 3.81, P = 0.0001; and (–18.45 ± 4.65)% vs. (–14.98 ± 3.85)%, P = 0.0001, respectively]. LVGLS (–17.35 ± 2.58, P = 0.000), TAPSE (14.57 ± 3.81, P = 0.0001), and RVGLS [(–14.98 ± 3.85)%, P = 0.0001] were decreased after ICI immunotherapy. Kaplan-Meier curve analysis showed that LVGLS was more sensitive than the cardiac toxicity events to assess ICI-related subclinical cardiac dysfunction (log-rank P = 0.205). The ROC curve showed that the cutoff value of ΔLVGLS was -13%.ConclusionSubclinical cardiac dysfunction can be detected using two-dimensional speckle-tracking imaging. LVGLS, RVGLS, and TAPSE are more sensitive indices for detection.Clinical trial registration[https://www.chictr.org.cn/showprojen.aspx?proj=27498], identifier [ChiCTR1800016216].

To establish age-specific and body surface area (BSA)-specific reference values of Tricuspid Annular Plane Systolic Excursion (TAPSE) for children under 15 years old in China. A retrospective study was conducted in Children's Hospital Attached to the Capital Institute of Pediatrics. A total of 702 cases were included in this research to establish reference values of TAPSE in Chinese children. SPSS 25.0 (IBM) was used for data analysis. Lambda-mu-sigma method was used to calculate and construct the age-specific and BSA-specific percentiles and Z-score curves of TAPSE. The mean value of TAPSE increased with age and BSA from 0 to 15 years in a nonlinear way and reached the adult threshold (17 mm) until 1 year old. There was no difference between genders. TAPSE values increased with age and BSA in Chinese children aged between 0 and 15 years and there was no difference between boys and girls. A prospective, multicenter cohort study from different parts of China is supposed to be conducted in the future to reflect the whole spectrum of TAPSE in Chinese children. [ABSTRACT FROM AUTHOR]

Patients undergoing coronary artery bypass grafting (CABG) face an elevated risk of heart failure (HF) and cardiovascular (CV) death. Detailed myocardial tissue analyses of the right ventricle are now possible and may hold prognostic value in these patients. Accordingly, we aimed to evaluate the usefulness of right ventricular (RV) layer-specific RV free wall strain (RVFWS) for predicting HF and/or CV death. Patients undergoing CABG at Gentofte Hospital from 2006 to 2011 with a preoperative echocardiogram underwent RVWFS analysis. RVFWS was obtained by speckle tracking. The outcome was defined as a composite of HF and/or CV death. Cox proportional hazards regression, Harrell's C-statistics, and competing risk regression were used to assess the prognostic value of RVFWS. Of 317 patients, 30 (9.5%) reached the endpoint at a median follow-up of 3.5 years. The mean age was 67 years, 83% were men, and the mean LVEF was 50%. In univariable analyses, endo-RVFWS (HR 1.08, P < 0.001), mid-RVFWS (HR 1.07, P = 0.002), and epi-RVFWS (HR 1.07, P = 0.004, per 1% absolute decrease) were associated with a higher risk of HF or/and CV death. Furthermore, all three layers remained independently associated with the outcome after multivariable adjustment for baseline clinical and echocardiographic measurements. Low endo-RVFWS was associated with a more than threefold increased risk of the outcome (HR = 3.04 (1.45–6.38) P = 0.003). The same was observed for mid-RVFWS (HR = 3.16 (1.45–6.91) P = 0.004), and epi-RVFWS (HR = 3.00 (1.46–6.17) P = 0.003). In patients undergoing CABG, RVFWS assessed by speckle-tracking is a predictor of adverse outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Mitral valve prolapse (MVP) has been associated with left heart remodeling. This study explored cardiac remodeling in patients with MVP without significant regurgitation, focusing on the right heart., Methods: This single-center study enrolled consecutive patients referred to trans-thoracic-echocardiography (TTE) with MVP, excluding those with significant regurgitation or known cardiovascular or pulmonary diseases. A group of healthy controls was included., Results: Forty-nine patients with MVP and 54 controls were finally selected (mean age of 62, 52-71; 52% males), and echocardiographic parameters were compared among groups. Twenty-nine (41%) patients with MVP showed tricuspid valve prolapse (TVP). Patients with MVP, irrespective of TVP, showed greater tricuspid annulus (systolic annulus: 31±6 vs. 32±5 vs. 27±3 mm for MVP + /TVP - , MVP + /TVP + , and controls, respectively; all p < 0.01) and greater minimum right atrial volume indexed (13, 12-15 mL/m 2  vs. 15, 12-20 mL/m 2 vs. 11, 10-14 mL/m 2 ; all p < 0.05). Right ventricular dimensions and systolic indexes did not differ among groups, except TAPSE, which was significantly greater in MVP + /TVP + patients compared to controls (25±4 vs. 22±3 mm, p = 0.004). A significant correlation (ρ = 0.43; p < 0.001) and an independent association at multivariate analysis (ß = 0.28; 95% CI 0.09-0.47; p = 0.004) were observed between end-systolic tricuspid diameter and TAPSE., Conclusion: In patients with MVP with less-than-moderate mitral or tricuspid regurgitation, dilation of the right atrium and tricuspid annulus was found. The latter finding was associated with increased values of TAPSE, which should then be used with caution, while other indexes may be preferred when assessing the systolic function of these patients., (© 2024 The Author(s). Echocardiography published by Wiley Periodicals LLC.)

Background: Acute pulmonary embolism (PE) increases pulmonary pressure and impair right ventricular (RV) function. Echocardiographic investigation can quantify this mismatch as the tricuspid annular plane systolic excursion (TAPSE) to pulmonary arterial systolic pressure (PASP) ratio. The aim of the study was to investigate the prognostic capabilities of TAPSE/PASP ratio in patients with acute PE., Methods: We utilized the RIETE registry to analyze consecutive hemodynamically stable PE patients. We used multivariable logistic regression analyses to assess the association between the TAPSE/PASP ratio and 30-day all-cause mortality across the strata of European Society of Cardiology (ESC) risk categories., Results: We included 4,478 patients, of whom 1,326 (30%) had low-risk, 2,425 (54%) intermediate-low risk, and 727 (16%) intermediate-high risk PE. Thirty-day mortality rates were 0.7%, 2.3% and 3.4%, respectively. Mean TAPSE/PASP ratio was 0.65±0.29 in low-risk patients, 0.46±0.30 in intermediate-low risk, and 0.33±0.19 in intermediate-high risk patients. In multivariable analyses, there was an inverse association between TAPSE/PASP ratio and 30-day mortality (adjusted OR 1.32 [95%CI 1.14-1.52] per 0.1 decrease in TAPSE/PASP). TAPSE/PASP ratio below optimal cut-points was associated with increased mortality in low- (<0.40, aOR: 5.88; 95%CI:1.63-21.2), intermediate-low (<0.43, aOR: 2.96; 95%CI:1.54-5.71) and intermediate-high risk patients (<0.34, aOR: 4.37; 95%CI:1.27-15.0). TAPSE/PASP <0.44 showed net reclassification improvement of 18.2% (95%CI:0.61-35.8) vs. RV/LV ratio >1, and 27.7% (95%CI:10.2-45.1) vs. ESC risk strata., Conclusions: Decreased TAPSE/PASP ratio was associated with increased mortality. The ratio may aid in clinical decision-making, particularly for intermediate-risk patients for whom the discriminatory capability of the current risk stratification tools is limited., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Reduced TAPSE/sPAP ratio has recently emerged as a predictive parameter risk factor for PH, however its role in SSc has been poorly investigated. The aim of the study was to investigate the prognostic value of the TAPSE/sPAP ratio for the prediction of mortality and cardiovascular events in patients with SSc complicated by PH. A comparison between SSc patients with PAH (SSc-PAH) and those with PH and significant ILD (SSc-PH) was also carried out., Materials and Methods: A retrospective single-center study in which all patients having SSc-complicated by PH-referring to the Scleroderma-Unit of the AOU Policlinico of Modena, from October 2013 to October 2023 were evaluated. All SSc patients underwent recurrent clinical examination, routine blood chemistry analysis, functional, instrumental evaluation., Results: 61 SSc patients (F/M 52/9) were enrolled. During the follow-up, 60.1% of patients experienced at least one cardiovascular event and 62% died. The main causes of death were PH (39.4%) and other heart-related events (39.4%). The TAPSE/sPAP ratio was significantly lower in deceased patients compared to survivors (mm/mmHg 0.3 ± 0.12SD vs. 0.48 ± 0.17SD, p  < 0.001). Compared to the SSc-PAH subgroup, the SSc-PH patients had lower survival rates (55.3 ± 31.2 SD months vs. 25 ± 19 SD, p  = 0,05). At the multivariate analysis, TAPSE/sPAP ratio <0.32 mm/mmHg, male gender, and the presence of significant ILD were identified as independent predictors of mortality and cardiovascular events., Conclusion: Our work confirmed the predictive role of the TAPSE/sPAP ratio for mortality and cardiovascular events in patients with SSc complicated by PH., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 de Pinto, Coppi, Spinella, Pagnoni, Morgante, Macripò, Boschini, Guerra, Tampieri, Secchi, Orlandi, Amati, Lumetti, Sandri, Rossi, Boriani, Mattioli, Ferri and Giuggioli.)

Objectives: To track and measure changes in the tricuspid annulus (TA) using 3-dimensional (3D) echocardiography during a complete cardiac cycle in patients with functional tricuspid regurgitation (TR) compared to patients without TR, and to compare tricuspid annular plane systolic excursion (TAPSE) derived from 2-dimensional (2D) and 3D coordinates as a measure of right ventricular (RV) function to the standard method of 2D fractional area change (FAC)., Design: Intraoperative 3D echocardiography data were collected prospectively, followed by postprocessing software analysis to track and reconstruct changes throughout the cardiac cycle., Setting: Data were collected from 108 patients undergoing left-sided heart surgery at 2 large academic centers-Beth Israel Deaconess Medical Center in Boston, MA and Rhode Island Hospital, Providence, RI-between November 2018 and April 2020., Participants: The final dataset (n = 92) included 2 groups: the no significant functional TR (NTR) group (n = 74), defined as ≤ mild TR and TA <35 mm, and the significant functional TR (FTR) group (n = 18), defined as ≥ moderate TR., Interventions: 3D TEE datasets were analyzed, and the motion of TA coordinates was tracked during complete cardiac cycle in 2D and 3D planes using postprocessing and software analysis. Computational modeling of TA motion was performed using computer-aided design. In further analysis, reconstructed and 3D printed models of TV were developed for the 2 groups., Measurements and Main Results: `Patients in FTR group had larger TA size during the cardiac cycle, with less overall excursion and reduced annular dynamism. The 3D motion of TA for lateral, anterolateral, and posterolateral coordinates was lower in the FTR group compared to the NTR group [18 ± 6.8 vs 13.6 ± 8.5( p = 0.02); 15.2 ± 5.5 vs 11.3 ± 6.0 (p = 0.009); and 17.6 ± 6.6 vs 12.3 ± 5.2 (p = 0.002), respectively]. TAPSE derived from 3D planes was more accurate for RV function assessment when comapred with 2D FAC (area under the curve [AUC], 0.704; p = 0.011) than 2D TAPSE (AUC, 0.625; p = 0.129). Finally, in the FTR group, the anteroseptal-posterolateral diameter was consistently larger during all phases of the cardiac cycle compared to the conventionally measured septolateral diameter., Conclusions: 3D echocardiographic assessment of TA helps better understand its geometry and dynamism in functional TR and is more accurate than 2D measurements for RV function assessment., Competing Interests: Declaration of competing interest Dr Mahmood reports relationships with GE Healthcare and Abbott that include speaking and lecture fees. The other authors report no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Right ventricle (RV)-to-pulmonary artery (PA) coupling measured by the ratio of echocardiography-derived tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is a meaningful prognostic marker in pulmonary hypertension (PH). It's unclear if balloon pulmonary angioplasty (BPA) treatment of chronic thromboembolic pulmonary hypertension (CTEPH) alters RV-PA coupling measured by TAPSE/PASP. We reviewed CTEPH patients treated with BPA at our institution who had a transthoracic echocardiogram (TTE) before BPA and a follow-up TTE at any point during BPA. TAPSE was obtained from the initial and lattermost TTE; hemodynamics were obtained before each BPA session. Between March 2015 to October 2023, there were 228 patients treated with BPA. After excluding post-PTE patients and those without PH, 67 were included. Initial TAPSE/PASP was 0.39 ± 0.21 mm/mmHg. Using previously defined TAPSE/PASP tertiles in PH (<0.19, 0.19-0.32, >0.32 mm/mmHg), there were 6 patients (9%) in low, 30 (45%) in middle, and 31 (46%) in the high tertiles at baseline. The lower TAPSE/PASP tertiles had more severe baseline hemodynamics ( p  < 0.001) compared to the high TAPSE/PASP cohort. At follow-up, TAPSE/PASP improved to 0.47 ± 0.20 mm/mmHg ( p  = 0.023), with 2 (3%), 13 (19%), and 52 (78%) patients in the low, middle, high TAPSE/PASP tertiles, respectively. As patients progress through BPA sessions, the TAPSE/PASP ratio increases, possibly reflecting improved RV mechanics and RV-PA coupling. TAPSE/PASP ratio as a marker of RV-PA coupling can improve with BPA treatment and may be an important measure to follow during treatment of CTEPH., Competing Interests: The authors Jenny Z. Yang served on advisory board for Janssen. Timothy M. Fernandes is a consultant for Penumbra; received research funding from Merck, United Therapeutics, Janssen. Kim M. Kerr received consulting fees from Merck. Nick H. Kim is a consultant for Bayer, Gossamer Bio, Johnson & Johnson, Merck, Pulnovo, United Therapeutics; speaker for Bayer, Johnson & Johnson, Merck; and research support from Enzyvant. The remaining authors declare no conflict of interest., (© 2024 The Author(s). Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)

Introduction: Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic parameter that serves as a prognostic indicator for severity of COPD clinical course. This study, consisting of a systematic review and meta-analysis, evaluates the current literature to elucidate the relationship between TAPSE measurement in COPD patients versus control subjects to discern baseline evidence of right heart strain., Methods: PubMedTM, ScopusTM, CINAHL, Web of Science, and Cochrane Review databases were searched from their beginning through November 1, 2023, for eligible studies. Outcomes included the difference of TAPSE measurement and right ventricular wall thickness between COPD patients and control patients. The Newcastle-Ottawa Scale was applied to assess risk of bias; Q-statistics and I2 values were used to assess for heterogeneity; and Egger's and Begg's test used to assess for publication bias., Results: The search yielded eleven studies reporting TAPSE values involving 1671 patients, 800 (47.9%) patients with COPD. The unadjusted mean TAPSE values for COPD patients was 18.9 mm (SD+/- 4), while the mean TAPSE value for control patients was 22.2 mm (SD+/- 0.8). The presence of COPD was significantly associated with decreased TAPSE values with the meta-analysis reporting the mean difference of TAPSE value between COPD and control patients was -3.0 (95% CI -4.3 to -1.7, P=0.001). Six studies reported the RV free wall thickness. The unadjusted mean RV free wall thickness for COPD patients was 4.9 mm (SD+/- 1.2), and control patients was 3.4 mm (SD+/- 0.7), respectively., Conclusions: This meta-analysis demonstrated statistically-significantly lower TAPSE values and thicker RV free wall among COPD patients versus control patients.

Abstract Background: Heart valve disease is still a significant health burden in the world, including Indonesia. The postoperative outcome of mitral valve surgery is influenced by many things, including decreased right ventricular (RV) function, which is the most common complication. Several studies have shown that decreased RV function after mitral valve surgery is associated with long-term outcomes. TAPSE is a routine and easy measurement of RV systolic function. A decrease in TAPSE after cardiac surgery is common because of the effects of pericardiotomy, and does not necessarily reflect a decrease in RV ejection fraction (RVEF). Regardless of whether postoperative TAPSE values ​​indicate right ventricular systolic function or only due to the effects of pericardiotomy, it is still not clear whether postoperative TAPSE values ​​have a prognostic value to long-term mortality after mitral valve surgery. Therefore, the objective of this study is to obtain information regarding the relationship of TAPSE echocardiographic parameters after mitral valve surgery with long-term mortality. Methods: This is a retrospective cohort study, looking at the effect of TAPSE on outcome after mitral valve surgery. The analysis starts from the starting point of the study when the patient was discharged alive from the hospital after mitral valve surgery (operation period January 2016 – February 2017) to the end point of the study, which was June 30th, 2021 and the observed outcome was mortality from any cause. Results: Of the 266 study subjects, 11 subjects died within 4-5 years after mitral valve surgery, the mortality is 4%. Bivariate analysis was performed on several factors and no relationship was found between the analyzed variables and mortality. Conclusion: There is no relationship between mortality and TAPSE after mitral valve surgery. Keywords: TAPSE, Mitral Valve Surgery, Mortality

IntroductionAccurate assessment of right ventricular (RV) systolic function has prognostic and therapeutic implications in many disease states. Echocardiography remains the most frequently deployed imaging modality for this purpose, but estimation of RV systolic function remains challenging. The purpose of this study was to evaluate the diagnostic performance of a novel measurement of RV systolic function called lateral annular systolic excursion ratio (LASER), which is the fractional shortening of the lateral tricuspid annulus to apex distance, compared to right ventricular ejection fraction (RVEF) derived by cardiac magnetic resonance imaging (CMR).MethodsA retrospective cohort of 78 consecutive patients who underwent clinically indicated CMR and transthoracic echocardiography within 30 days were identified from a database. Parameters of RV function measured included: tricuspid annular plane systolic excursion (TAPSE) by M-mode, tissue Doppler S', fractional area change (FAC) and LASER. These measurements were compared to RVEF derived by CMR using Pearson's correlation coefficients and receiver operating characteristic curves.ResultsLASER was measurable in 75 (96%) of patients within the cohort. Right ventricular systolic dysfunction, by CMR measurement, was present in 37% (n = 29) of the population. LASER has moderate positive correlation with RVEF (r = 0.54) which was similar to FAC (r = 0.56), S' (r = 0.49) and TAPSE (r = 0.37). Receiver operating characteristic curves demonstrated that LASER (AUC = 0.865) outperformed fractional area change (AUC = 0.767), tissue Doppler S' (AUC = 0.744) and TAPSE (AUC = 0.645). A cohort derived dichotomous cutoff of 0.2 for LASER was shown to provide optimal diagnostic characteristics (sensitivity of 75%, specificity of 87% and accuracy of 83%) for identifying abnormal RV function. LASER had the highest sensitivity, accuracy, positive and negative predictive values among the parameters studied in the cohort.ConclusionsWithin the study cohort, LASER was shown to have moderate positive correlation with RVEF derived by CMR and more favorable diagnostic performance for detecting RV systolic dysfunction compared to conventional echocardiographic parameters while being simple to obtain and less dependent on image quality than FAC and emerging techniques.

Aims There is a wide spectrum of diseases associated with pulmonary hypertension, pulmonary vascular remodelling, and right ventricular dysfunction. The NIH-sponsored PVDOMICS network seeks to perform comprehensive clinical phenotyping and endophenotyping across these disorders to further evaluate and define pulmonary vascular disease. Methods and results Echocardiography represents the primary non-invasive method to phenotype cardiac anatomy, function, and haemodynamics in these complex patients. However, comprehensive right heart evaluation requires the use of multiple echocardiographic parameters and optimized techniques to ensure optimal image acquisition. The PVDOMICS echo protocol outlines the best practice approach to echo phenotypic assessment of the right heart/pulmonary artery unit. Conclusion Novel workflow processes, methods for quality control, data for feasibility of measurements, and reproducibility of right heart parameters derived from this study provide a benchmark frame of reference. Lessons learned from this protocol will serve as a best practice guide for echocardiographic image acquisition and analysis across the spectrum of right heart/pulmonary vascular disease. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) has been assessed extensively, but few studies analysed the predictive value of the NT-proBNP in patients with de novo and acute HFpEF. We sought to identify NT-proBNP at admission as a predictor for all-cause mortality and rehospitalisation at 12 months in patients with new-onset HFpEF. Methods: We analysed 91 patients (73 ± 11 years, 68% females) admitted for de novo and acute HFpEF, using the Cox proportional hazard risk model. Results: An admission NT-proBNP level above the threshold of 2910 pg/mL identified increased all-cause mortality at 12 months (AUC = 0.72, sensitivity = 92%, specificity = 53%, p < 0.001). All-cause mortality adjusted for age, gender, medical history, and medication in the augmented NT-proBNP group was 16-fold higher (p = 0.018), but with no difference in rehospitalisation rates (p = 0.391). The predictors of increased NT-proBNP ≥ 2910 pg/mL were: age (p = 0.016), estimated glomerular filtration rate (p = 0.006), left atrial volume index (p = 0.001), history of atrial fibrillation (p = 0.006), and TAPSE (p = 0.009). Conclusions: NT-proBNP above 2910 pg/mL at admission for de novo and acute HFpEF predicted a 16-fold increased mortality at 12 months, whereas values less than 2910 pg/mL forecast a high likelihood of survival (99.3%) in the next 12 months, and should be considered as a useful prognostic tool, in addition to its utility in diagnosing heart failure. [ABSTRACT FROM AUTHOR]

Objective Early detection of pulmonary arterial hypertension (PAH) is crucial for improving patient outcomes. The aim of this study was to compare the positive predictive value (PPV) of the echocardiography-derived tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio with that of the DETECT algorithm for PAH screening in a cohort of SSc patients. Methods Fifty-one SSc patients were screened for PAH using the DETECT algorithm and echocardiography. Results Echocardiography was recommended by the DETECT algorithm step 1 in 34 patients (66.7%). Right heart catheterization (RHC) was recommended by the DETECT algorithm step 2 in 16 patients (31.4%). PAH was confirmed by RHC in 5 patients. The DETECT algorithm PPV was 31.3%. The TAPSE/sPAP ratio was higher in SSc patients not referred for RHC than in SSc patients referred for RHC according to the DETECT algorithm step 2 [0.83 (0.35–1.40) mm/mmHg vs 0.74 (0.12–1.09)  mm/mmHg, P  < 0.05]. Using a cut-off of 0.60 mm/mmHg, 8 (15.7%) SSc patients had a TAPSE/sPAP ratio of ≤0.60 mm/mmHg. PAH was confirmed by RHC in 5 patients. The PPV of TAPSE/sPAP was 62.5%. In multiple regression analysis, TAPSE/sPAP was associated with age [ β coefficient = −0.348 (95% CI: −0.011, −0.003); P  < 0.01], DETECT algorithm step 1 [ β coefficient = 1.023 (95% CI: 0.006, 0.024); P  < 0.01] and DETECT algorithm step 2 (β coefficient = −1.758 [95% CI: −0.059, −0.021]; P  < 0.0001). Conclusion In SSc patients with a DETECT algorithm step 2 total score of >35, the TAPSE/sPAP ratio can be used to further select patients requiring RHC to confirm PAH diagnosis. [ABSTRACT FROM AUTHOR]

Lately, RV dysfunction has emerged as a significant prognostic factor in heart failure with reduced ejection fraction (HFrEF). More so, recent data show a specific pattern of RV contraction in LBBB patients that is corrected by CRT, but not in patients with RV failure. The importance of RV evaluation in CRT patients is still under debate. Establishing the role of RV function in the setting of CRT may help identify patients with high risk of adverse events. Moreover, the changes induced by CRT upon RV may lead to a better understanding of the mechanisms behind CRT effects and may facilitate novel criteria for optimal selection of CRT candidates.

Background: Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Etiology may influence the outcome of patients undergoing CRT. Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT and overall outcome. Methods: Our study included HFrEF patients undergoing CRT between January 2017-November 2019. We assessed right ventricle (RV) and left ventricle (LV) function using transthoracic echocardiography at baseline and one year after CRT. The response to CRT was defined by a decrease of more than 15% of left ventricle systolic volume. Patients were divided in two groups: ischemic and non-ischemic based on personal history. Adverse events (HF related hospitalizations and deaths) were tracked for 33± 12.8 months. Results: 52 patients undergoing CRT were included (64±13.5 years, 55.7% male, 70% non-ischemic etiology) The two groups were similar considering LV systolic baseline parameters and volumes. Ischemic etiology was associated with non-LBBB morphology on ECG (p=0.03), a more severe LV diastolic dysfunction using E/e ratio (p