Ventricular Function, Right

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Original Article

Can we Trust in Routine Echocardiography to Assess the Right Ventricle and Pulmonary Insufficiency? A Comparative Study with Cardiac Magnetic Resonance

Manuela Baima Cabral et al. Marcelo Felipe Kozak Jorge Yussef Afiune

Abstract

Background

Cardiac magnetic resonance (CMR) is the method of choice for assessing right ventricular (RV) dimensions and function, and pulmonary insufficiency (PI).

Objectives

To assess the accuracy of two-dimensional echocardiography (2D ECHO) in estimating RV function and dimensions, and the degree of PI, and compare the 2D ECHO and CMR findings.

Methods

We compared ECHO and CMR reports of patients whose indication for CMR had been to assess RV and PI. A p-value < 0.05 was considered statistically significant.

Results

We included 51 congenital heart disease patients, with a median age of 9.3 years (7-13.3 years). There was poor agreement between 2D ECHO and CMR for classification of the RV dimension (Kappa 0.19; 95% CI 0.05 to 0.33, p 0.004) and function (Kappa 0.16; 95% CI -0.01 to +0.34; p 0.034). The RV was undersized by 2D ECHO in 43% of the cases, and RV function was overestimated by ECHO in 29% of the cases. The degree of agreement between the methods in the classification of PI was not significant (Kappa 0.014; 95% CI -0.03 to +0.06, p 0.27). 2D ECHO tended to overestimate the degree of PI.

Conclusions

The 2D ECHO showed a low agreement with CMR regarding the RV dimensions and function, and degree of PI. In general, ECHO underestimated the dimensions of the RV and overestimated the function of the RV and the degree of PI as compared with CMR.

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Editorial

The Challenge of Echocardiography in the Accurate Assessment of the Right Ventricle and Pulmonary Insufficiency

Claudia R. Pinheiro de Castro Grau

The current recognition of the importance of the right ventricle (RV) role in the evolution and prognosis of various cardiovascular conditions is indisputable and the proper assessment of its dimension and function has a direct impact on clinical management.

Pulmonary insufficiency (PI) is common after tetralogy of Fallot repair (POTF) and approach of congenital heart disease with pulmonary obstruction, being is an important determinant of outcome due to its consequences, causing RV dilation and dysfunction, exercise intolerance, increased risk of arrhythmias and sudden death.

[…]

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Original Article

Relationship between Right Ventricular Strain Signs in Electrocardiography and Levels of Biomarkers Associated with COVID-19 Pneumonia Severity

Veli Polat et al. Evin Bozcali Kadriye Kart Yasar Hayat Kumbasar Karaosmanoglu Ibrahim Faruk Akturk

Abstract

Background

The novel coronavirus disease (COVID-19) may lead to severe disease that can cause death. COVID-19 is known to affect the cardiovascular system. Early detection of the progression to the severe disease stage that affects the cardiovascular system may play a critical role in the treatment of COVID-19.

Objectives

To explore the possible relationship between the COVID-19 pneumonia and right ventricular strain findings on electrocardiography (ECG).

Methods

We conducted a retrospective study of 141 hospitalized patients with COVID-19. Spearman’s correlation and logistic regression analyses were applied to assess relationships between ECG manifestations of right ventricular strain and levels of biomarkers and other laboratory and chest imaging findings. The significance level was considered as < 0.05.

Results

The ECG signs of right ventricular stress were significantly more frequent and the levels of fibrinogen, CRP, and ferritin were significantly higher in COVID-19 patients with elevated levels of hs-cTnI, procalcitonin and D-dimer. The univariate analysis showed there are significant relations between the presence of bilateral pneumonia, most of the ECG signs of right ventricular strain and cardiac injury and inflammatory and thrombotic biomarkers. The multivariate analysis revealed that ST-segment elevation in V₁and the S₁Q₃T₃pattern are independent predictors of cardiac damage (odds ratio=0.23; 95% CI, 0.06 to 0.90; p=0.035) and elevated procalcitonin levels (odds ratio=0.19; 95% CI, 0.06 to 0.62; p=0.006), respectively.

Conclusion

The findings of the present study suggest that right heart damage is prevalent in COVID-19. In addition, our study shows the clinical value of ECG in evaluating and monitoring the patients with COVID-19 pneumonia.

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Brief Communication

Diastolic Function in Paced Children with Cardiac Defects: Septum vs Apex

Michel Cabrera Ortega et al. Adel Eladio Gonzalez Morejon Giselle Ricardo Serrano Dunia Barbara Benitez Ramos

Abstract

In children with structural congenital heart disease (CHD), the effects of chronic ventricular pacing on diastolic function are not well known. On the other hand, the beneficial effect of septal pacing over apical pacing is still controversial.

The aim of this study was to evaluate the influence of different right ventricular (RV) pacing site on left ventricular (LV) diastolic function in children with cardiac defects.

Twenty-nine pediatric patients with complete atrioventricular block (CAVB) and CHD undergoing permanent pacing were prospectively studied. Pacing sites were RV apex (n = 16) and RV septum (n = 13). Echocardiographic assessment was performed before pacemaker implantation and after it, during a mean follow‑up of 4.9 years.

Compared to RV septum, transmitral E-wave was significantly affected in RV apical pacing (95.38 ± 9.19 vs 83 ± 18.75, p = 0.038). Likewise, parameters at the lateral annular tissue Doppler imaging (TDI) were significantly affected in children paced at the RV apex. The E´ wave correlated inversely with TDI lateral myocardial performance index (Tei index) (R²= 0.9849, p ≤ 0.001). RV apex pacing (Odds ratio, 0.648; confidence interval, 0.067-0.652; p = 0.003) and TDI lateral Tei index (Odds ratio, 31.21; confidence interval, 54.6-177.4; p = 0.025) predicted significantly decreased LV diastolic function.

Of the two sites studied, RV septum prevents pacing-induced reduction of LV diastolic function.

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Letter to the Editor

Assessment of Natriuretic Peptides: The Heart Should Be Evaluated as a Whole

Emre Yalcinkaya et al. Murat Celik Galip Buyukturan

Dear Editor,

We read with great interest the article by Rodrigues et al entitled “Right Ventricular Assessment by Tissue-Doppler Echocardiography in Acute Pulmonary Embolism”, which was published of the Arquivos Brasileiros de Cardiologia. The authors aimed to evaluate the right ventricular (RV) systolic function using two-dimensional tissue Doppler echocardiography in patients with acute pulmonary embolism (PE) and to analyze its correlation with atrial natriuretic peptide (BNP) levels. The authors concluded that increased BNP levels (≥ 50 pg/mL) were associated with a higher prevalence of RV systolic dysfunction in patients with PE. Although the current article is well-managed, and we commend the authors for the detailed and valuable information that they have provided, some comments may be beneficial.

[…]

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Artigo Original

The impact of isolated obesity on right ventricular function in young adults

Abdullah Sokmen et al. Gulizar Sokmen Gurkan Acar Ahmet Akcay … Sedat Koroglu Murat Koleoglu Sila Yalcintas M. Naci Aydin

BACKGROUND: Obesity is an independent risk factor for cardiovascular diseases. The effects of obesity on left ventricular structure and function have been reported, but relatively little is known regarding right ventricular (RV) function in obesity. OBJECTIVE: To evaluate subclinical RV alterations in obese, but otherwise healthy, young adults by conventional echocardiography and tissue Doppler imaging (TDI). METHODS: In this study, we included 35 normal weight healthy subjects with a body mass index (BMI) 35 kg/m² (group III). All subjects underwent transthoracic echocardiography. In addition to standard echocardiographic measurements, tricuspid annular peak systolic (Sm), peak early (Em), and late diastolic (Am) velocities, isovolumetric contraction (ICTm), relaxation (IRTm) time, and ejection time (ETm) were obtained by TDI, and RV myocardial performance index (MPIm) was calculated. RESULTS: In group II, RV Em/Am was significantly decreased and IRTm and MPIm were significantly increased compared to group I (p < 0.01). RV Sm, Em, and the Em/Am ratio were significantly lower and RV IRTm and MPIm were significantly higher in group III than in group II (p < 0.05 for RV Sm and IRTm and p < 0.01 for others). RV Am differed significantly between groups III and I (p < 0.05). BMI was significantly and negatively correlated with RV Sm, Em, and the Em/Am ratio, but positively correlated with RV MPI (p < 0.01). CONCLUSION: Our study showed that isolated obesity in young normotensive adults was associated with subclinical abnormalities in RV structure and function.

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Artigo Original

Right ventricular assessment by tissue-Doppler echocardiography in acute pulmonary embolism

Ana Clara Tude Rodrigues et al. Adriana Cordovil Claudia Monaco Laise Guimarães … Alexandre Cury Gustavo A F Naccarato Edgar Lira-Filho Claudio Henrique Fischer Marcelo Luiz Campos Vieira Samira Morhy

BACKGROUND: Assessment of the right ventricular (RV) function by echocardiography in patients with pulmonary thromboembolism (PTE) is complex and frequently qualitative. Tissue Doppler has been used for the semiquantitative assessment of this chamber, although with some limitations. OBJECTIVE: To evaluate RV function in PTE using tissue-Doppler echocardiography, in addition to atrial natriuretic peptide (BNP). METHODS: Patients with PTE were studied using tissue-Doppler echocardiography and BNP up to 24 hours after diagnosis; myocardial velocities (s’), strain, strain rate and RV myocardial performance index were obtained. RV dysfunction was diagnosed by chamber hypokinesia, abnormal septal motion and a RV/LV ratio >1. According to their BNP levels, the patients were divided into Group I, BNP 50 pg/mL. RESULTS: Of 118 patients, 100 (60 men, age = 55 ± 17 years) were analyzed; RV dysfunction was observed in 28%, more frequently in group II (19 vs. 9 patients, p < 0.001). Patients in group II were older (64 ± 19 vs. 50 ± 15 years), and had lower s' velocity (10.5 ± 3.5 vs. 13.2 ± 3.1 cm/s), and higher pulmonary pressure (48 ± 11 vs. 35 ± 11 mmHg), p < 0.001. The cut-off point of s' for RV dysfunction was 10.8 cm/s (specificity = 85%, sensitivity = 54%), with moderate correlation between BNP and s' wave (r = -0.39). CONCLUSION: In PTE, RV dysfunction on echocardiography is accompanied by BNP elevation; although tissue-Doppler imaging adequately confirms the presence of RV dysfunction, it has a limited sensitivity for this diagnosis.

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Artigo Original

Correlation of myocardial interstitial collagen in the right ventricular septum with ventricular function of patients with ischemic cardiomyopathy

Marcelo Westerlund Montera et al. Cantídio Drumond Cristina Takiya Cláudio Tinoco Mesquita … Hans Fernando R. Dohmann Charles Mady

BACKGROUND: Myocardial collagen content influences ventricular relaxation, contraction, and morphology. Its relationship with ventricular function in patients (Pts) with ischemic cardiomyopathy (ICMP) has not yet been fully studied in humans. OBJECTIVE: To assess the relationship between interstitial collagen content in non-infarcted areas of the right ventricular septum and ventricular function in ICMP. METHODS: 31 pts with coronary artery disease were divided into four groups as follows:The control group consisted of 7 pts with normal left (LVEF) and right (RVEF) ventricular ejection fraction (group C); Group 1: 5 patients with RVEF < 40%; Group 2: 9 pts with LVEF < 40%; and Group 3, 10 pts with biventricular dysfunction. RVEF and LVEF were measured by radionuclide angiography. For quantitative analysis of interstitial collagen volume fraction (CVF), endomyocardial biopsy specimens were taken from the right ventricle and stained with picrosirius red. RESULTS: Mean CVF was significantly higher in group 3, compared with the control group and with groups 1 and 2 (30.2 ± 7.9% vs. 6.8 ± 3.3% vs. 15.8 ± 4.1% vs. 17.5±7.7%, respectively; p =0.0001). It was also significantly higher in patients belonging to group 2, compared with those in the control group (17.5 ± 7.7% vs. 6.8 ± 3.3%, p =0.0001). CVF was inversely correlated with RVEF (r = – 0.50, p = 0.003) and LVEF (r = -0.70, p = 0.0001). CONCLUSION: In ICMP, CVF is elevated in non-infarcted areas of the right ventricular septum and inversely correlated with right and left ventricular function.

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