The Echocardiographic Evaluation of the Right Heart: Current and Future Advances

O’Donnell, Christian; Sanchez, Pablo Amador; Celestin, Bettia; McConnell, Michael V.; Haddad, Francois

doi:10.1007/s11886-023-02001-6

Cited by 5 publications

(2 citation statements)

References 94 publications

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“…In our study, intermediate-risk patients who received escalated interventions had lower VTI, SV, and RV systolic function and larger RV chambers than adults without disease. 16 , 19 , 36 Patients who concerned clinicians enough to receive escalated interventions had significantly lower SV and VTI, greater RV dilation, and lower (worse) RV systolic function than patients treated with anticoagulation monotherapy. We believe these differences identify the subgroup of patients with current or impending subclinical shock.…”

Section: Discussionmentioning

confidence: 99%

Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study

Weekes,

Hambright,

Trautmann

et al. 2024

Western Journal of Emergency Medicine

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Introduction: Prognosis and management of patients with intermediate-risk pulmonary embolism (PE) is challenging. We investigated whether stroke volume may be used to identify the subset of this population at increased risk of clinical deterioration or PE-related death. Our secondary objective was to compare echocardiographic measurements of patients who received escalated interventions vs anticoagulation monotherapy. Methods: We selected patients with intermediate-risk PE, who had comprehensive echocardiography within 18 hours of PE diagnosis and before any escalated interventions, from a PE registry populated by 11 emergency departments. Echocardiographers measured right ventricle (RV) size, tricuspid annular plane systolic excursion (TAPSE), and stroke volume (SV) using velocity time integral (VTI) by left ventricular (LV) outﬂow tract Doppler or two-dimensional method of discs (MOD). The primary outcome was a composite of PE-related death, cardiac arrest, catecholamine administration for sustained hypotension, or emergency respiratory intervention during the index hospitalization. Secondary outcome was escalated intervention with reperfusion or extracorporeal membrane oxygenation therapy. Results: Of 370 intermediate-risk PE patients (mean age 64.0 ± 15.5 years, 38.1% male), 39 (10.5%) had the primary outcome. These 39 patients had lower mean SV regardless of measurement method than those without the primary outcome: SV MOD 36.2 vs 49.9 milliliters (mL), P < 0.001; SV Doppler 41.7 vs 57.2 mL, P = 0.003; VTI 13.6 vs 17.9 centimeters [cm], P = 0.003. Patients with primary outcome also had lower mean TAPSE than those without (1.54 vs 1.81 cm, P = 0.003). Multivariable models, selecting SV as predictor, had area under the receiver operating curve of 0.8 and Brier score 0.08. The best echocardiographic predictor of our primary outcome was SV MOD (odds ratio 0.72 [0.53, 0.94], P = 0.02). Patients who received escalated interventions had signiﬁcantly lower SV or surrogate measurements, greater RV dilatation, and lower RV systolic function than patients who received anticoagulation monotherapy. Conclusion: Low stroke volume was a predictor of clinical deterioration and PE-related death. Low SV may be used to identify a subset of intermediate-risk PE patients, who are higher risk (intermediate-high risk), and for whom escalated interventions should be considered.

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Section: Discussionmentioning

confidence: 99%

Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study

Weekes,

Hambright,

Trautmann

et al. 2024

Western Journal of Emergency Medicine

View full text Add to dashboard Cite

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“…However, beyond this physiological threshold, this process becomes disadvantageous, leading to RV large spherical remodeling, increasing RVEDV, enhancing its contraction in a horizontal or semi-horizontal plane, at the expense of the more physiological contraction along the longitudinal axis. Secondly, this causes a progressive RV concentric hypertrophy, attempting to balance its afterload [12][13][14]. Thirdly, within the pericardium, the increased RVEDV and internal tension, especially in the late diastolic and early systolic phases, hinders LV in increasing its diastolic compliance, promoted by the augmented circulating blood volume, so to simulate a restrictive cardiomyopathy with a paradoxically preserved ejection fraction.…”

Section: Cardiac Pathologymentioning

confidence: 99%

Insights into Sickle-cell Disease Cardiomyopathy: Early 3-D Echocardiographic Indicators and Pathophysiological Understanding

Coppi,

Tampieri,

Palazzi

et al. 2024

Preprint

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Purpose In sickle cell disease, 3-D transthoracic echocardiography is increasingly essential for early diagnosis and subsequent risk stratification of potential cardiac complications. This topic can be effectively explored by delving deeper into its pathophysiology. Methods With this aim the results of 3-D echocardiography explorations, performed in a cohort of 46 pediatric patients with homozygous or heterozygous sickle-cell disease, were reassessed using a predominant morpho-functional approach. Results Increased end-diastolic volume of the right ventricle appeared as the most obvious early cardiac pathology, promoted by a corresponding pulmonary hypertension and followed by its uncoupling with the pulmonary artery. Over the time, the dysfunction of the right ventricle extends to involve the left ventricle, leading in global heart failure, which can be described as “right ventricle-driven”. Conclusions 3-D trans-thoracic ecocardiography is an essential tool for diagnosis, prognosis and follow-up of sickle cell disease patients. It aids in evaluating the optimal medical treatment and, in the long run, may suggest the possibility of a bone marrow transplant.

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Tricuspid annular plane systolic excursion in pulmonary hypertension—Moving beyond the sector plane

Ichimura,

Celestin,

Bagherzadeh

et al. 2024

Pulm. circ.

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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.

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The Echocardiographic Evaluation of the Right Heart: Current and Future Advances

Cited by 5 publications

References 94 publications

Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study

Low Stroke Volume Predicts Deterioration in Intermediate-Risk Pulmonary Embolism: Prospective Study

Insights into Sickle-cell Disease Cardiomyopathy: Early 3-D Echocardiographic Indicators and Pathophysiological Understanding

Tricuspid annular plane systolic excursion in pulmonary hypertension—Moving beyond the sector plane

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