Assessment of Right Ventricular Function—a State of the Art

Hameed, Abdul; Condliffe, Robin; Swift, Andrew J.; Alabed, Samer; Kiely, David G.; Charalampopoulos, Athanasios

doi:10.1007/s11897-023-00600-6

Cited by 8 publications

(2 citation statements)

References 175 publications

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“…In order to ensure the best possible treatment of CS and the most optimal Impella support, appropriate monitoring of RV function appears to be essential [ 25 , 26 , 27 ]. Josiassen et al recently showed that the LV Impella can benefit RV function in cases of myocardial infarction-related CS in pigs [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock

Markus,

Kreutz,

Chatzis

et al. 2024

JCM

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Background: Right ventricular (RV) dysfunction or failure occurs in more than 30% of patients in cardiogenic shock (CS). However, the importance of timely diagnosis of prognostically relevant impairment of RV function is often underestimated. Moreover, data regarding the impact of mechanical circulatory support like the Impella on RV function are rare. Here, we investigated the effects of the left ventricular (LV) Impella on RV function. Moreover, we aimed to identify the most optimal and the earliest applicable parameter for bedside monitoring of RV function by comparing the predictive abilities of three common RV function parameters: the pulmonary artery pulsatility index (PAPi), the ratio of right atrial pressure to pulmonary capillary wedge pressure (RA/PCWP), and the right ventricular stroke work index (RVSWI). Methods: The data of 50 patients with CS complicating myocardial infarction, supported with different flow levels of LV Impella, were retrospectively analyzed. Results: Enhancing Impella flow (1.5 to 2.5 L/min ± 0.4 L/min) did not lead to a significant variation in PAPi (p = 0.717), RA/PCWP (p = 0.601), or RVSWI (p = 0.608), indicating no additional burden for the RV. PAPi revealed the best ability to connect RV function with global hemodynamic parameters, i.e., cardiac index (CI; p < 0.001, 95% CI: 0.181–0.663), pulmonary capillary wedge pressure (PCWP; p = 0.005, 95% CI: −6.721–−1.26), central venous pressure (CVP; p < 0.001, 95% CI: −7.89–5.575), and indicators of tissue perfusion (central venous oxygen saturation (SvO2); p = 0.008, 95% CI: 1.096–7.196). Conclusions: LV Impella does not impair RV function. Moreover, PAPi seems to be to the most effective and valid predictor for early bedside monitoring of RV function.

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Section: Discussionmentioning

confidence: 99%

Monitoring a Mystery: The Unknown Right Ventricle during Left Ventricular Unloading with Impella in Patients with Cardiogenic Shock

Markus,

Kreutz,

Chatzis

et al. 2024

JCM

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“…In addition to assessing the function of the left ventricle, it is also important to assess the right ventricle (estimation of its size, systolic excursion of the tricuspid annulus-TAPSE, etc.) [173]. A significant reduction in right ventricular function is a powerful predictor of death and the need for heart transplantation in patients with proven myocarditis [46].…”

Section: Echocardiographymentioning

confidence: 99%

Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment

Lasica,

Djukanovic,

Savic

et al. 2023

Diagnostics

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Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.

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