Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

Lahm, Tim; Douglas, Ivor S.; Archer, Stephen L.; Bogaard, Harm Jan; Chesler, Naomi C.; Haddad, François; Hemnes, Anna R.; Kawut, Steven M.; Kline, Jeffrey A.; Kolb, Todd M.; Mathai, Stephen C.; Mercier, Olaf; Michelakis, Evangelos D.; Naeije, Robert; Tuder, Rubin M.; Ventetuolo, Corey E.; Vieillard‐Baron, Antoine; Voelkel, Norbert F.; Vonk‐Noordegraaf, Anton; Hassoun, Paul M.

doi:10.1164/rccm.201806-1160st

Cited by 236 publications

(251 citation statements)

References 306 publications

(340 reference statements)

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“…We performed a prospective observational study involving patients admitted to two medical intensive care units (ICU) at University Hospital of Nancy, France (Unit 1 from January 2016 to July 2017; Unit 2 from November 2016 to July 2017). Consecutive patients were eligible if they fulfilled the following criteria: [1] adult patients who met the Berlin definition criteria for moderate to severe ARDS, [2] were predicted to be under invasive mechanical ventilation (MV) for > 48 h, and [3] were expected to undergo a complete echocardiography from 1 to 36 h after MV initiation. Exclusion criteria were (i) vulnerable patients under curatorship or guardianship; (ii) a history of chronic respiratory failure (long-term oxygen therapy or non-invasive ventilation) or (iii) chronic right ventricular failure or (iv) chronic heart failure with LVEF < 35% or (v) severe valvular heart disease and (vi) extracorporeal membrane oxygenation started before echocardiography assessment.…”

Section: Patientsmentioning

confidence: 99%

“…Thus, assessment of RV function is part of ARDS patient care [2]. Cardiac MRI allows highly accurate and reliable measurement of RV ejection fraction and is currently the gold standard imaging technique for RV assessment [3]. However, echocardiography is more practical in the unstable patient because it can be performed quickly at the bedside in a safer environment.…”

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confidence: 99%

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Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study

Lemarié¹,

Maigrat

Kimmoun³

et al. 2020

Ann. Intensive Care

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Background: Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantification of RV deformation by speckle-tracking echocardiography (STE) is a recently available and reproducible technique that provides an integrated analysis of the RV. However, data are scarce regarding its use in critically ill patients. The aim of this study was to assess its feasibility and clinical usefulness in moderate-severe ARDS patients.Results: Forty-eight ARDS patients under invasive mechanical ventilation (MV) were consecutively enrolled in a prospective observational study. A full transthoracic echocardiography was performed within 36 h of MV initiation. STE-derived and conventional parameters were recorded. Strain imaging of the RV lateral, inferior and septal walls was highly feasible (47/48 (98%) patients). Interobserver reproducibility of RV strain values displayed good reliability (intraclass correlation coefficients (ICC) > 0.75 for all STE-derived parameters) in ARDS patients. ROC curve analysis showed that lateral, inferior, global (average of the 3 RV walls) longitudinal systolic strain (LSS) and global strain rate demonstrated significant diagnostic values when compared to several conventional indices (TAPSE, S′, RV FAC). A RV global LSS value > − 13.7% differentiated patients with a TAPSE < vs > 12 mm with a sensitivity of 88% and a specificity of 83%. Regarding clinical outcomes, mortality and cumulative incidence of weaning from MV at day 28 were not different in patients with normal versus abnormal STE-derived parameters. Conclusions:Global STE assessment of the RV was highly achievable and reproducible in moderate-severe ARDS patients under MV and additionally correlated with several conventional parameters of RV function. In our cohort, STE-derived parameters did not provide any incremental value in terms of survival or weaning from MV prediction. Further investigations are needed to evaluate their theranostic usefulness. Trial registration NCT02638844: NCT

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Section: Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study

Lemarié¹,

Maigrat

Kimmoun³

et al. 2020

Ann. Intensive Care

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“…Ventricle dysfunction is the most common cause of heart failure, including left-sided HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF), as well as right-sided HF secondary to pulmonary hypertension and congenital heart disease (CHD) [7][8][9][10][11][12][13][14]. The malfunction of the myocardium in these diseases can occur in the left ventricle (LV), right ventricle (RV), or both ventricles (biventricular HF).…”

Section: Introductionmentioning

confidence: 99%

Current Understanding of the Biomechanics of Ventricular Tissues in Heart Failure

Liu

Wang

2019

Bioengineering

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Heart failure is the leading cause of death worldwide, and the most common cause of heart failure is ventricular dysfunction. It is well known that the ventricles are anisotropic and viscoelastic tissues and their mechanical properties change in diseased states. The tissue mechanical behavior is an important determinant of the function of ventricles. The aim of this paper is to review the current understanding of the biomechanics of ventricular tissues as well as the clinical significance. We present the common methods of the mechanical measurement of ventricles, the known ventricular mechanical properties including the viscoelasticity of the tissue, the existing computational models, and the clinical relevance of the ventricular mechanical properties. Lastly, we suggest some future research directions to elucidate the roles of the ventricular biomechanics in the ventricular dysfunction to inspire new therapies for heart failure patients.

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“…Finally, similar to the left heart, female sex hormones may protect the right ventricle (RV) when it is exposed to increased afterload. Recent data in animals, healthy people, and PAH patients support this notion [13][14][15][16]. Recently, the estrogen paradox concept was expanded to encompass the beneficial effects of estrogens concerning RV function and prognosis in PAH [17].…”

Section: Introductionmentioning

confidence: 96%

Estradiol Metabolism: Crossroads in Pulmonary Arterial Hypertension

Tofovic

Jackson

2019

IJMS

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Pulmonary arterial hypertension (PAH) is a debilitating and progressive disease that predominantly develops in women. Over the past 15 years, cumulating evidence has pointed toward dysregulated metabolism of sex hormones in animal models and patients with PAH. 17β-estradiol (E2) is metabolized at positions C2, C4, and C16, which leads to the formation of metabolites with different biological/estrogenic activity. Since the first report that 2-methoxyestradiol, a major non-estrogenic metabolite of E2, attenuates the development and progression of experimental pulmonary hypertension (PH), it has become increasingly clear that E2, E2 precursors, and E2 metabolites exhibit both protective and detrimental effects in PH. Furthermore, both experimental and clinical data suggest that E2 has divergent effects in the pulmonary vasculature versus right ventricle (estrogen paradox in PAH). The estrogen paradox is of significant clinical relevance for understanding the development, progression, and prognosis of PAH. This review updates experimental and clinical findings and provides insights into: (1) the potential impacts that pathways of estradiol metabolism (EMet) may have in PAH; (2) the beneficial and adverse effects of estrogens and their precursors/metabolites in experimental PH and human PAH; (3) the co-morbidities and pathological conditions that may alter EMet and influence the development/progression of PAH; (4) the relevance of the intracrinology of sex hormones to vascular remodeling in PAH; and (5) the advantages/disadvantages of different approaches to modulate EMet in PAH. Finally, we propose the three-tier-estrogen effects in PAH concept, which may offer reconciliation of the opposing effects of E2 in PAH and may provide a better understanding of the complex mechanisms by which EMet affects the pulmonary circulation–right ventricular interaction in PAH.

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Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

Abstract: This statement provides a roadmap to further advance the state of knowledge, with the ultimate goal of developing RV-targeted therapies for patients with RV failure of any etiology.

Cited by 236 publications

References 306 publications

Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study

Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional speckle-tracking echocardiography in ARDS patients: the ARD strain study

Current Understanding of the Biomechanics of Ventricular Tissues in Heart Failure

Estradiol Metabolism: Crossroads in Pulmonary Arterial Hypertension

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