Development and prognostic validation of partition values to grade right ventricular dysfunction severity using 3D echocardiography

Abstract

Aims Transthoracic 3D echocardiography (3DE) has been shown to be feasible and accurate to measure right ventricular (RV) ejection fraction (EF) when compared with cardiac magnetic resonance (CMR). However, RV EF, either measured with CMR or 3DE, has always been reported as normal (RV EF > 45%) or abnormal (RV EF ≤ 45%). We therefore sought to identify the partition values of RV EF to stratify RV dysfunction in mildly, moderately, or severely reduced as we are used to do with the left ventricle. Methods and results We used 3DE to measure RV EF in 412 consecutive patients (55 ± 18 years, 65% men) with various cardiac conditions who were followed for 3.7 ± 1.4 years to obtain the partition values which defined mild, moderate, and severe reduction of RV EF (derivation cohort). Then, the prognostic value of these partition values was tested in an independent population of 446 patients (67 ± 14 years, 58% men) (validation cohort). During follow-up, we recorded 59 cardiac deaths (14%) in the derivation cohort. Using K-Adaptive partitioning for survival data algorithm we identified four groups of patients with significantly different mortality according to RV EF: very low > 46%, 40.9% < low ≤ 46%, 32.1% < moderate ≤ 40.9%, and high ≤ 32.1%. To make the partition values easier to remember, we approximated them to 45%, 40%, and 30%. During 4.1 ± 1.2 year follow-up, 38 cardiac deaths and 88 major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction, ventricular fibrillation, or admission for heart failure) occurred in the validation cohort. The partition values of RV EF identified in the derivation cohort were able to stratify both the risk of cardiac death (log-rank = 100.1; P < 0.0001) and MACEs (log-rank = 117.6; P < 0.0001) in the validation cohort too. Conclusion Our study confirms the independent prognostic value of RV EF in patients with heart diseases, and identifies the partition values of RV EF to stratify the risk of cardiac death and MACE.

Assessment of Subclinical Deterioration of Right Ventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Breast Cancer Patients Undergoing Anthracycline-Based Chemotherapy

“…6,15 However, RV dysfunction is not considered in the diagnosis of CTRCD. Given the established prognostic significance of RV dysfunction on outcome of patients with heart failure, 16,17 anthracycline-related toxic effects on the right ventricle have become the focus of greater interest. Although the assessment of the right ventricle by conventional 2D echocardiography has prognostic value, its accuracy and reproducibility are limited.…”

Left and right ventricular dysfunction in patients with COVID-19-associated myocardial injury

“…Diastolic LV dysfunction (LVD dia ) was present if three out of the following six parameters were found: Mitral peak E velocity ≤ 50 cm/s, E/A ratio ≤ 0.8, average E/e′ > 14, septal e′ velocity < 7 cm/s or lateral e′ velocity < 10 cm/s, tricuspid regurgitation (TR) velocity > 280 cm/s or left atrial volume (3D-LAV) index > 34 ml/m 2 [12]. Systolic right ventricular (RV) dysfunction (RVD sys ) was defined as 3D-RVEF below 45% [13] or impaired RV free wall strain (RV-FWS) above -20% [9].…”

“…Admission to intensive care unit (61% vs. 29% patients, p = 0.031) did statistically differ, whereas need for intubation due to respiratory failure (10 vs. 4 patients, p = 0.133) did not statistically differ between groups. Median duration of ICU treatment was 15 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days. None of the 32 patients died during hospitalisation or time to follow-up.…”

Comprehensive Echocardiographic Assessment of the Right Ventricular Performance: beyond TAPSE and Fractional Area Change

“…Current chamber quantification guidelines for the first time included recommendations for 3DE analysis of the RV and cut-off values for RV volumes and EF (Table 2) specifying RV EF >45% as the lower limits of normal [20]. In the recent study, partition values of the RV EF to classify RV systolic dysfunction as mild (40-45%), moderate (30-40%) or severe (<30%) have been introduced and their prognostic value validated [21]. Figures 2 and 3 provide two practical examples of an added value of the 3DE volumetric analysis of the RV in routine clinical practice.…”