Right ventricular ejection fraction: An indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease

Fisch

et al. 2014

JoVE

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure [1][2][3] . Moreover, the RV is significantly affected in pulmonary diseases such as pulmonary artery hypertension (PAH). In addition, the RV is remarkably sensitive to cardiac pathologies, including left ventricular (LV) dysfunction, valvular disease or RV infarction 4 . To understand the role of RV in the pathogenesis of cardiac diseases, a reliable and noninvasive method to access the RV structurally and functionally is essential.A noninvasive trans-thoracic echocardiography (TTE) based methodology was established and validated for monitoring dynamic changes in RV structure and function in adult mice. To impose RV stress, we employed a surgical model of pulmonary artery constriction (PAC) and measured the RV response over a 7-day period using a high-frequency ultrasound microimaging system. Sham operated mice were used as controls. Images were acquired in lightly anesthetized mice at baseline (before surgery), day 0 (immediately post-surgery), day 3, and day 7 (post-surgery). Data was analyzed offline using software.Several acoustic windows (B, M, and Color Doppler modes), which can be consistently obtained in mice, allowed for reliable and reproducible measurement of RV structure (including RV wall thickness, end-diastolic and end-systolic dimensions), and function (fractional area change, fractional shortening, PA peak velocity, and peak pressure gradient) in normal mice and following PAC.Using this method, the pressure-gradient resulting from PAC was accurately measured in real-time using Color Doppler mode and was comparable to direct pressure measurements performed with a Millar high-fidelity microtip catheter. Taken together, these data demonstrate that RV measurements obtained from various complimentary views using echocardiography are reliable, reproducible and can provide insights regarding RV structure and function. This method will enable a better understanding of the role of RV cardiac dysfunction. Video LinkThe video component of this article can be found at

Section: Representative Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography

Fisch

et al. 2014

JoVE

“…Prognosis in patients with heart failure can be determined by measuring RVEF [43][44][45][46]. In moderate congestive heart failure, RVEF has been shown to be an independent predictor of survival, with 1-year survival rates for RVEF <25%, ⩾25% to <35% and ⩾35% of 80%, 90% and 95%, respectively [43].…”

Section: Prognosismentioning

confidence: 99%

Under pressure: pulmonary hypertension associated with left heart disease

Farber

Gibbs

2015

Eur Respir Rev

Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common type of PH, but its natural history is not well understood. PH-LHD is diagnosed by right heart catheterisation with a mean pulmonary arterial pressure ⩾25 mmHg and a pulmonary capillary wedge pressure >15 mmHg. The primary causes of PH-LHD are left ventricular dysfunction of systolic and diastolic origin, and valvular disease. Prognosis is poor and survival rates are low. Limited progress has been made towards specific therapies for PH-LHD, and management focuses on addressing the underlying cause of the disease with supportive therapies, surgery and pharmacological treatments. Clinical trials of therapies for pulmonary arterial hypertension in patients with PH-LHD have thus far been limited and have provided disappointing or conflicting results. Robust, long-term clinical studies in appropriate target populations have the potential to improve the outlook for patients with PH-LHD. Herein, we discuss the knowledge gaps in our understanding of PH-LHD, and describe the current unmet needs and challenges that are faced by clinicians when identifying and managing patients with this disease. @ERSpublications Pulmonary hypertension due to left heart disease is associated with multiple unmet medical needs http://ow.ly/TFET8Case study part 1: initial assessment A 63-year-old male with hypertension, diabetes mellitus, dyslipidaemia, coronary artery disease and obstructive sleep apnoea presented to the clinic with worsening dyspnoea upon exertion (World Health Organization (WHO) functional class IIIb). Echocardiography revealed a normal-sized left ventricle, left ventricular ejection fraction (LVEF) of 35-40%, delayed left ventricular diastolic relaxation, normal left atrium, right ventricular dilation with moderately depressed systolic function, mild right atrial enlargement, flattened interventricular septum, dilated inferior vena cava, and a pulmonary artery systolic pressure of 85 mmHg. Computed tomography pulmonary angiography revealed no pulmonary embolus or parenchymal lung disease. The patient failed to reach the target heart rate in a treadmill exercise test, but there was no evidence of myocardial ischaemia. Pulmonary function testing and right heart catheterisation (RHC) were performed (table 1).Question 1: Based on these data, what would be your initial assessment of this patient? This real-life patient case study highlights some of the many factors that can make diagnosing pulmonary hypertension associated with left heart disease (PH-LHD) challenging. Based on the information presented, would you diagnose this patient with PH-LHD?

“…that RV function is related to exercise tolerance and determines the severity of the patient's condition more than LV function, and that increasing RVEF is the measure of the effectiveness of revascularization in CHD patients with congestive HF [19][20][21]. According to G. Karatasakis et al [22], in patients with advanced heart failure, preserved RV function as indicated by an echocardiographically derived RV shortening >1.25cm was a strong predictor of survival.…”

Section: Fig 1 Causes Of Death In Dcm Patientsmentioning

confidence: 99%

“…The expected both right and left heart dilatation with marked reduction of inotropic miocardial function was registered in DCM patients with BV-HF. Polak J. F. et al [21] showed that in patients with depressed left ventricular ejection fraction (less than 40%) and clinically evident congestive heart failure secondary to atherosclerotic coronary artery disease the reduction in right ventricular ejection fraction is a useful index not only for assessing biventricular function, but also for predicting patient outcome. These data were confirmed in other studies [5,10].…”

Section: Fig 1 Causes Of Death In Dcm Patientsmentioning

confidence: 99%

Clinical Profile and Prognosis of Patients with Right Ventricular Dilated Cardiomyopathy: Results of a Prospective Study

Akhmatov¹,

Abdullayev²,

Марданов³

2015

Int J Biomed

The aim of our study was to investigate the clinical prevalence of dilated cardiomyopathy (DCM) with predominantly failure of the right-side heart (right ventricular DCM, RV-DCM), and features of the clinical course and prognosis of the disease compared to DCM with biventricular heart failure (BV-HF).The study design suggests a prospective observation of 300 patients with idiopathic DCM between 2000 and 2012. Herewith, we followed the criteria of the WHO/ISFC task force (1995) on the definition and classification of cardiomyopathies. All patients underwent a comprehensive examination. Two groups were formed for further comparative analysis. Group 1 included 22 patients (mean age 42.9±14.3 years, male/female 5/17) with RV-DCM. Group 2 included 38 patients (mean age 43.6±13.8, male/female 29/9) with DCM and BV-HF. The groups were matched for age, NYHA class II-III, and disease duration. According to our aim, we studied 5-year survival prognosis and analyzed the incidence and causes of deaths, as well as the occurrence of nonfatal complications of the disease. Medical therapy for DCM patients was performed according to the CHF therapy guidelines (ACC/ AHA 2001.The results of our investigations during many years of research have shown that the clinical incidence of RV-DCM was 7.3% among all forms of DCM. The study of life prognosis in patients with 2 forms of DCM showed that 5-year mortality of patients was about 50%. Fatal pulmonary embolism was a leading cause (50%) in RV-DCM patients.