Right ventricular ejection fraction

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Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model

Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model

The complex shape of the RV, and the relatively large element of trabeculations, makes its function more chal- lenging to assess as compared to the left ventricle (LV), when using echocardiography. Cardiac magnetic reson- ance (CMR) imaging is considered to be the reference method for RV evaluation allowing full ventricular coverage. In CMR, right ventricular ejection fraction (RVEF) is often used as a measure of RV function. RVEF can be determined by calculating the end-diastolic and end-systolic volumes of the RV in the short-axis (SA) plane [5]. Previous studies have shown that RVEF pre- dicts long-term outcome in PH patients for both chil- dren and adults [6, 7].
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Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

Results: Most of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan- Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH.
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Impaired right ventricular ejection fraction after cardiac surgery is associated with a complicated ICU stay

Impaired right ventricular ejection fraction after cardiac surgery is associated with a complicated ICU stay

APACHE: Acute Physiology and Chronic Health Evaluation; CABG: Coronary artery bypass grafting; CI: Confidence interval; CK-MB: Creatine kinase-myoglobin bind- ing; CO: Cardiac output; COPD: Chronic obstructive pulmonary disease; CVA: Cerebral vascular accident; CVP: Central venous pressure; CVVHD: Continuous veno-venous haemodialysis; ECC: Extracorporeal circulation; EDVi: End-diastolic volume index; EuroSCORE: European System for Cardiac Operative Risk Evaluation; ICU: Intensive care unit; IQR: Interquartile range; LOS: Length of stay; LV: Left ventricular; LVEF: Left ventricular ejection fraction; PAC: Pulmonary artery catheter; PAP: Pulmonary artery pressure; PEEP: Postoperative end-expiratory pressure; RV: Right ventricular; RVEF: Right ventricular ejection fraction; RVFAC: Fractional area change; SvO 2 : Mixed venous oxygen saturation; TAPSE: Tricuspid annular
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Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method

Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method

Conventional echocardiographic parameters of the RV Echocardiography is a widely used, non-invasive imaging modality to describe cardiac morphology and function. However, ultrasonic assessment of the RV is challenging due to the complex anatomy of the chamber. Conven- tional two-dimensional acquisition protocols require to obtain several imaging views using the parasternal, apical and subcostal approaches. The most commonly used echocardiographic measures to characterize RV morph- ology are simple linear diameters, while functional as- pects are mainly investigated by measuring the tricuspid annular plane systolic excursion (TAPSE) and the RV fractional area change (FAC) [11]. The latter parameters have shown their correlation with RV ejection fraction measured by cardiac magnetic resonance imaging (MRI) [12] and proven their prognostic value as well [13–16]. Nevertheless, several limitations have to be taken into consideration, especially in certain pathological condi- tions. TAPSE is an easy-to-obtain M-mode parameter of RV function, referring solely to longitudinal motion of RV free wall (Fig. 5). However, since the reference is out- side of the heart, TAPSE measures not only the shorten- ing of the RV free wall but also the traction of the RV resulting from left ventricular contraction and the effects of the heart translation within the chest [4]. FAC incor- porates both the radial displacement of the RV free wall and the longitudinal motion of the tricuspid annulus toward the apex, assessed on a single tomographic apical
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Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension

Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension

Figure 1 Four-chamber and short axis views of a healthy subject, a patient with moderate PH and a patient with severe PH. The figure illus- trates how the longitudinal dimension (from tricuspid annulus to apex (TA)) and transverse dimensions (from septum to free-wall (SF)) are determined. Firstly, both in end-diastole and end-systole, the left and right lateral annulus-apex lines were drawn. Secondly, the intersection through the centres of these lines was drawn. SF dimensions were considered parallel to this intersecting line. Thirdly, RV endocardial contours were drawn to determine the SF dimension at seven different levels covering the whole RV (indicated as apex-1 through base-7, with level mid-4 exactly halfway through the RV). The white lines in the short axis views indicate the intersections of the four-chamber views. RV = right ventricle, RA = right atrium, LV = left ven- tricle, LA = left atrium, A = Apex, T = lateral tricuspid annulus, S = RV endocardial septum, F = RV endocardial free wall.
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Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients

CI: Confident interval; CO: Cardiac output; dPAP: Diastolic pulmonary arterial pressure; EDDr: End-diastolic diameter ratio; ICU: Intensive care medicine; IVA: Isovolumic acceleration; LV: Left ventricle; LVEF: Left ventricular ejection fraction; mPAP: Mean pulmonary arterial pressure; MRI: Magnetic resonance imaging; NPV: Negative predictive value; PAC: Pulmonary artery catheter; PAP: Pulmonary arterial pressure; PCWP: Pulmonary capillary wedge pressure; PPV: Positive predictive value; RAP: Right atrial pressure; RIMP: Right ventricular index of myocardial performance; RV: Right ventricle; RVEDV: Right ventricular end-diastolic volume; RVEF: Right ventricular ejection fraction; RVESV: Right ventricular end-systolic volume; SAPS: Simplified acute physiological score; Se: Sensitivity; SOFA: Sequential Organ Failure Assessment; Sp: Specificity; sPAP: Systolic pulmonary arterial pressure; SV: Stroke volume; TAPSE: Tricuspid annular plane systolic excursion; TR: Tricuspid regurgitation; TTE: Transthoracic echocardiography
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Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

Prediction of doxorubicin cardiotoxicity by early detection of subclinical right ventricular dysfunction

Anthracyclines are commonly used anti-neoplastic agents in the treatment of a variety of malignancies, including lymphoma; and cardiotoxicity remains an irreversible complication of anthracycline-based chemo- therapy. Most current guidelines and clinical trials describe cardiotoxicity as changes in resting cardiac systolic function [1] defined by the current European Society of Medical Oncology [2] consensus statement as left ventricular ejection fraction (LVEF) drop by > 10– 15% or to < 50% of total LVEF. The incidence of cardio- toxicity during doxorubicin-based chemotherapy is dose-dependent with higher cumulative doses being associated with higher risk of cardiotoxicity [2], and is yet unpredictable.
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Determinants of left ventricular ejection fraction and a novel method to improve its assessment of myocardial contractility

Determinants of left ventricular ejection fraction and a novel method to improve its assessment of myocardial contractility

This study confirms that LV Ees and Ea are the main determinants of LVEF. Not surprisingly, we also corrob- orated the strong relationship between LVEF and both VAC and LVeff, which are mathematically coupled to Ees Fig. 1 Relationship between ventriculo-arterial coupling, left ventricular mechanical efficiency and left ventricular ejection fraction. Left: linear regression analysis between ventriculo-arterial coupling (VAC), calculated as the ratio between effective arterial elastance (Ea) and left ventricular end-systolic elastance (Ees), and left ventricular ejection fraction (LVEF). Right: linear regression analysis between left ventricular mechanical efficiency, calculated as the ratio between stroke work (SW) and the left ventricular pressure–volume area (PVA), and left ventricular ejection fraction. Colors inside circles represent different experimental interventions: red, afterload; green: preload; blue: contractility
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The subxiphoid view cannot replace the apical view for transthoracic echocardiographic assessment of hemodynamic status

The subxiphoid view cannot replace the apical view for transthoracic echocardiographic assessment of hemodynamic status

Methods: This prospective study took place in a teaching hospital medical ICU. Over a 4-month period, TTE was performed in patients admitted for more than 24 hours. Two operators rated the quality of parasternal, apical, and subxiphoid acoustic windows as Excellent, Good, Acceptable, Poor, or No image. In the subpopulation presenting adequate (rated as acceptable or higher) apical and subxiphoid views, we compared the left ventricular ejection fraction (LVEF), the ratio between right and left ventricular end-diastolic areas (RVEDA/LVEDA), the ratio between early and late mitral inflow on pulsed Doppler (E/A ratio), the aortic velocity time integral (Ao VTI), and the ratio between early mitral inflow and displacement of the mitral annulus on tissue Doppler imaging (E/Ea ratio).
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Reduced fractional shortening of right ventricular outflow tract is associated with adverse outcomes in patients with left ventricular dysfunction

Reduced fractional shortening of right ventricular outflow tract is associated with adverse outcomes in patients with left ventricular dysfunction

Values are expressed as absolute number or the mean ± SD. Each variable was analyzed by 1) unpaired t-test, 2) Fisher's exact test and 3) Mann-Whitney test. NYHA New York Heart Association, IHD ischemic heart disease, Af atrial fibrillation, BNP brain natriuretic peptide, eGFR estimated glomerular filtration rate, LA left atrial dimension (diastole), IVSTd intraventricular septal wall thickness (diastole), LVPWTd left ventricular posterior wall thickness (diastole), LVDd left ventricular end-diastolic dimension, LVDs left ventricular end-systolic dimension, LVEF left ventricular ejection fraction, RVFAC right ventricular fractional area change, TR-PG tricuspid regurgitation-pressure gradient, ACE-I angiotensin converting enzyme inhibitor, ARB angiotensin II type 1 receptor antagonist.
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Association of serum calcium and heart failure with preserved ejection fraction in patients with type 2 diabetes

Association of serum calcium and heart failure with preserved ejection fraction in patients with type 2 diabetes

To minimize the possibility that some abnormal condi- tions may influence the results, patients with any of the following conditions were excluded: (1) history of left ventricular ejection fraction (LVEF) <50  % at any time; (2) isolated right heart failure due to pulmonary disease; (3) dyspnoea due to non-cardiac causes such as pulmo- nary disease, anaemia, or severe obesity; (4) primary val- vular or myocardial diseases, atrial fibrillation, coronary artery or cerebrovascular disease needing revascularisa- tion within 3 months; (5) serum creatinine >130 μmol/L (normal range: 50–130  μmol/L) or urine albumin per gram urine creatinine (Alb/Cr) >300  mg/g; (6) uncon- trolled thyroid diseases, history of parathyroid disease or vitamin D-related disorders; (7) medication history including vitamin D, bisphosphonate, estrogen replace- ment therapy and diuretics which may influence calcium metabolism within the past 1 month; (8) serum calcium out of normal range from central laboratory of Renmin hospital (8.42–10.42  mg/dL, or 2.10–2.60  mmol/L); (9) serum phosphate out of normal range from central laboratory of Renmin hospital (3.00–4.50  mg/dL, or 0.97–1.45 mmol/L).
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The limited usefulness of real-time 3-dimensional echocardiography in obtaining normal reference ranges for right ventricular volumes

The limited usefulness of real-time 3-dimensional echocardiography in obtaining normal reference ranges for right ventricular volumes

The recent introduction of RT3DE with fast online analy- sis may allow bedside measurements of RV volumes and ejection fraction (EF). The purpose of the present study was to obtain normal reference values for RV volumes and EF with RT3DE parallel to reference ranges for 2DE- derived areas corrected for body surface area (BSA). In addition, a blinded and unblinded reproducibility study of the two methods was carried out.

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Cardiac Abnormalities in HIV Infected Children Presenting to a Tertiary Level Teaching Hospital at New Delhi

Cardiac Abnormalities in HIV Infected Children Presenting to a Tertiary Level Teaching Hospital at New Delhi

regurgitation was found in only one child who had associated LV dilatation with depressed ejection fraction. Mild tricuspid regurgitation was found in 8 (13.3%) children in our study which has been postulated to be secondary to recurrent lung infections with isolated right ventricular enlargement and not due to myocardial disease [13]. Various other echocardiographic findings reported in literature were not found in our study population. This could be due to majority of our study patients being in WHO clinical stage I or II with no evidence of immunosuppression, and of the 26 children who had opportunistic infections; majority had already recovered from it or were in recovery phase. With prolonged survival of HIV infected persons with effective treatment, HIV infection seems destined to become an important cause of cardiac complications worldwide. Echocardiography is a cheaper and effective modality in identifying early cardiac involvement in asymptomatic HIV infected patients. A longer follow-up time of children is necessary to evaluate the impact of combination anti-retroviral therapy on the onset of cardiac manifestations. There is no Indian study on echocardiographic findings in normal children. However in a study by Steinberger J et al in a cohort of 357 children echocardiography identified 13 (3.6%) children with previously unknown cardiac abnormalities [14].
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Interatrial shunt devices for heart failure with normal ejection fraction: a technology update

Interatrial shunt devices for heart failure with normal ejection fraction: a technology update

Abbreviations: NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; RVSD, right ventricular systolic dysfunction; RAP, right atrial pressure; LAP, left atrial pressure; MACCE, major adverse cardiac and cerebrovascular events; 6MWT, 6-minute walk test; HF, heart failure; PCWP, pulmonary capillary wedge pressure; NTproBNP, N-terminal B-type natriuretic peptide; SR, sinus rhythm; AF, atrial fibrillation; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; ICD, implantable cardio-defibrilator; CRT, cardiac resynchroniozation therapy; HR, heart rate; BP, blood pressure.
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Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

Associations of (pre)diabetes with right ventricular and atrial structure and function: the Maastricht Study

This study extends previous research because of the assessment of RA and RV structure and RV function (i.e. systolic and diastolic) in a relatively large population- based study, with special emphasis on prediabetes; the comprehensive clinical characterization, which enables extensive adjustment for potential confounders; and sta- tistical mediation analyses to investigate the role of LV structure and function in these associations. With regard to the RV structure, and in agreement with earlier stud- ies [9, 18, 19] we showed that pre(diabetes) was associ- ated with a smaller RV (i.e. RV diameter and RV length) although some smaller and(or) unadjusted studies [12–14, 16, 17, 22, 24–27] did not find this association. With regard to RV systolic function, and in agreement with earlier study [24–27], we showed that (pre)diabetes is associated with RV impaired systolic function inde- pendent of traditional risk factors, in contrast to most smaller and(or) unadjusted studies [9, 11–14, 16–18, 20, 22], which found no association. The Mesa study [19], which used RV ejection fraction as measurement for sys- tolic function, found no association either. This could be explained by the fact that TDI-derived measurements, which are used in our study, are more sensitive to altera- tion of RV systolic function [35]. With regard to diastolic function, in agreement with most earlier studies [9, 13, 14, 17, 18, 20, 22, 24–27] we showed that (pre)diabe- tes was associated with impaired RV diastolic function (lower E ′ RV, lower E/A ratio of the tricuspid valve). In contrast to other studies [14, 17, 22, 25–27] we observed Table 1 (continued)
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Hyperdynamic left ventricular ejection fraction in the intensive care unit

Hyperdynamic left ventricular ejection fraction in the intensive care unit

Our study is limited by its retrospective nature and its inclusion of a relatively heterogeneous group of patients whose data were extracted from electronic medical re- cords in a large clinical database. Other variables not captured in the database may account for residual con- founding. Disease associations such as hypertension and cancer are based on ICD-9 codes, which can lead to in- consistent levels of reporting, but this may be somewhat mitigated by the single-center scope of the study. The indications for TTE could be variable and could not be accounted for in this study. Common reasons for TTE in our institution include workup for hypotension and heart failure and evaluation for bacterial endocarditis or right heart strain owing to acute pulmonary embolism. In this study, the need for TTE was at the discretion of the ordering physicians. The indication was not documented.
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Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

Acute left ventricular dysfunction secondary to right ventricular septal pacing in a woman with initial preserved contractility: a case report

The Pacing to Avoid Cardiac Enlargement study [12] showed that the mean LVEF declined by almost seven percentage points (from 61.5 ± 6.6% to 54.8 ± 9.1%) in the first year of RVA pacing in patients with a normal ejection fraction. Among nine patients in whom the LVEF decreased to less than 45% at 12 months, eight (89%) were in the RV pacing group. The authors suggest that the ejection fraction could decrease rapidly in vul- nerable patients and that these patients might benefit even more from biventricular pacing [12].

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Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance

Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance

The aim of our study was to evaluate and compare the pre- dictive values of several well-established ECG- criteria for LVH against left ventricular mass and volume as assessed by CMR in a large set of patients with a high prevalence of LVH due to aortic valve disease. Furthermore, we aimed to study the effect of the different geometric forms of LVH (concentric and eccentric) on depolarization and repolari- zation. To address this issue, we studied 120 patients with aortic valve disease and 30 healthy volunteers without his- tory or evidence of cardiovascular disease.

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Evaluation of left ventricular ejection fraction using through time radial GRAPPA

Evaluation of left ventricular ejection fraction using through time radial GRAPPA

shown here have similar image quality for some features, and had only a modest drop in ratings for other features, when compared to the standard images. Overall, the rat- ings for the real-time images generated in this study were high, averaging between “good” and “excellent” for all cat- egories. For features including myocardium, endocardial border, and cardiac motion, all related to ejection fraction, statistical tests showed that there was no significant differ- ence between the gold-standard method and real-time imaging with radial GRAPPA. However, the analysis indi- cates that standard cine scans should be performed when specific anatomical structures (i.e. the mitral valve) must be assessed, when patients can provide the requisite breath-holds.
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Traditional Chinese medicine, Danlou tablets alleviate adverse left ventricular remodeling after myocardial infarction: results of a double blind, randomized, placebo controlled, pilot study

Traditional Chinese medicine, Danlou tablets alleviate adverse left ventricular remodeling after myocardial infarction: results of a double blind, randomized, placebo controlled, pilot study

and salvianolic acid A (Additional file 1). The most important determinants characterizing the magnitude and kind of LV remodeling are the actual size of the infarct, the existence of microcirculation in the ischemic zone, as well as the quality and quantity of the newly deposited extracellular matrix (ECM). The Danlou tablet-related improvements of LV remodeling are probably due to its established multiple effects which play vital roles in reversing the pathological remodeling process. Previously published studies of experimental infarcts in animal models suggested that Danlou tablets may protect vascu- lar endothelium and improve formation of new capillaries on the edges of the ischemic myocardial zones, thereby contributed to the ultimate reduction of the infarct size, promotion of myocardial healing and subsequent allevi- ation of the progressive ventricular fibrosis [25–27]. Our previous studies performed on cultured human cardiac fibroblasts further confirmed that tanshinone IIA, an effective component of Danlou tablets, significantly inhib- ited the deposition of collagen fibers which exacerbate mechanical stiffness and reduced contractility, but simul- taneously enhanced production of new elastic fibers contributing to more resilient matrix [28, 29]. Since the optimal proportions of these ECM components eventually determine the beneficial healing of the infarcted myocar- dium, we speculate that addition of the Danlou tablets to the classic Western pharmacological therapy of our MI patients, likely shifted the initial adverse remodeling processes toward the ultimate regeneration and formation of the more elastic post-infarct scars, complying with the action of the initially injured hearts and preserving global contractility and compliance. Moreover, results of only few clinical reports also suggested that administration of Danlou tablets in patients with ischemic heart disease induced improvement of clinical angina symptoms and decreased frequency of major atherothrombotic complica- tions (plaque rupture and thrombosis) that eventually lead to MI [30]. However, up to date the observed beneficial effects of Danlou tablets have not been mechanistically confirmed by the adequate randomized, prospective, double-blind, placebo-controlled clinical trial.
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