Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy
Abstract Aims Although comprehensive assessment of right ventricular (RV) function using multiple echocardiographic parameters is recommended for management of patients with non‐ischaemic dilated cardiomyopathy (DCM), it is unclear which RV parameters to combine. Additionally, normalization of RV pa...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13519 |
| _version_ | 1818394538856677376 |
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| author | Jumpei Ishiwata Masao Daimon Koki Nakanishi Tadafumi Sugimoto Takayuki Kawata Tomohiro Shinozaki Tomoko Nakao Megumi Hirokawa Naoko Sawada Yuriko Yoshida Eisuke Amiya Masaru Hatano Hiroyuki Morita Yutaka Yatomi Issei Komuro |
| author_facet | Jumpei Ishiwata Masao Daimon Koki Nakanishi Tadafumi Sugimoto Takayuki Kawata Tomohiro Shinozaki Tomoko Nakao Megumi Hirokawa Naoko Sawada Yuriko Yoshida Eisuke Amiya Masaru Hatano Hiroyuki Morita Yutaka Yatomi Issei Komuro |
| author_sort | Jumpei Ishiwata |
| collection | DOAJ |
| description | Abstract Aims Although comprehensive assessment of right ventricular (RV) function using multiple echocardiographic parameters is recommended for management of patients with non‐ischaemic dilated cardiomyopathy (DCM), it is unclear which RV parameters to combine. Additionally, normalization of RV parameters by estimated pulmonary artery systolic pressure (PASP), in consideration of RV–pulmonary artery coupling, may be clinically significant. The aim of our study was to elucidate the best combination of echocardiographic RV functional parameters, with or without indexing for PASP, to predict outcome in patients with heart failure with reduced ejection fraction secondary to DCM. Methods and results We retrospectively analysed 109 DCM patients with left ventricular ejection fraction <40%. RV size was assessed by RV end‐diastolic area (RVEDA) and RV end‐systolic area (RVESA) from RV‐focused apical four‐chamber view. RV function was assessed by fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) and by RV longitudinal strain (RVLS) using two‐dimensional speckle‐tracking echocardiography. All functional parameters were also indexed for estimated PASP. Cox analyses were used to evaluate the association of RV morphology and functional parameters with 1 year outcome (composite of left ventricular assist device implantation and all‐cause death). Area under the curve was used to compare prognostic values. Mean age was 44 ± 14 years, and 76 (69.7%) were men. Mean left ventricular ejection fraction was 21.9%, median RVEDA was 22.1 cm2, FAC was 27.0%, TAPSE was 15.0 mm, and RVLS was −12.5%. Forty‐one (37.6%) patients experienced the primary outcome. Multivariate Cox analysis revealed that RVEDA, RVESA, FAC, TAPSE, RVLS, FAC/PASP, and RVLS/PASP were independent predictors for primary outcome (all P < 0.05). However, normalization with PASP did not improve area under the curve for any RV functional parameters. When we evaluate hazard ratios according to the combination of two echocardiographic parameters of RV function, patients with impairment of both FAC (<27%) and RVLS (>−8.6%) had significantly higher hazard ratio than those with either impairment alone (11.3 vs. 3.4, P < 0.001); the other combinations did not improve prognostic value. Conclusions Normalizing echocardiographic RV parameters for PASP did not improve the prognostic values for our population. Meanwhile, combined evaluation of FAC and RVLS improved risk stratification in patients with heart failure with reduced ejection fraction secondary to DCM. |
| first_indexed | 2024-12-14T06:02:48Z |
| format | Article |
| id | doaj.art-d4ba9ee8ec9e4c02b0356aeab241626c |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-14T06:02:48Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-d4ba9ee8ec9e4c02b0356aeab241626c2022-12-21T23:14:23ZengWileyESC Heart Failure2055-58222021-10-01853947395610.1002/ehf2.13519Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathyJumpei Ishiwata0Masao Daimon1Koki Nakanishi2Tadafumi Sugimoto3Takayuki Kawata4Tomohiro Shinozaki5Tomoko Nakao6Megumi Hirokawa7Naoko Sawada8Yuriko Yoshida9Eisuke Amiya10Masaru Hatano11Hiroyuki Morita12Yutaka Yatomi13Issei Komuro14Department of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Clinical Laboratory Mie University Hospital Mie JapanDepartment of Cardiovascular Medicine Sassa General Hospital Tokyo JapanDepartment of Information and Computer Technology, Faculty of Engineering Tokyo University of Science Tokyo JapanDepartment of Clinical Laboratory The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanDepartment of Clinical Laboratory The University of Tokyo Hospital Tokyo JapanDepartment of Cardiovascular Medicine The University of Tokyo Hospital Tokyo JapanAbstract Aims Although comprehensive assessment of right ventricular (RV) function using multiple echocardiographic parameters is recommended for management of patients with non‐ischaemic dilated cardiomyopathy (DCM), it is unclear which RV parameters to combine. Additionally, normalization of RV parameters by estimated pulmonary artery systolic pressure (PASP), in consideration of RV–pulmonary artery coupling, may be clinically significant. The aim of our study was to elucidate the best combination of echocardiographic RV functional parameters, with or without indexing for PASP, to predict outcome in patients with heart failure with reduced ejection fraction secondary to DCM. Methods and results We retrospectively analysed 109 DCM patients with left ventricular ejection fraction <40%. RV size was assessed by RV end‐diastolic area (RVEDA) and RV end‐systolic area (RVESA) from RV‐focused apical four‐chamber view. RV function was assessed by fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) and by RV longitudinal strain (RVLS) using two‐dimensional speckle‐tracking echocardiography. All functional parameters were also indexed for estimated PASP. Cox analyses were used to evaluate the association of RV morphology and functional parameters with 1 year outcome (composite of left ventricular assist device implantation and all‐cause death). Area under the curve was used to compare prognostic values. Mean age was 44 ± 14 years, and 76 (69.7%) were men. Mean left ventricular ejection fraction was 21.9%, median RVEDA was 22.1 cm2, FAC was 27.0%, TAPSE was 15.0 mm, and RVLS was −12.5%. Forty‐one (37.6%) patients experienced the primary outcome. Multivariate Cox analysis revealed that RVEDA, RVESA, FAC, TAPSE, RVLS, FAC/PASP, and RVLS/PASP were independent predictors for primary outcome (all P < 0.05). However, normalization with PASP did not improve area under the curve for any RV functional parameters. When we evaluate hazard ratios according to the combination of two echocardiographic parameters of RV function, patients with impairment of both FAC (<27%) and RVLS (>−8.6%) had significantly higher hazard ratio than those with either impairment alone (11.3 vs. 3.4, P < 0.001); the other combinations did not improve prognostic value. Conclusions Normalizing echocardiographic RV parameters for PASP did not improve the prognostic values for our population. Meanwhile, combined evaluation of FAC and RVLS improved risk stratification in patients with heart failure with reduced ejection fraction secondary to DCM.https://doi.org/10.1002/ehf2.13519Dilated cardiomyopathyRight ventricular functionEchocardiographySpeckle‐tracking echocardiographyPulmonary artery |
| spellingShingle | Jumpei Ishiwata Masao Daimon Koki Nakanishi Tadafumi Sugimoto Takayuki Kawata Tomohiro Shinozaki Tomoko Nakao Megumi Hirokawa Naoko Sawada Yuriko Yoshida Eisuke Amiya Masaru Hatano Hiroyuki Morita Yutaka Yatomi Issei Komuro Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy ESC Heart Failure Dilated cardiomyopathy Right ventricular function Echocardiography Speckle‐tracking echocardiography Pulmonary artery |
| title | Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy |
| title_full | Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy |
| title_fullStr | Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy |
| title_full_unstemmed | Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy |
| title_short | Combined evaluation of right ventricular function using echocardiography in non‐ischaemic dilated cardiomyopathy |
| title_sort | combined evaluation of right ventricular function using echocardiography in non ischaemic dilated cardiomyopathy |
| topic | Dilated cardiomyopathy Right ventricular function Echocardiography Speckle‐tracking echocardiography Pulmonary artery |
| url | https://doi.org/10.1002/ehf2.13519 |
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