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Prevalence of RV failure assessed by echocardiography in acute dyspnoea cohort

Session Poster Session 6

Speaker Kamile Cerlinskaite

Event : ESC Congress 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Imaging
  • Session type : Poster Session

Authors : K Cerlinskaite (Vilnius,LT), J Bugaite (Vilnius,LT), D Gabartaite (Vilnius,LT), D Verikas (Kaunas,LT), A Krivickiene (Kaunas,LT), J Motiejunaite (Kaunas,LT), D Zaliaduonyte-Peksiene (Kaunas,LT), D Zakarkaite (Vilnius,LT), A Mebazaa (Paris,FR), A Kavoliuniene (Kaunas,LT), J Celutkiene (Vilnius,LT)

Authors:
K. Cerlinskaite1 , J. Bugaite1 , D. Gabartaite1 , D. Verikas2 , A. Krivickiene2 , J. Motiejunaite2 , D. Zaliaduonyte-Peksiene2 , D. Zakarkaite1 , A. Mebazaa3 , A. Kavoliuniene2 , J. Celutkiene1 , 1Vilnius University, Clinic of Cardiac and Vascular diseases, Centre of Cardiology and Angiology - Vilnius - Lithuania , 2Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences - Kaunas - Lithuania , 3Hospital Lariboisiere, Inserm UMR-S 942 and Anesthesia and Critical Care Department - Paris - France ,

On behalf: the GREAT network

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 3298

Introduction: Recently more attention has been placed on right ventricle (RV) parameters in acute settings. The present study investigates echocardiographic RV parameters in patients with acute heart failure (AHF) or non-AHF acute dyspnoea.

Purpose: To determine the patterns of RV injury in different profiles of acute dyspnoea.

Methods: Prospective multicentre observational study included 1455 acutely dyspnoeic patients from 2015 to 2017. RV focused echocardiography was performed during the first 48 hours in 452 (31%) patients. They were compared in three patient profiles based on cause of dyspnoea and history of chronic HF (CHF): 1) AHF; 2) Non-AHF with CHF (Non-AHF+CHF); 3) other non-AHF patients (Non-AHF+other).

Results: Significant differences in RV morphology and function were observed in the study groups (Table 1). RV global function assessed by tricuspid annular plane systolic excursion (TAPSE) and RV longitudinal shortening was mostly affected in AHF patients. This was accompanied by more enlarged RV and increased right atrial pressure (RAP), assessed by the inferior vena cava diameter and respiratory collapse. Less severely impaired RV function and increased RAP were also observed in non-AHF+CHF patients indicating RV involvement in the chronic disease. Normal RV parameters dominated in Non-AHF+other group, however pulmonary artery systolic pressure >40 mmHg was observed in all profiles, suggesting similar severity of pulmonary hypertension in cardiac or pulmonary causes of acute dyspnoea.

Conclusions: Our data confirm more pronounced acute failure of right ventricle in acute heart failure patients than in chronic heart failure patients admitted due to other causes of dyspnoea. Pulmonary hypertension is present in a majority of the acute dyspnoea patients.

Table 1. RV parameters in acute dyspnoea profiles
ParameterAHF (n=291)Non-AHF + CHF (n=73)Non-AHF + other (n=88)p value
LVEF, %38 [25–55]50 [40–55]55 [50–55]<0.001
RV basal diameter, cm4.5 [3.9–5.2]4 [3.5–4.5]4 [3.5–4.55]<0.001
TAPSE, cm1.5 [1.2–1.8]1.8 [1.6–2]2 [1.5–2.4]<0.001
RV free wall strain, -%−15.3 [−19; −11.24]−19.3 [−24.5; −15.78]−23 [−24.5; −19.69]<0.001
Entire RV strain, -%−12.03 [−15.17; −9.11]−16.4 [−19.31; −10.5]−18 [−18.75; −16.9]<0.001
PASP >40, %66%51%50%0.039
IVC diameter, cm2.4 [2–2.8]2 [1.7–2.4]1.8 [1.4–2.3]<0.001
IVC collapse, %34.9 [19.7–50.2]44.1 [28.7–59.3]52.6 [35–72.7]<0.001
LVEF, left ventricular ejection fraction; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure; IVC, inferior vena cava; AHF, acute heart failure; CHF, chronic heart failure.

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