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Right Ventricular assessment using Advanced Cardiac Imaging in Mid-Range patients: Keys to detect the risk

Session Poster session 2

Speaker Marina Pascual Izco

Event : EuroEcho 2019

  • Topic : imaging
  • Sub-topic : Imaging: Heart Failure
  • Session type : Poster Session

Authors : M Pascual Izco (Madrid,ES), A Garcia Martin (Madrid,ES), A Lorente Ros (Madrid,ES), R Hinojar Baydes (Madrid,ES), GL Alonso Salinas (Madrid,ES), JM Vieitez Flores (Madrid,ES), A Gonzalez Gomez (Madrid,ES), JD Sanchez Vega (Madrid,ES), J Ramos Jimenez (Madrid,ES), E Casas Rojo (Madrid,ES), JJ Jimenez Nacher (Madrid,ES), A Garcia De Vicente (Madrid,ES), A Urena (Madrid,ES), JL Zamorano (Madrid,ES), C Fernandez-Golfin Loban (Madrid,ES)

M Pascual Izco1 , A Garcia Martin1 , A Lorente Ros1 , R Hinojar Baydes1 , GL Alonso Salinas1 , JM Vieitez Flores1 , A Gonzalez Gomez1 , JD Sanchez Vega1 , J Ramos Jimenez1 , E Casas Rojo1 , JJ Jimenez Nacher1 , A Garcia De Vicente2 , A Urena2 , JL Zamorano1 , C Fernandez-Golfin Loban1 , 1Ramón y Cajal University Hospital, Cardiology - Madrid - Spain , 2Ramón y Cajal University Hospital, Radiology - Madrid - Spain ,


Background: Patients with mid-range ejection fraction heart failure (HFmrEF) are a new category defined in actual guidelines. The aim of this study was to establish the prognostic value of several parameters obtained by Cardiac Magnetic Resonance (CMR) and Transthoracic Echocardiography (TTE) in patients with HFmrEF.

Methods: Thirty patients, defined as HFmrEF by TTE and CMR, were included between 2012-2018. Patients with structural heart disease different from Left Ventricular (LV) dysfunction were excluded. Cine sequences in CMR (SSFP) were used to obtain atrial and ventricular volumes and mass. Myocardial fibrosis was quantified by late gadolinium enhancement. TTE was used to obtain anatomical and functional parameters as LV and Right Ventricular (RV) ejection-fraction, LV and RV global longitudinal strain, and RV free-wall longitudinal strain. 
The primary endpoint was the combination of all-cause death or heart failure admission. The median follow-up was 1.9 (0.5-3.3) years.

Results: Mean age was 59.3±12.4 years, and 67.9% patients were male. The aetiology of LV dysfunction was mainly ischemic (n=16, 53.3%). Results are shown in Table1. Patients who presented the primary endpoint had a lower RV ejection-fraction by CMR and a lower absolute value of RV free-wall longitudinal strain by TTE(Figure 1).

Conclusions: In HFmrEF patients, worse RV function (by CMR and TTE-Speckle Tracking) may be associated with a worse prognosis. Larger studies are needed to confirm this hypothesis.

All-cause death or HF admission (n=5; 16.7%)

No all-cause death of HF admission (n=25; 83.3%)


iRVEDV (ml/m2) by CMR

65.5 ± 13.5

66.2 ± 12.3


iRVESV (ml/m2) by CMR

30.4 ± 7.5

24.4 ± 6.2


iLVEDV (ml/m2) by CMR

85.8 ± 23.7

98 ± 19.5


iLVESV (ml/m2) by CMR

47.8 ± 15.3

54.9 ± 11.7


Indexed LA Volume (ml/m2) by CMR

42.8 (36.5 - 49)

48.4 (42 - 63.5)


LVEF (%) by CMR

44.9 ± 3.3

44 ± 2.6


RVEF (%) by CMR

52.2 ± 7.2

61.7 ± 7.2


RV-FAC (%) by TTE

43.4 ± 4.4

44.7 ±7.5



2.1 ± 0.3

2.5 ± 0.1


LV Longitudinal Global Strain by TTE

-14.3 ± 3.3

-15.5 ± 4.9


RV Longitudinal Global Strain by TTE

-11.3 (-13.2 - -7.0)

-19.5 (-23.7 - -10)


RV Free-Wall Longitudinal Strain by TTE

-11.5 (-14.2 - -8.2)

-20 (-26 - -13.7)


HF: Heart Failure; CMR: Cardio Magnetic Resonance; LV: Left Ventricle; RV: Right Ventricle; iRVEDV: Indexed RV End-Diastolic Volume; iRVESV: Indexed RV End-Systolic Volume; iLVEDV: Indexed LV End-Diastolic Volume; iLVESV: Indexed LV End-Systolic Volume; LA: Left Atrium; LVEF: LV Ejection Fraction; RVEF: RV Ejection Fraction; RV-FAC: RV Fractional Area Change; TAPSE: Tricuspid Annular Plane Systolic Excursion

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