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American Journal of Respiratory and... Nov 2022
Topics: Humans; Hypertension, Pulmonary; Ventricular Dysfunction, Left; Cognitive Dysfunction; Ventricular Dysfunction, Right
PubMed: 35904426
DOI: 10.1164/rccm.202204-0726LE -
Current Opinion in Anaesthesiology Aug 2014This review summarizes the approach to and recent developments in the treatment of acute right ventricular dysfunction and failure in the perioperative setting. Right... (Review)
Review
PURPOSE OF REVIEW
This review summarizes the approach to and recent developments in the treatment of acute right ventricular dysfunction and failure in the perioperative setting. Right ventricular failure, defined as the inability to deliver sufficient blood flow through the pulmonary circulation at normal central venous pressure, is a common problem in the perioperative setting and is associated with an increased mortality. The failure of the right ventricle is caused by reduced right ventricular contractility or an increased right ventricular afterload or both.
RECENT FINDINGS
Management of acute right ventricular failure continues to be challenging because of the poor understanding of the pathophysiology, difficulties in diagnosing, the absence of guidelines, and limited therapeutic options. Recent research efforts have led to an improved understanding of the underlying mechanisms and have established a reasonable therapeutic framework.
SUMMARY
Right ventricular dysfunction may cause venous congestion and systemic hypoperfusion. After identifying right ventricular dysfunction, the primary goal is to correct reversible causes of excessive load or reduced right-ventricular contractility. If the underlying abnormalities cannot be reversed, diuretic, vasodilator, or inotropic therapy may be required.
Topics: Humans; Perioperative Care; Ventricular Dysfunction, Right
PubMed: 24842720
DOI: 10.1097/ACO.0000000000000092 -
Texas Heart Institute Journal Sep 2022Right ventricle (RV) dysfunction after a coronary artery bypass grafting procedure is a challenge that adversely affects RV filling pressure and contraction. This study...
BACKGROUND
Right ventricle (RV) dysfunction after a coronary artery bypass grafting procedure is a challenge that adversely affects RV filling pressure and contraction. This study sought to determine whether additional bypass of an RV branch would lessen RV dysfunction.
METHODS
Patients with severe right coronary artery (RCA) stenosis were divided into 2 groups. Group 1 patients (n = 50) had a single distal bypass on the RCA. Group 2 patients (n = 50) had both distal RCA and additional bypass on the RV branch of the RCA. Right ventricular function was examined by echocardiogram by measuring transannular plane systolic excursion, fractional area change, tissue Doppler S-wave velocity, and inferior vena cava diameter.
RESULTS
Transannular plane systolic excursion and fractional area change measurements rapidly decreased below the cutoff in both groups, but group 2 patient values reached normal limits at 90 days. Tissue Doppler S-wave velocity reached the normal limit in 7 days. Inotropic agents were required in 11 patients in group 1 and 2 patients in group 2 (P = .013). The mean (SD) intensive care unit stay was 2.11 (1.12) days and 1.45 (0.71) days (P = .033), and the hospital stay was 7.32 (1.44) days and 6.22 (0.45) days in groups 1 and 2, respectively (P = .027).
CONCLUSION
The data in this study suggest that an additional graft on the RV branch of the RCA (eg, conus, marginal, any good runoff vessels on the RV) prevents severe RV dysfunction and allows for rapid recovery of RV dysfunction after off-pump coronary surgery.
Topics: Humans; Ventricular Dysfunction, Right; Coronary Vessels; Ventricular Function, Right; Coronary Artery Bypass; Coronary Stenosis; Cardiomyopathies
PubMed: 36315844
DOI: 10.14503/THIJ-21-7607 -
Journal of Nephrology Jun 2021Preclinical left ventricular diastolic dysfunction (LVDD) is a high-risk state for heart failure. Kidney dysfunction is a known risk factor for heart failure, but its...
BACKGROUND
Preclinical left ventricular diastolic dysfunction (LVDD) is a high-risk state for heart failure. Kidney dysfunction is a known risk factor for heart failure, but its association with asymptomatic LVDD is not well-known.
METHODS
A hospital-based retrospective cohort study was conducted on patients who underwent echocardiogram between 2006 and 2016 to assess the association between baseline kidney function and LVDD on echocardiogram. E/e' ratio was defined as the ratio of peak velocity of early diastolic left ventricular inflow (E) to mitral annular velocity (e'). The primary outcome was time to development of LVDD, which was defined as E/e' ratio > 14. The changes in the E/e' ratio and other echocardiographic parameters were assessed using a mixed effects model.
RESULTS
Among 1167 patients, the mean age was 61 years, and the mean baseline E/e' ratio and ejection fraction were 9.6 and 69%, respectively. During a median follow-up of 3.2 years, 231 (19.8%) people developed LVDD. According to eGFR (mL/min/1.73 m), the risk for LVDD based on hazard ratio [95% confidence interval (95% CI)] was 1.20 (0.82, 1.75) for 60 to < 90, 1.42 (0.87, 2.31) for 45 to < 60, and 2.57 (1.61, 4.09) for < 45 (P trend < 0.001). The adjusted risks (95% CI) for annual change in E/e' ratio was 0.09 (0.03, 0.14) overall and 0.28 (0.11, 0.45) in the lowest eGFR group; the trend in changes in annual E/e' ratio by baseline eGFR was significant (P trend = 0.01).
CONCLUSIONS
Relatively low kidney function was related with the risks for LVDD. Long-term cohort studies are warranted to confirm the association between LVDD and symptomatic heart failure in patients with kidney dysfunction.
Topics: Diastole; Echocardiography; Hospitals; Humans; Kidney; Middle Aged; Retrospective Studies; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 33400138
DOI: 10.1007/s40620-020-00940-9 -
Advances in Clinical and Experimental... 2015The main adverse effect of chronic stimulation is stimulation-induced heart failure in case of ventricular contraction dyssynchrony. Because of this fact, new techniques... (Review)
Review
BACKGROUND
The main adverse effect of chronic stimulation is stimulation-induced heart failure in case of ventricular contraction dyssynchrony. Because of this fact, new techniques of stimulation should be considered to optimize electrotherapy. One of these methods is pacing from alternative right ventricular sites.
OBJECTIVES
The purpose of this article is to review currently accumulated data about alternative sites of cardiac pacing.
MATERIAL AND METHODS
Medline and PubMed bases were used to search English and Polish reports published recently.
RESULTS
Recent studies report a deleterious effect of long term apical pacing. It is suggested that permanent apical stimulation, by omitting physiological conduction pattern with His-Purkinie network, may lead to electrical and mechanical dyssynchrony of heart muscle contraction. In the long term this pathological situation can lead to severe heart failure and death. Because of this, scientists began to search for some alternative sites of cardiac pacing to reduce the deleterious effect of stimulation. Based on current accumulated data, it is suggested that the right ventricular outflow tract, right ventricular septum, direct His-bundle or biventricular pacing are better alternatives due to more physiological electrical impulse propagation within the heart and the reduction of the dyssynchrony effect. These methods should preserve a better left ventricular function and prevent the development of heart failure in permanent paced patients. As there is still not enough, long-term, randomized, prospective, cross-over and multicenter studies, further research is required to validate the benefits of using this kind of therapy.
CONCLUSIONS
The article should pay attention to new sites of cardiac stimulation as a better and safer method of treatment.
Topics: Animals; Cardiac Pacing, Artificial; Equipment Design; Heart Conduction System; Heart Failure; Heart Ventricles; Humans; Myocardial Contraction; Pacemaker, Artificial; Time Factors; Treatment Outcome; Ventricular Dysfunction; Ventricular Function, Left; Ventricular Function, Right
PubMed: 25931370
DOI: 10.17219/acem/27568 -
Herz Mar 2023Arrhythmia-induced cardiomyopathy (AIC) is classified as a form of dilated cardiomyopathy in which left ventricular systolic dysfunction (LVSD) is triggered by... (Review)
Review
Arrhythmia-induced cardiomyopathy (AIC) is classified as a form of dilated cardiomyopathy in which left ventricular systolic dysfunction (LVSD) is triggered by tachycardic or arrhythmic heart rates. On the one hand AIC can develop in patients without cardiac disease and on the other hand it can appear in patients with pre-existing LVSD, leading to a further reduction in left ventricular (LV) ejection fraction. A special aspect of AIC is the potential termination or partial reversibility of LVSD; thus, AIC is curatively treatable by the elimination of the underlying arrhythmia. Since arrhythmias are often seen merely as a consequence than as an underlying cause of LVSD, and due to the fact that the diagnosis of AIC can be made only after recovery of LV function, the prevalence of AIC is probably underestimated in clinical practice. Pathophysiologically, animal models have shown that continuous tachycardic pacing induces consecutive changes such as the occurrence of LVSD, increased filling pressures, LV dilatation, and decreased cardiac output. After termination of tachycardia, reversibility of the described pathologies can usually be observed. Studies in human ventricular myocardium have recently demonstrated that various cellular structural and functional mechanisms are activated even by normofrequent atrial fibrillation, which may help to explain the clinical AIC phenotype.
Topics: Animals; Humans; Atrial Fibrillation; Heart Diseases; Ventricular Function, Left; Ventricular Dysfunction, Left; Cardiomyopathy, Dilated
PubMed: 36695877
DOI: 10.1007/s00059-022-05158-y -
Circulation. Cardiovascular... May 2017Despite a high rate of early revascularization and use of intra-aortic balloon pump counterpulsation therapy, the prognosis of patients with cardiogenic shock has... (Review)
Review
Despite a high rate of early revascularization and use of intra-aortic balloon pump counterpulsation therapy, the prognosis of patients with cardiogenic shock has remained poor. In the hopes of improving outcomes, clinicians are increasingly turning to percutaneous left and right mechanical circulatory support devices. Until recently, the evidence base for these devices had consisted only of observational data, meta-analyses, and small feasibility trials. In this article, we describe the contemporary outcomes of patients with cardiogenic shock, the hemodynamics of cardiogenic shock, and hemodynamic effects of percutaneous mechanical circulatory support devices. We then use this discussion to provide clinicians with a useful framework for understanding when selecting between or while managing patients with a percutaneous mechanical circulatory support devices. We critically review the recently published data for and against the use of commercially available devices-the intra-aortic balloon pump counterpulsation, the Impella system, the TandemHeart, and venous-arterial extracorporeal membrane oxygenation-and highlight gaps in our understanding. Given such gaps, a consensus multidisciplinary approach that combines expertise from interventional cardiologists, heart failure specialists, cardiac surgeons, and cardiac anesthesiologists may help pair the right patient with the right device at the right time.
Topics: Extracorporeal Membrane Oxygenation; Heart-Assist Devices; Hemodynamics; Humans; Intra-Aortic Balloon Pumping; Prosthesis Design; Recovery of Function; Risk Factors; Shock, Cardiogenic; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right
PubMed: 28500136
DOI: 10.1161/CIRCINTERVENTIONS.116.004337 -
Cardiovascular Diabetology Apr 2023To investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular...
BACKGROUND
To investigate the difference of right ventricular (RV) structural and functional alteration in patients with diabetes mellitus (DM) with preserved left ventricular ejection fraction (LVEF), and the ventricular interdependence in these patients, using cardiac MR (CMR) feature tracking.
METHODS
From December 2016 to February 2022, 148 clinically diagnosed patients with DM who underwent cardiac MR (CMR) in our hospital were consecutively recruited. Fifty-four healthy individuals were included as normal controls. Biventricular strains, including left/right ventricular global longitudinal strain (LV-/RVGLS), left/right ventricular global circumferential strain (LV-/RVGCS), left/right ventricular global radial strain (LV-/RVGRS) were evaluated, and compared between patients with DM and healthy controls. Multiple linear regression and mediation analyses were used to evaluate DM's direct and indirect effects on RV strains.
RESULTS
No differences were found in age (56.98 ± 10.98 vs. 57.37 ± 8.41, p = 0.985), sex (53.4% vs. 48.1%, p = 0.715), and body surface area (BSA) (1.70 ± 0.21 vs. 1.69 ± 0.17, p = 0.472) between DM and normal controls. Patients with DM had decreased RVGLS (- 21.86 ± 4.14 vs. - 24.49 ± 4.47, p = 0.001), RVGCS (- 13.16 ± 3.86 vs. - 14.92 ± 3.08, p = 0.011), and no decrease was found in RVGRS (22.62 ± 8.11 vs. 23.15 ± 9.05, p = 0.743) in patients with DM compared with normal controls. The difference in RVGLS between normal controls and patients with DM was totally mediated by LVGLS (indirect effecting: 0.655, bootstrapped 95%CI 0.138-0.265). The difference in RVGCS between normal controls and DM was partly mediated by the LVGLS (indirect effecting: 0.336, bootstrapped 95%CI 0.002-0.820) and LVGCS (indirect effecting: 0.368, bootstrapped 95%CI 0.028-0.855).
CONCLUSIONS
In the patients with DM and preserved LVEF, the difference in RVGLS between DM and normal controls was totally mediated by LVGLS. Although there were partly mediating effects of LVGLS and LVGCS, the decrease in RVGCS might be directly affected by the DM.
Topics: Humans; Ventricular Function, Left; Stroke Volume; Ventricular Dysfunction, Right; Heart Ventricles; Diabetes Mellitus; Ventricular Dysfunction, Left
PubMed: 37085847
DOI: 10.1186/s12933-023-01806-7 -
Advances in Experimental Medicine and... 2020Heart failure (HF) is defined as a clinical syndrome resulting from structural or functional impairment of ventricular fillings or ejections of blood. Currently, HF is... (Review)
Review
Heart failure (HF) is defined as a clinical syndrome resulting from structural or functional impairment of ventricular fillings or ejections of blood. Currently, HF is divided into three groups which include HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF) and HF with midrange EF (HFmrEF). Even though major advances have been made in treating HFrEF during the past decades, heart failure is a fatal disease. In this review, we briefly summarize the current advances in pharmaceutical managements for heart failure, which includes drugs used in acute heart failure as well as those that prevent heart failure progression, in each category major clinical trials are also described. In addition, information about some of potential new drugs are also mentioned. Traditional Chinese medicine also shows its potential in treating HF, and we are still lack of medicine to treat HFpEF.
Topics: Disease Progression; Heart Failure; Humans; Stroke Volume; Ventricular Dysfunction, Left
PubMed: 32246448
DOI: 10.1007/978-981-15-2517-9_7 -
Cardiology Clinics Feb 2016Phase analysis of gated myocardial perfusion single-photon emission computed tomography is a widely available and reproducible measure of left ventricular (LV)... (Review)
Review
Phase analysis of gated myocardial perfusion single-photon emission computed tomography is a widely available and reproducible measure of left ventricular (LV) dyssynchrony, which also provides comprehensive assessment of LV function, global and regional scar burden, and patterns of LV mechanical activation. Preliminary studies indicate potential use in predicting cardiac resynchronization therapy response and elucidation of mechanisms. Because advances in technology may expand capabilities for precise LV lead placement in the future, identification of specific patterns of dyssynchrony may have a critical role in guiding cardiac resynchronization therapy.
Topics: Cardiac Imaging Techniques; Cardiac Resynchronization Therapy; Humans; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 26590783
DOI: 10.1016/j.ccl.2015.08.006