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The New England Journal of Medicine Mar 2023
Review
Topics: Humans; Heart Failure; Heart-Assist Devices; Ventricular Dysfunction, Right
PubMed: 36947468
DOI: 10.1056/NEJMra2207410 -
European Journal of Heart Failure Mar 2016Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left... (Review)
Review
Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.
Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.
Topics: Echocardiography; Heart Failure; Humans; Pulmonary Circulation; Ventricular Dysfunction, Right
PubMed: 26995592
DOI: 10.1002/ejhf.478 -
The American Journal of Medicine Jan 2006Transient left ventricular dysfunction in patients under emotional or physical stress, also known as tako-tsubo-like left ventricular dysfunction, has been recently been... (Review)
Review
PURPOSE
Transient left ventricular dysfunction in patients under emotional or physical stress, also known as tako-tsubo-like left ventricular dysfunction, has been recently been recognized as a distinct clinical entity. The aims of this review are to define this phenomenon and to explore its similarities to the left ventricular dysfunction seen in patients with acute brain injury.
METHODS
MEDLINE database, bibliographies of each citation for relevant articles, and consultation with clinical experts were used to examine the clinical picture of tako-tsubo-like left ventricular dysfunction.
RESULTS
We identified case series and a systematic review that report on patients with this syndrome. This phenomenon occurs predominantly in female patients, presenting with a variety of ST-T segment changes and mildly elevated cardiac enzymes that mimic an acute coronary syndrome. The left ventricular dysfunction, typically showing a hyperkinetic basal region and an akinetic apical half of the ventricle, occurs in the absence of obstructed epicardial coronary arteries. The ventricular dysfunction usually resolves within weeks with a generally favorable prognosis. This phenomenon has similarities to that seen in patients with acute brain injury with regard to clinical presentation, pathology, and its reversible nature.
CONCLUSIONS
Transient left ventricular dysfunction occurs in the absence of obstructive epicardial coronary artery disease. In its broadest sense, this phenomenon may encompass a range of disorders including left ventricular dysfunction after central nervous system injury.
Topics: Electrocardiography; Female; Humans; Stress, Physiological; Stress, Psychological; Sympathetic Nervous System; Syndrome; Ventricular Dysfunction, Left
PubMed: 16431176
DOI: 10.1016/j.amjmed.2005.08.022 -
Journal of Insurance Medicine (New... 2004Diastolic dysfunction of the heart is characterized by normal left ventricular contractility and normal ejection fraction, however ventricular relaxation is impaired. In... (Review)
Review
Diastolic dysfunction of the heart is characterized by normal left ventricular contractility and normal ejection fraction, however ventricular relaxation is impaired. In systolic dysfunction, ventricular contractility and ejection fraction are reduced, in addition to impaired relaxation. The prevalence of diastolic dysfunction is increased in the elderly, especially those who have had inadequately treated hypertension. Both diastolic and systolic dysfunction may result in similar clinical signs and symptoms. Therefore, echocardiography is needed to make the distinction. Left atrial (LA) enlargement, assessed by left atrial volume indexed to body surface area, appears to be the best measure to assess diastolic function. LA enlargement is likely when indexed LA volume is > or = 34-40 mL/m2. B-type natriuretic protein appears to be useful for the diagnosis, assessment and prognosis of heart failure, but it does not distinguish between the two types of dysfunctions. Several drug treatments that have effects on the mechanism of diastolic dysfunction are under investigation.
Topics: Adult; Aged; Animals; Diastole; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prevalence; Prognosis; Risk Factors; United States; Ventricular Dysfunction, Left
PubMed: 15683207
DOI: No ID Found -
Annual Review of Medicine 2004Thirty to fifty percent of patients presenting with signs and symptoms of heart failure have a normal left ventricular (LV) systolic ejection fraction. The clinical... (Review)
Review
Thirty to fifty percent of patients presenting with signs and symptoms of heart failure have a normal left ventricular (LV) systolic ejection fraction. The clinical examination cannot distinguish these patients (diastolic heart failure) from those with a depressed ejection fraction (systolic heart failure), but echocardiography can. The management of diastolic heart failure has two major objectives. The first is to reverse the consequences of diastolic dysfunction (e.g., venous congestion), and the second is to eliminate or reduce the factors responsible for diastolic dysfunction (e.g., myocardial hypertrophy, fibrosis, and ischemia).
Topics: Diastole; Heart Failure; Humans; Ventricular Dysfunction, Left
PubMed: 14746527
DOI: 10.1146/annurev.med.55.091902.104417 -
Reviews in Cardiovascular Medicine 2012Right ventricular systolic dysfunction (RVSD) has been related to prognosis in patients with heart failure (HF) and/or left ventricular systolic dysfunction. However,... (Meta-Analysis)
Meta-Analysis Review
Right ventricular systolic dysfunction (RVSD) has been related to prognosis in patients with heart failure (HF) and/or left ventricular systolic dysfunction. However, most of the studies addressing this issue are not large enough, have different inclusion criteria, and use different methods to evaluate RV function to draw definite conclusions. We sought to investigate the association between RVSD and outcomes in patients with left ventricular dysfunction. Eleven studies of 40 (27.5%), with 4732 patients, were included in the meta-analysis. RVSD was present in 2234 patients (47.2%). Four of the studies had admission for HF as an endpoint. We found a significant association between RVSD and overall mortality with significant between-studies heterogeneity and presence of publication bias (funnel plot). A significant association was found between RVSD and admission for HF. RVSD is associated with overall mortality and admission for HF during follow-up. Significant between-studies heterogeneity and publication bias must be taken into account when interpreting this information.
Topics: Chi-Square Distribution; Heart Failure; Humans; Odds Ratio; Patient Admission; Prognosis; Risk Assessment; Risk Factors; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Left; Ventricular Function, Right
PubMed: 23160163
DOI: 10.3909/ricm0602 -
Lancet (London, England) Jan 1998
Topics: Humans; Ventricular Dysfunction, Left
PubMed: 9652647
DOI: 10.1016/s0140-6736(05)78300-8 -
Progress in Cardiovascular Diseases 2012Group 2 pulmonary hypertension is most frequently caused by left heart disease, a heterogeneous set of disorders. These processes include left ventricular systolic... (Review)
Review
Group 2 pulmonary hypertension is most frequently caused by left heart disease, a heterogeneous set of disorders. These processes include left ventricular systolic dysfunction, left ventricular dysfunction with preserved ejection fraction and valvular (mitral and/or aortic) diseases. Left heart disease may cause passive backward transmission of pressure leading to elevated left atrial and pulmonary arterial pressures due to a myriad of processes. Increasingly, it has been recognized that some patients may develop pulmonary arterial pressure out of proportion from what is expected. This is believed to be due to increases in vasomotor tone and/or vascular remodeling. Over time patients may go on to develop progressive right ventricular dysfunction, a marker for poor prognosis. This review will explore the different characteristics of these conditions including the incidence, pathophysiology, clinical implications, prognosis and current state of available medical therapies.
Topics: Diagnostic Imaging; Humans; Hypertension, Pulmonary; Prognosis; Pulmonary Wedge Pressure; Severity of Illness Index; Stroke Volume; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 23009907
DOI: 10.1016/j.pcad.2012.07.007 -
Revista Espanola de Cardiologia... Jan 2023
Topics: Humans; Diabetes Mellitus, Type 2; Ventricular Dysfunction; Biomarkers; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 35787949
DOI: 10.1016/j.rec.2022.06.008 -
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