Awareness of the involvement of the right ventricle in both common and rare cardiovascular diseases has grown. Recent developments in echocardiography and electrocardiography have contributed... Show moreAwareness of the involvement of the right ventricle in both common and rare cardiovascular diseases has grown. Recent developments in echocardiography and electrocardiography have contributed to further insight into the pathophysiology of the right ventricle as well as its relation to the pulmonary circulation and the left ventricle. Because echocardiography is accessible, non-invasive, and inexpensive it is an ideal technique for the assessment of the right ventricle and can be used for screening patients at risk of right ventricular dysfunction as well as monitor therapeutic responses. Furthermore, advanced echocardiographic techniques such as 2-dimensional speckle-tracking imaging may add to a better understanding of right ventricular mechanics. Integrated application of echocardiographic and electrocardiographic techniques could provide further understanding into the different pathophysiological aspects of right ventricular function. These insights could be used to identify risk factors, prognostic factors and monitor response to therapy through serial assessment in patients at risk for right ventricular dysfunction and failure such as patients with pulmonary hypertension, heart failure and those undergoing cardiac surgery. Furthermore, a better understanding of the mechanisms that lead to right ventricular remodeling may aid to the development of right ventricular specific therapies that improve survival in patients with right ventricular dysfunction. Show less
Haeck, M.L.A.; Hoogslag, G.E.; Boden, H.; Velders, M.A.; Katsanos, S.; Amri, I. al; ... ; Delgado, V. 2016
BACKGROUND Right ventricular (RV) function is an important prognostic marker in patients with pulmonary hypertension. The present evaluation assessed the prognostic value of RV longitudinal peak... Show moreBACKGROUND Right ventricular (RV) function is an important prognostic marker in patients with pulmonary hypertension. The present evaluation assessed the prognostic value of RV longitudinal peak systolic strain (LPSS) in patients with pulmonary hypertension. METHODS AND RESULTS A total of 150 patients with pulmonary hypertension of different etiologies (mean age, 59±15 years; 37.3% male) were evaluated. RV fractional area change and tricuspid annular plane systolic excursion index were evaluated with 2-dimensional echocardiography. RV LPSS was assessed with speckle-tracking echocardiography. The patient population was categorized according to a RV LPSS value of -19%. Among several clinical and echocardiographic parameters, the significant determinants of all-cause mortality were evaluated. There were no significant differences in age, sex, pulmonary hypertension cause and left ventricular ejection fraction between patients with RV LPSS <-19% and patients with RV LPSS ≥-19%. However, patients with RV LPSS ≥-19% had significantly worse New York Heart Association functional class (2.7±0.6 versus 2.3±0.8; P=0.003) and lower tricuspid annular plane systolic excursion (16±4 mm versus 18±3 mm; P<0.001) than their counterparts. During a median follow-up of 2.6 years, 37 patients died. RV LPSS was a significant determinant of all-cause mortality (HR, 3.40; 95% CI, 1.19-9.72; P=0.02). CONCLUSIONS In patients with pulmonary hypertension, RV LPSS is significantly associated with all-cause mortality. RV LPSS may be a valuable parameter for risk stratification of these patients. Future studies are needed to confirm these results in the pulmonary hypertension subgroups. Show less
Chronic heart failure is a major healthcare problem associated with high morbidity and mortality. Despite significant progress in treatment strategies, the prognosis of heart failure patients... Show moreChronic heart failure is a major healthcare problem associated with high morbidity and mortality. Despite significant progress in treatment strategies, the prognosis of heart failure patients remains poor. The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy. In order to improve patients' outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option. Structured care for heart failure patients according to the most recent international heart failure guidelines may further contribute to optimal decision-making. This article will review the conventional and novel treatment modalities of heart failure. Show less
