Background: Both chronic obstructive pulmonary disease (COPD) and right ventricular (RV) dysfunction are common factors that have been associated with poor prognosis after aortic valve replacement ... Show moreBackground: Both chronic obstructive pulmonary disease (COPD) and right ventricular (RV) dysfunction are common factors that have been associated with poor prognosis after aortic valve replacement (AVR). Since there is still uncertainty about the impact of COPD on RV function and dilatation in patients undergoing AVR, we sought to explore RV function and remodeling in the presence and absence of COPD as well as their prognostic implications. Methods: Patients who received surgical or transcatheter AVR due to severe AS were screened for COPD. Demographic and clinical data were collected at baseline while echocardiographic measurements were performed at baseline and 1 year after AVR. The study end-point was all-cause mortality. Results: In total 275 patients were included, with 90 (33%) patients having COPD. At 1-year follow-up, mild worsening of tricuspid annular planar systolic excursion and RV dilatation were observed in patients without COPD, while there were significant improvements in RV longitudinal strain, RV wall thickness but dilatation of RV outflow tract distal dimension in the COPD group compared to the baseline. On multivariable analysis, the presence of COPD provided significant incremental prognostic value over RV dysfunction and remodeling. Conclusions: At 1-year after AVR, RV function and dimensions mildly deteriorated in non-COPD group whereas COPD group received significant benefit of AVR in terms of RV function and hypertrophy. COPD was independently associated with >2-fold all-cause mortality and had incremental prognostic value over RV dysfunction and remodeling. Show less
Tricuspid regurgitation is a disorder in which the tricuspid valve does not close properly, causing backward flow of blood. It is a heterogeneous disease which can be classified based on the... Show moreTricuspid regurgitation is a disorder in which the tricuspid valve does not close properly, causing backward flow of blood. It is a heterogeneous disease which can be classified based on the underlying mechanism. The large majority of tricuspid regurgitation is secondary to conditions that cause tricuspid annulus dilation or leaflet tethering due to right ventricular or right atrial dilation. Part I focusses on the relationship between secondary tricuspid regurgitation and the right ventricle. Right ventricular dysfunction was demonstrated to be an important prognostic parameter in patients with secondary tricuspid regurgitation. A new staging system, incorporating right ventricular dysfunction and symptoms of right heart failure, may be valuable for risk stratification in patients with secondary tricuspid regurgitation. Patients who received tricuspid valve annuloplasty during left-sided valve surgery developed less right ventricular dilation and had less severe tricuspid regurgitation at long-term follow-up.Part II focusses on tricuspid regurgitation in specific patient populations: men and women, patients with atrial fibrillation and patients with obesity. An etiology-specific approach to detection and management of significant tricuspid regurgitation may be the most effective way to improve prognosis in all patients. Treatment of patients with tricuspid regurgitation remains challenging, but is developing rapidly with ongoing research. Show less
Background Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in... Show moreBackground Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV and left ventricular (LV) function measured by cardiovascular magnetic resonance with uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF). Methods Women with repaired ToF were examined, who had been enrolled in a prospective multicenter study of pregnant women with congenital heart disease. Clinical data and CMR evaluation before pregnancy were compared with uteroplacental Doppler parameters at 20 and 32 weeks gestation. In particular, pulsatility index (PI) of uterine and umbilical artery were studied. Results We studied 31 women; mean age 30 years, operated at early age. Univariable analyses showed that reduced RV ejection fraction (RVEF;P = 0.037 andP = 0.001), higher RV end-systolic volume (P = 0.004) and higher LV end-diastolic and end-systolic volume (P = 0.001 andP = 0.003, respectively) were associated with higher uterine or umbilical artery PI. With multivariable analyses (corrected for maternal age and body mass index), reduced RVEF before pregnancy remained associated with higher umbilical artery PI at 32 weeks (P = 0.002). RVEF was lower in women with high PI compared to women with normal PI during pregnancy (44% vs. 53%,p = 0.022). LV ejection fraction was not associated with uterine or umbilical artery PI. Conclusions Reduced RV function before pregnancy is associated with abnormal uteroplacental Doppler flow parameters. It could be postulated that reduced RV function on pre-pregnancy CMR (<= 2 years) is a predisposing factor for impaired placental function in women with repaired ToF. Show less
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
