Transtorakální echokardiografické vyšetření (TTE) hraje nezastupitelnou úlohu při diagnostice příčiny akutního srdečního selhání. Při pátrání po srdeční dysfunkci by se mělo využít možnosti všech srdečních ultrazvukových zobrazovacích technik, včetně dvourozměrné/trojrozměrné echokardiografie, pulzního a kontinuálního vlnového dopplerovského zobrazení, barevného průtokového dopplerovského mapování, tkáňového dopplerovského zobrazování i deformační analýzy.
Transthoracic echocardiography (TTE) is the method of choice for assessment of myocardial systolic and diastolic function of both the left and right ventricles. Echocardiography is a term used here to refer to all cardiac ultrasound imaging techniques, including two-dimensional/three-dimensional echocardiography, pulsed and continuous wave Doppler, colour flow Doppler, tissue Doppler imaging, contrast echocardiography, and deformation imaging (strain and strain rate).
Echokardiografie patří mezi základní metody při podezření na akutní plicní embolii. Vedle diferenciální diagnostiky jiných kardiovaskulárních onemocnění s podobnými klinickými projevy jako plicní embolie umožňuje především neinvazivní rizikovou stratifikaci pacienta, a tím přispívá k rozhodování o léčebné strategii. Vyšetření by mělo být provedeno co nejčasněji u lůžka nemocného.
Echocardiography is one of the basic methods in suspected acute pulmonary embolism. In addition to the differential diagnosis of other cardiovascular diseases with similar clinical manifestations to pulmonary embolism, it allows, above all, non-invasive risk stratification of the patient and thus contributes to the decision-making process regarding the treatment strategy. The investigation should should be performed as early as possible at the patient's bedside.
BACKGROUND AND AIMS: Right bundle branch block (RBBB) and resulting right ventricular (RV) electromechanical discoordination are thought to play a role in the disease process of subpulmonary RV dysfunction that frequently occur post-repair tetralogy of Fallot (ToF). We sought to describe this disease entity, the role of pulmonary re-valvulation, and the potential added value of RV cardiac resynchronization therapy (RV-CRT). METHODS: Two patients with repaired ToF, complete RBBB, pulmonary regurgitation, and significantly decreased RV function underwent echocardiography, cardiac magnetic resonance, and an invasive study to evaluate the potential for RV-CRT as part of the management strategy. The data were used to personalize the CircAdapt model of the human heart and circulation. Resulting Digital Twins were analysed to quantify the relative effects of RV pressure and volume overload and to predict the effect of RV-CRT. RESULTS: Echocardiography showed components of a classic RV dyssynchrony pattern which could be reversed by RV-CRT during invasive study and resulted in acute improvement in RV systolic function. The Digital Twins confirmed a contribution of electromechanical RV dyssynchrony to RV dysfunction and suggested improvement of RV contraction efficiency after RV-CRT. The one patient who underwent successful permanent RV-CRT as part of the pulmonary re-valvulation procedure carried improvements that were in line with the predictions based on his Digital Twin. CONCLUSION: An integrative diagnostic approach to RV dysfunction, including the construction of Digital Twins may help to identify candidates for RV-CRT as part of the lifetime management of ToF and similar congenital heart lesions.
- MeSH
- Bundle-Branch Block diagnostic imaging etiology therapy MeSH
- Ventricular Dysfunction, Right * diagnostic imaging etiology therapy MeSH
- Echocardiography MeSH
- Tetralogy of Fallot * diagnostic imaging surgery MeSH
- Humans MeSH
- Computer Simulation MeSH
- Heart Ventricles MeSH
- Cardiac Resynchronization Therapy * adverse effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
PURPOSE: Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). METHODS: Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis. RESULTS: Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 [0.284-0.803] times when compared to patients with all examinations depicting no ACP (P = 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 [0.405-1.018] (P = 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (P = 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 [2.38-4.45], P < 0.001). CONCLUSION: RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.
PURPOSE: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). METHODS: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). RESULTS: Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). CONCLUSION: Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.
- MeSH
- COVID-19 * MeSH
- Ventricular Dysfunction, Left * MeSH
- Ventricular Dysfunction, Right * diagnostic imaging MeSH
- Echocardiography MeSH
- Intensive Care Units MeSH
- Humans MeSH
- Pulmonary Embolism * MeSH
- Hypertension, Pulmonary * MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Failure * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
BACKGROUND: Phosphodiesterase-5A inhibitors (PDE5i) are sometimes used in patients with advanced heart failure with reduced ejection fraction before heart transplant or left ventricular assist device implantation to decrease right ventricular (RV) afterload and mitigate the risk of right heart failure. Conflicting evidence exists regarding the impact of these drugs on RV contractility. The aim of this study was to explore the acute effects of PDE5i on ventricular-vascular coupling and load-independent RV contractility. METHODS: Twenty-two patients underwent right heart catheterization and gated equilibrium blood pool single photon emission computed tomography, before and after 20 mg intravenous sildenafil. Single photon emission computed tomography and right heart catheterization-derived data were used to calculate RV loading and contractility. RESULTS: PDE5i induced a decrease in the right atrial pressure (-43%), pulmonary artery (PA) mean pressure (-26%), and PA wedge pressure (PAWP; -23%), with favorable reductions in pulmonary vascular resistance (-41%) and PA elastance (-40%), and increased cardiac output (+13%) (all P < 0.01). The RV ejection fraction increased with sildenafil (+20%), with no change of RV contractility (P = 0.74), indicating that the improvement in the RV ejection fraction was related to enhanced RV-PA coupling (r = 0.59, P = 0.004) by a decrease in the ventricular load. RV diastolic compliance increased with sildenafil. The decrease in the PAWP correlated with RV end-diastolic volume decrease; no relationship was observed with the change in LV transmural pressure, suggesting decreased pericardial constraint. CONCLUSIONS: Acute PDE5i administration has profound RV afterload-reducing effects, improves the RVEF, decreases RV volumes, and decreases the PAWP, predominantly through relief of pericardial constraint, without effects on RV chamber contractility. These findings support further study of PDE5i in protection of RV function in advanced heart failure with reduced ejection fraction who are at risk of RV failure.
Objectives: Development of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation remains a leading cause of perioperative morbidity, end-organ dysfunction and mortality. The objective of this study was to investigate whether the etiology of HF (ischemic HF versus non-ischemic HF) affects the risk of RVF within admission for LVAD implantation and during long-term follow-up. Methods: Between January 2011 and June 27, 2018, 3536 patients were prospectively enrolled into EUROMACS registry. Adult patients (>18 years) who received a first time LVAD were included. When excluding patients with congenital, restrictive, hypertrophic, valvular cardiomyopathies, and myocarditis the total population consisted of 2404 patients. Results: The total cohort consists of 2404 patients. Mean age were 55 years and predominantly male sex [2024 (84.2%)]. At the time of LVAD implantation 1355 (56.4%) patients had ischemic HF and 1049 (43.6%) patients had non-ischemic HF. The incidence of RVF was significantly increased in the non-ischemic HF group in the adjusted model (p = .026). The relative risk difference for RVF in patients with non-ischemic HF was in the adjusted model increased by an absolute value of 5.1% (95% CI: 0.61-9.6). In the ischemic HF group 76 patients (13.4%) developed late RVF and 62 patients (14.8%) in the non-ischemic HF group (p = .56). No differences in occurrence of RVF between HF etiology was observed after 2 and 4 years of follow-up, respectively (crude: p = .25, adjusted (sex and age) p = .2 and crude: p = .59, adjusted (sex and age) p = .44). Conclusions: Patients with non-ischemic HF undergoing LVAD had an increased incidence of early RVF compared to patients with ischemic HF in a large European population. During follow-up after discharge 14% patients developed RVF. We recommend HF etiology to be considered in identifying patients who are at risk for postoperative RVF after LVAD implantation.
- MeSH
- Time Factors MeSH
- Adult MeSH
- Ventricular Dysfunction, Right diagnostic imaging epidemiology physiopathology MeSH
- Ventricular Function, Left * MeSH
- Ventricular Function, Right * MeSH
- Risk Assessment MeSH
- Prosthesis Implantation adverse effects instrumentation MeSH
- Incidence MeSH
- Middle Aged MeSH
- Humans MeSH
- Heart-Assist Devices * MeSH
- Registries MeSH
- Risk Factors MeSH
- Heart Failure diagnostic imaging epidemiology physiopathology therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Comparative Study MeSH
- Geographicals
- Europe MeSH
- MeSH
- Molecular Targeted Therapy trends MeSH
- Dobutamine administration & dosage MeSH
- Ventricular Dysfunction, Right * diagnostic imaging drug therapy surgery classification MeSH
- Hemodynamic Monitoring methods instrumentation MeSH
- Cardiotonic Agents MeSH
- Humans MeSH
- Milrinone administration & dosage MeSH
- Mitral Valve pathology transplantation MeSH
- Heart-Assist Devices trends MeSH
- Cardiac Resynchronization Therapy methods MeSH
- Heart Transplantation methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Srdeční selhání je častou komplikací dospělých pacientů s vrozenou srdeční vadou (VSV) a významně zvyšuje jejich mortalitu. Multifaktoriální etiologie srdečního selhání u VSV zahrnuje jednak morfologické nálezy patřící k jednotlivým vrozeným vadám nebo rezidua po katetrizačních a operačních výkonech, ale také dysfunkci levé nebo pravé komory v systémové nebo subpulmonální pozici. Při vyšetření nemocných se srdečním selháním je kromě konvenčních vyšetřovacích metod s výhodou provádět sériová zátěžová vyšetření a odběry NT-proBNP, které umožní sledovat progresi srdečního selhání v čase. Nejpodstatnější složkou léčby nemocných se srdečním selháním je odstranění příčin, ať už chirurgickou či katetrizační cestou, a vyvolávajících faktorů, jimiž jsou velmi často arytmie. Medikamentózní léčba založená na důkazech se vztahuje pouze k systémové levé komoře, všechna ostatní uspořádání hemodynamiky vyžadují spíše kreativní přístup založený na zkušenosti. Ultimátním řešením je transplantace srdce s velmi dobrými dlouhodobými výsledky, nicméně s vysokou mortalitou na waiting listu.
Heart failure is a common complication in adult patients with congenital heart disease, and it significantly increases their mortality. The multifactorial etiology of heart failure in CHD includes not only morphological findings pertinent to particular congenital defects or residua following catheterization and surgical procedures, but also dysfunction of the left or right ventricles in the systemic or subpulmonary positions. When examining patients with heart failure, in addition to conventional examination techniques, it is advisable to perform serial exercise tests and NT-proBNP assessments allowing to monitor the progression of heart failure over time. The mainstay of treatment in patients with heart failure is elimination of the causes, whether by surgery or catheterization, and of the causative factors, which very often include arrhythmias. Evidence-based medical therapy is only relevant to the systemic left ventricle, with all the other haemodynamic arrangements rather requiring a creative approach based on experience. Heart transplantation is an ultimate option with very good long-term results; however, it is associated with a high mortality on the waiting list..
- MeSH
- Adult MeSH
- Ventricular Dysfunction, Left diagnostic imaging classification complications MeSH
- Ventricular Dysfunction, Right diagnostic imaging classification complications MeSH
- Humans MeSH
- Heart Failure, Systolic * diagnostic imaging drug therapy classification MeSH
- Heart Defects, Congenital complications MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Review MeSH
Transpozice velkých tepen jsou heterogenní skupinou komplexních vrozených srdečních vad a liší se i způsobem řešení, následnými komplikacemi i dlouhodobou prognózou. Vrozeně korigovaná transpozice bez operace a nekorigovaná transpozice po atriálním switchi má v systémové pozici pravou komoru a v dospělosti pak dominují problémy se srdečním selháním popřípadě regurgitací systémové trikuspidální chlopně, časté jsou i arytmie. Nekorigovaná transpozice po arteriálním switchi v dětství má naopak v dospělosti velmi příznivý průběh.
Transpositions of the great arteries are a heterogeneous group of complicated congenital heart diseases that vary in terms of the management, subsequent complications, and long-term prognosis. In congenitally corrected transposition without surgery and uncorrected transposition after arterial switch, there is the right ventricle in the systemic position, and in adulthood there predominate problems with heart failure and/or systemic tricuspid valve regurgitation, with arrhythmias also being frequent. On the contrary, uncorrected transposition after arterial switch in childhood has a very favourable course in adulthood.
- MeSH
- Adult MeSH
- Ventricular Dysfunction, Right surgery diagnostic imaging complications MeSH
- Humans MeSH
- Cardiac Resynchronization Therapy MeSH
- Transposition of Great Vessels * surgery diagnostic imaging complications physiopathology MeSH
- Tricuspid Valve Insufficiency diagnostic imaging etiology therapy MeSH
- Congenitally Corrected Transposition of the Great Arteries diagnostic imaging complications physiopathology MeSH
- Heart Defects, Congenital MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Review MeSH
