Cardiac damage in severe aortic stenosis (AS) is not limited to the aortic valve and left ventricle, but is a systemic disease characterized by a significant alteration in cardiac structure and function. Therefore, a new classification of AS based on the degree of myocardial damage was proposed. A significant number of patients with AS have right ventricular dysfunction likely due to ventricular interdependence. Relationship between right ventricular dysfunction and increased mortality in both symptomatic and asymptomatic patients with severe AS was demonstrated. These patients could benefit more from intervention. Therefore, a standardized echocardiographic examination of a patients with severe aortic stenosis should provide a detailed analysis of right ventricular function.

• Klíčová slova
• TAVI, aortic stenosis, right ventricular dysfunction,
• MeSH
• aortální chlopeň MeSH
• aortální stenóza * komplikace   diagnostické zobrazování   chirurgie   MeSH
• chirurgická náhrada chlopně * MeSH
• dysfunkce levé srdeční komory * MeSH
• dysfunkce pravé srdeční komory * diagnostické zobrazování   MeSH
• echokardiografie MeSH
• funkce levé komory srdeční MeSH
• lidé MeSH
• srdeční komory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: Right ventricular apical pacing has a detrimental effect on left ventricular (LV) function. More optimal pacing site may be found by invasive measurement of LV mechanical performance during pacing from different RV pacing sites. We aimed to investigate the effect of RV pacing lead location on invasive indices of LV mechanical performance. METHODS AND RESULTS: Patients undergoing catheter ablation for persistent atrial fibrillation were enrolled. Single-site endocardial pacing from the lateral LV region was periodically switched to pacing from the mapping catheter navigated to different RV sites within the three-dimensional electroanatomical RV map. SystIndex, DiastIndex, and PPIndex were defined as the ratio of LV dP/dtmax, LV dP/dtmin, and arterial pulse pressure during RV pacing to corresponding values from adjacent periods of LV pacing. Haemodynamic data were analysed in 18 RV segments created by dividing RV horizontally (basal, mid, and apical portion), vertically (inferior, mid, and superior portion) and frontally (septum and free wall). Eight patients (58 ± 7 years; 2 females; 26 ± 4 RV pacing sites per patient) were enrolled into the study. Compared with LV pacing, the best RV pacing values of SystIndex and DiastIndex were achieved in basal-mid-septal segment (+6.9%, P = 0.02 and +3.4%, P = 0.36, respectively) while the best PPIndex was obtained in superior-mid-septal segment of RV (+4.5%, P = 0.02). All indices were fairly concordant showing significant improvement of haemodynamics during RV pacing in the direction from free wall to septum, from apex to base, and from inferior to superior segments. CONCLUSION: The best LV mechanical performance was achieved by RV septal pacing in the non-apical mid-to-superior segments.

• Klíčová slova
• Electroanatomical mapping, Haemodynamics of pacing, Optimal pacing site, Resynchronization, Right ventricular pacing,
• MeSH
• časové faktory MeSH
• diastola * MeSH
• elektrofyziologické techniky kardiologické MeSH
• elektrokardiografie MeSH
• fibrilace síní diagnóza   patofyziologie   chirurgie   MeSH
• funkce levé komory srdeční * MeSH
• funkce pravé komory srdeční * MeSH
• kardiostimulace umělá metody   MeSH
• katetrizační ablace MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezikomorová přepážka patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• srdeční komory patofyziologie   MeSH
• systola * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

BACKGROUND: In the Phase III PATENT-1 (NCT00810693) and CHEST-1 (NCT00855465) studies, riociguat demonstrated efficacy vs placebo in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Clinical effects were maintained at 2 years in the long-term extension studies PATENT-2 (NCT00863681) and CHEST-2 (NCT00910429). METHODS: This post hoc analysis of hemodynamic data from PATENT-1 and CHEST-1 assessed whether riociguat improved right ventricular (RV) function parameters including stroke volume index (SVI), stroke volume, RV work index, and cardiac efficiency. REVEAL Risk Score (RRS) was calculated for patients stratified by SVI and right atrial pressure (RAP) at baseline and follow-up. The association between RV function parameters and SVI and RAP stratification with long-term outcomes was assessed. RESULTS: In PATENT-1 (n = 341) and CHEST-1 (n = 238), riociguat improved RV function parameters vs placebo (p < 0.05). At follow-up, there were significant differences in RRS between patients with favorable and unfavorable SVI and RAP, irrespective of treatment arm (p < 0.0001). Multiple RV function parameters at baseline and follow-up were associated with survival and clinical worsening-free survival (CWFS) in PATENT-2 (n = 396; p < 0.05) and CHEST-2 (n = 237). In PATENT-2, favorable SVI and RAP at follow-up only was associated with survival and CWFS (p < 0.05), while in CHEST-2, favorable SVI and RAP at baseline and follow-up were associated with survival and CWFS (p < 0.05). CONCLUSION: This post hoc analysis of PATENT and CHEST suggests that riociguat improves RV function in patients with PAH and CTEPH.

• Klíčová slova
• CTEPH, PAH, hypertension, pulmonary, ventricular function, right,
• MeSH
• aktivátory enzymů aplikace a dávkování   MeSH
• dospělí MeSH
• funkce pravé komory srdeční účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• plicní embolie komplikace   MeSH
• plicní hypertenze farmakoterapie   etiologie   patofyziologie   MeSH
• pyrazoly aplikace a dávkování   MeSH
• pyrimidiny aplikace a dávkování   MeSH
• síňový tlak účinky léků   MeSH
• tepový objem fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• aktivátory enzymů MeSH
• pyrazoly MeSH
• pyrimidiny MeSH
• riociguat MeSH Prohlížeč

AIMS: We sought to assess whether the peak systolic and diastolic tricuspid annular velocities as indicators of the right ventricular systolic and diastolic function are of prognostic importance in patients with symptomatic heart failure. METHODS AND RESULTS: The study included 139 consecutive patients with symptomatic heart failure. Their mean left ventricular ejection fraction was 24% (range, 10-39%); 107 patients (77%) were in functional class III according to the New York Heart Association. All patients underwent clinical and laboratory examination, standard echocardiography completed by the Doppler tissue imaging of the tricuspid annular motion, and the right-sided heart catheterization. They were followed up for cardiac-related death and non-fatal cardiac events including the need for implantation of a cardioverter-defibrillator and hospitalization for heart failure. The median follow-up was 11 months (range, 1-48 months). There were 17 cardiac-related deaths and 23 non-fatal cardiac events. The multivariate stepwise Cox regression modelling revealed three effective predictors for both survival and event-free survival: aetiology of heart failure, left ventricular end-diastolic diameter, and the peak systolic tricuspid annular velocity (Sa). Patients with Sa<10.8cms(-1) exhibited worse survival (P=0.048) and event-free survival (P<0.001) compared with those having Sa>/=10.8cms(-1). Risk values of Sa (<10.8cms(-1)) and the left ventricular end-diastolic diameter (>70mm) were found to be of additive simultaneous influence leading to a very poor prognosis, mainly if aetiology of heart failure was idiopathic dilated cardiomyopathy (P<0.001). CONCLUSION: The Sa represents a significant independent predictor of survival and event-free survival in patients with symptomatic heart failure. Its combination with the left ventricular end-diastolic diameter provides a very powerful tool for patient risk stratification.

• MeSH
• dopplerovská echokardiografie * MeSH
• dospělí MeSH
• funkce pravé komory srdeční * MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• mladiství MeSH
• přežití po terapii bez příznaků nemoci MeSH
• prognóza MeSH
• proporcionální rizikové modely MeSH
• ROC křivka MeSH
• srdeční katetrizace MeSH
• srdeční selhání diagnostické zobrazování   mortalita   patofyziologie   MeSH
• tepový objem MeSH
• trikuspidální chlopeň diagnostické zobrazování   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

We employed two-dimensional echocardiography for the assessment of right ventricular (RV) volumes and/or function in a series of 44 patients. The results of three different echocardiographic approaches were compared with the data obtained from single-plane RV angiography following ultrasound within a 7-day interval. Only the echocardiographic area length method with two orthogonal imaging planes employed (apical 4-chamber and subcostal projections) yielded the beneficial results. The correlations between echocardiographic and angiographic RV volume estimates were rather high (end-diastolic volume: r = 0.83, end-systolic volume: r = 0.82, stroke volume: r = 0.81) and satisfactory in ejection fraction (r = 0.75). Using the method mentioned, the differentiation of patients with an angiographic evidence of RV failure (echocardiographic ejection fraction less than 0.55) from those without it was possible with a sensitivity of 0.68 and a specificity of 0.82. Concerning the clinical impact of the presented study, we can recommend the technique in question as a screening procedure for the detection of changes in RV function exceeding 12% (95% confidence limits).

• MeSH
• echokardiografie metody   MeSH
• funkce pravé komory srdeční fyziologie   MeSH
• kinematografická angiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci srdce diagnostické zobrazování   epidemiologie   MeSH
• prediktivní hodnota testů MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Right ventricular (RV) function is currently being evaluated solely according to the properties of RV myocardium. We have tested a concept that in patients with heart failure with reduced ejection fraction (HFrEF), RV assessment should integrate the information about both RV function as well as size. METHODS: A total of 836 stable patients with HFrEF (LVEF 23.6 ± 5.8%, 82.8% males, 68% NYHA III/IV) underwent echocardiographic evaluation and were prospectively followed for a median of 3.07 (IQRs 1.11; 4.89) years for the occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support. RESULTS: RV size (measured as RV-basal diameter, RVD1) was significantly associated with an adverse outcome independent of RV dysfunction grade (p = 0.0002). The prognostic power of RVD1 was further improved by indexing to body surface area (RVD1i, p < 0.05 compared to non-indexed value). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade alone (ΔAUC >0.03, p < 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p > 0.50), independent of tricuspid regurgitation severity and degree of pulmonary hypertension. CONCLUSION: RV dilatation is a manifestation of RV dysfunction. The evaluation of RV performance should integrate the information about both RV size and function.

• Klíčová slova
• heart failure, outcome, right ventricular dysfunction, right ventricular function assessment, right ventricular size,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Electromechanical discoordination may contribute to long-term pulmonary right ventricular (RV) dysfunction in patients after surgery for congenital heart disease. We sought to evaluate changes in RV function after temporary RV cardiac resynchronization therapy. METHODS AND RESULTS: Twenty-five patients aged median 12.0 years after repair of tetralogy of Fallot and similar lesions were studied echocardiographically (n=23) and by cardiac catheterization (n=5) after primary repair (n=4) or after surgical RV revalvulation for significant pulmonary regurgitation (n=21). Temporary RV cardiac resynchronization therapy was applied in the presence of complete right bundle branch block by atrial-synchronized RV free wall pacing in complete fusion with spontaneous ventricular depolarization using temporary electrodes. The q-RV interval at the RV free wall pacing site (mean 77.2% of baseline QRS duration) confirmed pacing from a late activated RV area. RV cardiac resynchronization therapy carried significant decrease in QRS duration (P<0.001) along with elimination of the right bundle branch block QRS morphology, increase in RV filling time (P=0.002), pulmonary artery velocity time integral (P=0.006), and RV maximum +dP/dt (P<0.001), and decrease in RV index of myocardial performance (P=0.006). RV mechanical synchrony improved: septal-to-lateral RV mechanical delay decreased (P<0.001) and signs of RV dyssynchrony pattern were significantly abolished. RV systolic stretch fraction reflecting the ratio of myocardial stretching and contraction during systole diminished (P=0.001). CONCLUSIONS: In patients with congenital heart disease and right bundle branch block, RV cardiac resynchronization therapy carried multiple positive effects on RV mechanics, synchrony, and contraction efficiency.

• Klíčová slova
• cardiac resynchronization therapy, echocardiography, heart defects, congenital, pediatrics, right ventricle, tetralogy of Fallot,
• MeSH
• biomechanika MeSH
• blokáda Tawarova raménka diagnostické zobrazování   etiologie   patofyziologie   terapie   MeSH
• časové faktory MeSH
• dítě MeSH
• dysfunkce pravé srdeční komory diagnostické zobrazování   etiologie   patofyziologie   MeSH
• elektrofyziologické techniky kardiologické MeSH
• elektrokardiografie MeSH
• Fallotova tetralogie komplikace   diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• funkce pravé komory srdeční * MeSH
• hemodynamika MeSH
• kardiochirurgické výkony * MeSH
• kontrakce myokardu * MeSH
• lidé MeSH
• mladiství MeSH
• obnova funkce MeSH
• pulzní dopplerovská echokardiografie MeSH
• srdeční katetrizace MeSH
• srdeční resynchronizační terapie * MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: This study sought to examine the relationships between right ventricular (RV) function, body composition, and prognosis in patients with advanced heart failure (HF). BACKGROUND: Previous studies investigating HF-related cachexia have not examined the impact of RV function on body composition. We hypothesized that RV dysfunction is linked to weight loss, abnormal body composition, and worsened prognosis in advanced HF. METHODS: Subjects with advanced HF (n = 408) underwent prospective assessment of body composition (skinfold thickness, dual-energy X-ray absorptiometry), comprehensive echocardiography, and blood testing. Subjects were followed up for adverse events (defined as death, transplantation, or circulatory assist device). RESULTS: Subjects with RV dysfunction (51%) had lower body mass index, lower fat mass index, and were more likely to display cachexia (19%). The extent of RV dysfunction correlated with greater antecedent weight loss and a lower fat/lean body mass ratio. Over a median follow-up of 541 days, there were 150 events (37%). Risk of event was greater in subjects with RV dysfunction (hazard ratio: 3.09 [95% confidence interval (CI): 2.18 to 4.45]) and cachexia (hazard ratio: 2.90 [95% CI: 2.00 to 4.12]) in univariate and multivariate analyses. Increased body mass index was associated with a lower event rate (HR per kg/m(2): 0.92 [95% CI: 0.88 to 0.96]), and this protection was mediated by a higher fat mass (0.91 [95% CI: 0.87 to 0.96]) but not a fat-free mass index (0.97 [95% CI: 0.92 to 1.03]). CONCLUSIONS: RV dysfunction and cardiac cachexia often coexist, have additive adverse impact, and might be mechanistically interrelated. Wasting of fat but not of lean mass was predictive of adverse outcome, suggesting that fat loss is either a surrogate of enhanced catabolism or adipose tissue is cardioprotective in the context of HF.

• Klíčová slova
• B-type natriuretic peptide, BMI, BNP, CI, DEXA, HF, HR, LV, RV, RVD, body composition, body mass index, cachexia, confidence interval, dual-energy X-ray absorptiometry, hazard ratio, heart failure, left ventricular, obesity paradox, right ventricular, right ventricular dysfunction, right ventricular function,
• MeSH
• adiponektin krev   MeSH
• distribuce tělesného tuku MeSH
• dysfunkce pravé srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• echokardiografie MeSH
• index tělesné hmotnosti MeSH
• kachexie patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• natriuretický peptid typu B krev   MeSH
• plicní hypertenze patofyziologie   MeSH
• prognóza MeSH
• složení těla fyziologie   MeSH
• srdeční frekvence fyziologie   MeSH
• stupeň závažnosti nemoci MeSH
• systolické srdeční selhání mortalita   patofyziologie   MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• adiponektin MeSH
• natriuretický peptid typu B MeSH

The right ventricular (RV) function was comprehensively examined in 18 patients with dilated cardiomyopathy (DCMP) and compared with RV function in 10 controls. In most cases of DCMP, the RV function is affected simultaneously with a disturbance of the left ventricular (LV) function. However, the degree of its affection is usually less pronounced and, with less severe LV dysfunction, the right ventricle can work even normally. There can be substantial individual differences in the degree of affection of the right ventricle in DCMP. However, severe LV dysfunction is invariably associated with a marked involvement of the right ventricle. A disturbance of the RV function results (besides the influence of the decreased LV function) from both a decrease in its own contractility and a decrease in RV compliance. There exist significant relations between the RV systolic and diastolic function. The degree of RV disturbance in DCMP both of the systolic and diastolic function) can be approximately estimated from the level of diastolic pressure.

• MeSH
• diastola MeSH
• dilatační kardiomyopatie patofyziologie   MeSH
• kontrakce myokardu * MeSH
• lidé středního věku MeSH
• lidé MeSH
• poddajnost MeSH
• srdeční komory MeSH
• tepový objem MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články 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.

• Klíčová slova
• PDE5 inhibitors, LVAD, Right ventricle, heart failure, pulmonary hypertension,
• MeSH
• arteria pulmonalis MeSH
• dysfunkce pravé srdeční komory * diagnostické zobrazování   farmakoterapie   MeSH
• funkce pravé komory srdeční MeSH
• lidé MeSH
• sildenafil citrát MeSH
• srdeční selhání * farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• sildenafil citrát MeSH