IC en VD en fraccion de ejeccion conservado

VD en IC preservada

1. Is the right ventricle relevant in heart
failure with preserved ejection fraction?
Felix C. Tanner, MD
Associate Professor, Cardiology
Director, Echocardiography
University Heart Center Zürich

6. Anatomy of Right Ventricle
Leonardi B. et al. Eur Heart J Cardiovasc Imaging 2013;14:381-386

7. Right Ventricle - 3D

8. Right Ventricular Systolic Function - TAPSE

9. Right Ventricular Systolic Function - Fractional Area Change

10. Saguner A.M. et al. Circ Cardiovasc Imaging 2014;7:230-239
Right Ventricular Systolic Function and Outcome
TAPSE FAC

11. Tricuspid Regurgitation

12. Hahn RT. Circ Cardiovasc Imaging 2016
Tricuspid Regurgitation

13. Fröhlich GM et al. Eur Heart J 2013;34:1414-1423
Tricuspid Regurgitation And Outcome
Nath J et al. J Am Coll Cardiol 2004;43:405-409
n = 5‘223 (retrospective study)
mean follow up = 498±402 days
Independent of LVEF and PAH

14. Dyspnea and HFpEF
Dalos D. et al. J Am Coll Cardiol 2016;68:189-199
n=193; prospective cohort study.

15. Right Ventricle and HFpEF
Mohammed S.F. et al. Circulation 2014;130:2310-2320
CB
A Prospective
cohort
study
n=562
LV-EF >= 50%
Heart failure
Median follow-
up = 4.6 a
TAPSE = 17 mm
(14-21)

16. Clinical Parameters and RV Function
Mohammed S.F. et al. Circulation 2014;130:2310-2320

17. Cardiac Parameters and RV Function
Mohammed S.F. et al. Circulation 2014;130:2310-2320

18. RV Function and Survival (All-Cause Mortality)
Pulmonary Artery Pressure and Survival (All-Cause Mortality)
Mohammed S.F. et al. Circulation 2014;130:2310-2320

19. RV Function and Outcome
Mohammed S.F. et al. Circulation 2014;130:2310-2320

20. Right Ventricular FAC and HFpEF
Melenovsky V. et al. Eur Heart J 2014;35:3452-3462
Distribution of RV Function Survival and RV Function

21. Melenovsky V. et al. Eur Heart J 2014;35:3452-3462
Predictors of mortality
Right Ventricular FAC and HFpEF

22. Right Ventricle and HFpEF During Exercise
Borlaug B. et al. Eur Heart J 2016;37:3294-3302
Exercise Hemodynamics
n = 50 (HFpEF), n = 24 (control), Heart failure symptoms, LV-EF >= 50%
Invasive hemodynamic exercise stress test with simultaneous echo
Mildly elevated LV and RV filling pressure at rest
Mildy elevated PA systolic pressure at rest (mPAP = 27±8 mmHg
Normal RV tissue velocities (S‘ and E‘) at rest

23. Right Ventricle and HFpEF During Exercise
Borlaug B. et al. Eur Heart J 2016;37:3294-3302
Ventricular Tissue Velocities

24. Right Ventricle and HFpEF During Exercise
Borlaug B. et al. Eur Heart J 2016;37:3294-3302
Ventricular Tissue Velocities

25. Right Ventricle and HFpEF - Metaanalysis
Gorter T.M. et al. Eur J Heart Fail 2016;18:1472-1487
RV Systolic Parameters as Predictor of Mortality

26. Right Ventricle and HFpEF
• Right ventricular dysfunction, CMR, prognosis
Aschauer S et al. Eur J Heart Fail 2016;18:71-80
• Right ventricular dysfunction, comorbidities, prognosis
Aschauer S et al. Int J Cardiol 2017;228:422-426
• Right ventricular dysfunction, HFrEF, prognosis
Ghio S et al. Eur J Heart Fail 2017;19:873-879
• Right ventricular pulmonary artery coupling:
Guazzi M et al. J am Coll Cardiol Img 2017 (in press)

27. Right Ventricle and HFpEF
x
Chatterjee N.A. et al. Circulation 2014;130:2272-2275Gorter T.M. et al. Eur J Heart Fail 2016;18:1472-1487

28. Right Ventricle and HFpEF
• RV dysfunction is frequent in HFpEF, although less
frequent than RV dysfunction in HFrEF
• RV dysfunction contributes to exercise intolerance
in HFpEF
• RV dysfunction in HFpEF is associated with more
advanced disease
• RV dysfunction in HFpEF is associated with worse
outcome
• RV dysfunction appears to predict outcome regard-
less of the severity of pulmonary hypertension

29. Right Ventricle and HFpEF
• HFpEF primarily affects the left ventricle, but is a biventricular
disorder in many patients
• HFpEF primarily affects diastole, but systole also appears to be
altered
• Echocardiography is the ideal method for assessing both right
ventricle and pulmonary pressure