Key result
Novel echocardiographic RVD score ≥2 is linked to ~5-fold greater likelihood of decompensated LVD.
Why the study?
Recognizing congestion and hypoperfusion in chronic left ventricular dysfunction has therapeutic and prognostic implications, prompting evaluation of whether a multiparameter echocardiographic right ventricular dysfunction score can characterize hemodynamic profiles.
Does a novel 5-point echocardiographic right ventricular dysfunction (RVD) score accurately identify invasive hemodynamic severity profiles in patients with chronic left ventricular dysfunction?
Observational (n=105)
No
Does a novel 5-point echocardiographic right ventricular dysfunction (RVD) score accurately identify invasive hemodynamic severity profiles in patients with chronic left ventricular dysfunction?
A novel 5-point echocardiographic right ventricular dysfunction score can accurately identify invasive hemodynamic severity profiles in patients with chronic left ventricular dysfunction, outperforming standard echocardiography.
Answers are grounded in this paper and cite their sources.
May support RV dysfunction scoring for decompensation risk stratification in chronic LV dysfunction; leaves open prospective validation against invasive hemodynamics.
Purpose Recognition of congestion and hypoperfusion in patients with chronic left ventricular dysfunction (LVD) has therapeutic and prognostic implications. In the present study we hypothesized that a multiparameter echocardiographic grading of right ventricular dysfunction (RVD) can facilitate the characterization of hemodynamic profiles. Methods Consecutive patients ( n = 105, age 53 ± 14 years, males 77%, LV ejection fraction 28 ± 11%) referred for heart transplant or heart failure work-up, with catheterization and echocardiography within 48 h, were reviewed retrospectively. Three hemodynamic profiles were defined: compensated LVD (cLVD, normal pulmonary capillary wedge pressure (PCWP < 15 mmHg) and normal mixed venous saturation (SvO 2 ≥ 60%)); decompensated LVD (dLVD, with increased PCWP) and LV failure (LVF, increased PCWP and reduced SvO 2 ). We established a 5-point RVD score including pulmonary hypertension, reduced tricuspid annular plane systolic excursion, RV dilatation, ≥ moderate tricuspid regurgitation and increased right atrial pressure. Results The RVD score [median (IQR 25%;75%)] showed significant in-between the three groups differences with 1 (0;1), 1 (0.5;2) and 3.0 (2;3.5) in patients with cLVD, dLVD and LVF, respectively. The finding of RVD score ≥ 2 or ≥ 4 increased the likelihood of decompensation or LVF 5.2-fold and 6.7-fold, respectively. On the contrary, RVD score < 1 and < 2 reduced the likelihood 11.1-fold and 25-fold, respectively. The RVD score was more helpful than standard echocardiography regarding identification of hemodynamic profiles. Conclusions In this proof of concept study an echocardiographic RVD score identified different hemodynamic severity profiles in patients with chronic LVD and reduced ejection fraction. Further studies are needed to validate its general applicability.
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Bech‐Hanssen et al. (2022) conducted an observational in Chronic left ventricular dysfunction (n=105). Echocardiographic right ventricular dysfunction (RVD) score vs. Standard echocardiography was evaluated on Detection of decompensated LVD (PCWP ≥ 15 mmHg) using RVD score ≥ 2 (PLR 5.2, 95% CI 2.3-11.8). A novel 5-point echocardiographic right ventricular dysfunction score ≥ 2 increased the likelihood of decompensation 5.2-fold in patients with chronic left ventricular dysfunction.
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