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Targeted Diagnosis and Treatment of Right Ventricular Function and Failure
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Targeted Diagnosis and Treatment of Right Ventricular Function and Failure

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 2988

Special Issue Editor

Dr. Karl Patrik Kresoja

E-Mail Website
Guest Editor
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
Interests: valve repair; acute heart failure; chronic heart failure; tricuspid regurgitation

Special Issue Information

Dear Colleagues,

This Special Issue, titled "Targeted Diagnosis and Treatment of Right Ventricular Function and Failure", strives to present an all-encompassing panorama of clinical methodologies and breakthroughs concerning the diagnosis and management of right ventricular dysfunction and failure. This Special Issue hones in on the intricate challenges inherent to right ventricular function while shedding light on emerging methodologies for precision-based interventions.

Contained within this collection is a diverse array of articles, spanning topics that encompass imaging modalities, biomarker utilization, therapeutic protocols, and innovative surgical approaches. By meticulously addressing the distinctive facets of right ventricular dysfunction, the ultimate goal of this Special Issue is to improve patient outcomes while fostering a deeper comprehension of this multifaceted ailment.

Dr. Karl Patrik Kresoja
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • transcatheter tricuspid valve repair
  • right ventricular dysfunction
  • right ventricular failure
  • diagnostic imaging
  • therapeutic interventions
  • surgical approaches
  • cardiac imaging
  • pulmonary hypertension
  • right heart catheterization
  • echocardiography
  • heart failure management
  • right ventricular remodeling
  • prognosis
  • risk stratification
  • clinical outcomes

Published Papers (4 papers)

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Research

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14 pages, 1061 KiB  
Article
Prognostic Value of a New Right Ventricular-to-Pulmonary Artery Coupling Parameter Using Right Ventricular Longitudinal Shortening Fraction in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prospective Echocardiography Study
by Christophe Beyls, Mathilde Yakoub-Agha, Alexis Hermida, Nicolas Martin, Maxime Crombet, Thomas Hanquiez, Alexandre Fournier, Geneviève Jarry, Dorothée Malaquin, Audrey Michaud, Osama Abou-Arab, Laurent Leborgne and Yazine Mahjoub
J. Clin. Med. 2024, 13(4), 1006; https://doi.org/10.3390/jcm13041006 - 09 Feb 2024
Viewed by 809
Abstract
Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) [...] Read more.
Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58–0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49–0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg−1 was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38–74]) for patients with RV-LSF/PASP < 0.30%.mmHg−1 and 17% (95%CI = [12–23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg−1; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg−1 was associated with MACE at 6 months. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Right Ventricular Function and Failure)
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16 pages, 4803 KiB  
Article
Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept
by Vincenzo Tarzia, Matteo Ponzoni, Demetrio Pittarello and Gino Gerosa
J. Clin. Med. 2023, 12(24), 7604; https://doi.org/10.3390/jcm12247604 - 10 Dec 2023
Viewed by 774
Abstract
Background: When heart transplantation and myocardial recovery are unlikely, patients presenting with biventricular cardiogenic shock initially treated with extracorporeal membrane oxygenation (ECMO) may benefit from a mechanical support upgrade. In this scenario, a micro-invasive approach is proposed: the combination of the double-lumen ProtekDuo [...] Read more.
Background: When heart transplantation and myocardial recovery are unlikely, patients presenting with biventricular cardiogenic shock initially treated with extracorporeal membrane oxygenation (ECMO) may benefit from a mechanical support upgrade. In this scenario, a micro-invasive approach is proposed: the combination of the double-lumen ProtekDuo cannula (Livanova, London, UK) and the Impella 5.5 (Abiomed, Danvers, MA) trans-aortic pump that translates into a hybrid BiVAD. Methods: All consecutive ECMO patients presenting with biventricular cardiogenic shock and ineligibility to heart transplantation from August 2022 were prospectively enrolled. The clinical course, procedural details, and in-hospital events were collected via electronic medical records. Results: A total of three patients, who were temporarily not eligible for heart transplantation or durable LVAD due to severe acute pneumonia and right ventricular (RV) dysfunction, were implanted with a hybrid BiVAD. This strategy provided high-flow biventricular support while pulmonary function ameliorated. Moreover, by differentially sustaining the systemic and pulmonary circulation, it allowed for a more adequate reassessment of RV function. All the patients were considered eligible for isolated durable LVAD and underwent less invasive LVAD implantation paired with a planned postoperative RVAD. In all cases, RV function gradually recovered and the RVAD was successfully removed. Conclusions: The Hybrid BiVAD represents an up-to-date micro-invasive mechanical treatment of acute biventricular failure beyond ECMO. Its rationale relies on more physiological circulation across the lungs, the complete biventricular unloading, and the possibility of including an oxygenator in the circuit. Finally, the independent and differential control of pulmonary and systemic flows allows for more accurate RV function evaluation for isolated durable LVAD eligibility reassessment. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Right Ventricular Function and Failure)
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Review

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12 pages, 7997 KiB  
Review
Electrocardiographic Changes after Endovascular Mechanical Thrombectomy in a Patient with Pulmonary Embolism—A Case Report and Literature Review
by Lukas Ley, Florian Messmer, Lukas Vaisnora, Hossein Ardeschir Ghofrani, Dirk Bandorski and Michael Kostrzewa
J. Clin. Med. 2024, 13(9), 2548; https://doi.org/10.3390/jcm13092548 - 26 Apr 2024
Viewed by 175
Abstract
Background: Pulmonary embolism (PE) is a common disease with an annual incidence of about 1/1000 persons. About every sixth patient dies within the first 30 days after diagnosis. The electrocardiogram (ECG) is one of the first diagnostic tests performed, and is able to [...] Read more.
Background: Pulmonary embolism (PE) is a common disease with an annual incidence of about 1/1000 persons. About every sixth patient dies within the first 30 days after diagnosis. The electrocardiogram (ECG) is one of the first diagnostic tests performed, and is able to confirm the suspicion of PE with typical electrocardiographic signs. Some ECG signs and their regression are also prognostically relevant. Endovascular mechanical thrombectomy is one option for PE treatment, and aims to relieve right heart strain immediately. The first studies on endovascular mechanical thrombectomy using a dedicated device (FlowTriever System, Inari Medical, Irvine, CA, USA) yielded promising results. Methods: In the following, we report the case of a 66-year-old male patient who presented with New York Heart Association III dyspnea in our emergency department. Among typical clinical and laboratory results, he displayed very impressive electrocardiographic and radiological findings at the time of PE diagnosis. Results: After endovascular mechanical thrombectomy, the patient’s complaints and pulmonary hemodynamics improved remarkably. In contrast, the ECG worsened paradoxically 18 h after intervention. Nevertheless, control echocardiography 4 days after the intervention no longer showed any signs of right heart strain, and dyspnea had disappeared completely. At a 4-month follow-up visit, the patient presented as completely symptom-free with a high quality of life. His ECG and echocardiography were normal and excluded recurrent right heart strain. Conclusions: Overall, the patient benefitted remarkably from endovascular mechanical thrombectomy, resulting in an almost complete resolution of electrocardiographic PE signs at the 4-month follow-up after exhibiting multiple typical electrocardiographic PE signs at time of diagnosis and initial electrocardiographic worsening 18 h post successful intervention. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Right Ventricular Function and Failure)
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12 pages, 550 KiB  
Review
Right Ventricular Dysfunction before and after Cardiac Surgery: Prognostic Implications
by Anna Merlo, Camilla Cirelli, Enrico Vizzardi, Laura Fiorendi, Federica Roncali, Marco Marino, Maurizio Merlo, Michele Senni and Edoardo Sciatti
J. Clin. Med. 2024, 13(6), 1609; https://doi.org/10.3390/jcm13061609 - 11 Mar 2024
Viewed by 966
Abstract
Right ventricular dysfunction is a prognostic factor for morbidity and mortality across a broad spectrum of cardiovascular diseases. While the role of the right ventricle in surgical patients has emerged, the prognostic impact of right ventricular dysfunction remains unclear in a large cardiac [...] Read more.
Right ventricular dysfunction is a prognostic factor for morbidity and mortality across a broad spectrum of cardiovascular diseases. While the role of the right ventricle in surgical patients has emerged, the prognostic impact of right ventricular dysfunction remains unclear in a large cardiac surgery population. We reviewed the existing literature about the role of right ventricular dysfunction in adults undergoing different kinds of cardiac surgery either present before or developed after surgery itself. Pre- and post-operative right ventricular dysfunction has demonstrated substantial prognostic implications. However, there remains a lack of consensus regarding its definition and diagnostic criteria. The available literature is limited to small-sized studies, underscoring the need for studies with larger populations. Full article
(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Right Ventricular Function and Failure)
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