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Background: Since hyperthyroidism could be associated with right ventricular dysfunction, this study intended to investigate right ventricular (RV) function using strain echocardiography in hyperthyroid patients both at rest and in maximum-stress conditions. Methods: This cross-sectional study was conducted at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, from January 2019 to January 2020. All study participants completed a maximum treadmill exercise test, as well as a complete two-dimensional echocardiogram at rest and the peak of stress test. The data were analyzed using SPSS statistical software. The independent samples t test and Mann–Whitney U test were used for numerical, and the Chi square test was used for nominal variables. P

Compressed sensing (CS) is a rapidly developing technique that can acquire functional cines of the heart within seconds while free-breathing and it is ideal for assessing cardiac function in non-typical conditions such as when patients are sedated or anaesthetized or undergoing stress exams. CS cines can further include retrospective temporal resolution interpolation (INTP TR ) to improve the frame count per heartbeat, and the impact of INTP TR on biventricular functional measurements is unknown. We investigated the impact of INTP TR on left and right ventricular volumetry and strain measurements of CS cines. Nineteen patients with 51 different CS acquisitions were prospectively enrolled. CS cines were acquired at rest, under adenosine stress, oxygen inhalation or while under general anaesthesia with mechanical ventilation. From the same CS acquisition, a dataset with and without INTP TR were generated by the scanner. The outputs were separated and analysed by blinded readers for left and right ventricular volumetry, as well as systolic and diastolic strain parameters using feature-tracking techniques. Measurements were compared between the INTP TR and non-INTP TR outputs. Similar measurements were obtained for biventricular volumes and ejection fraction independent of INTP TR . Peak strain was significantly underestimated on INTP TR cines for both longitudinal and circumferential orientations (p < 0.01). Nevertheless, good-to-excellent correlations were observed between the two measurements (r > 0.65, p < 0.01), and there was still a high area under the curve (AUC ≥ 0.95, p < 0.01) for detecting abnormal patients defined by strain analysis on the standard segmented cine. INTP TR especially negatively influenced strain rates analysis, as many strain rate curves were deemed unusable with this technique. These findings were consistent independent if the patient was in a resting, stress or anaesthetized condition. Although INTP TR is a feature which improves temporal resolution on CS cines, quantification of biventricular strain and strain rates is not feasible or comparable, thus, feature tracking analysis should be performed on non-INTP TR data. However, volumetry and ejection fraction analysis are consistent independent of which output is analysed., Competing Interests: Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Cantonal Research Ethics Board of Bern, Switzerland (#2020 − 01258, July, 2020). All participants provided written informed consent. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Cardiopulmonary transit time (CPTT) represents the time needed for the circulation of blood from the right to the left ventricle. This parameter can be measured during dynamic acquisition of rubidium ([ 82 Rb]) cardiac PET/CT. To further characterize this marker, we wanted to assess the association between CPTT and parameters of cardiac function derived from echocardiography. Retrospective single center analysis of patients referred to [ 82 Rb]RbCl-PET/CT with rest/stress protocol on an integrated hybrid PET/CT system (Biograph mCT, Siemens Healthineers, Erlangen, Germany) and echocardiography within 100 days. After intravenous injection of 7.5 MBq/kg [ 82 Rb]RbCl dynamic scans with initially 12 × 10 s frames were started. For data analysis a volume of interest (VOI) was drawn in the left and right ventricle using dedicated software. The difference between the peak time for the two time activity curves (TAC) was extracted as CPTT and normalized for heart rate (NCPTT). Associations between NCPTT and echo parameters such as left ventricular ejection fraction (EF Echo ) were analyzed using linear regression models. 44 patients (sex: 28 male, 16 female) were enrolled with a time difference between PET and echocardiography of 19.65 ± 23.3 days. 9 patients had a rest CPTT of 0 s, 32 patients 10 s and 3 patients 20 s. The association between EF Echo and NCPTT revealed a significant negative correlation (beta = -0.77; CI: -1.32, -0.22; p = 0.007). Given this association, univariate predictive models for EF Echo were applied. Root mean square error was 6.83% for the EF PET , and 6.0% for NCPTT, which indicates a slightly higher predictive performance for the NCPTT model with a lower error. Pulmonary transit time can be estimated with [ 82 Rb]RbCl-PET/CT, with a high positive association to rest EF Echo . However, smaller time frames than 10 s are needed, for more accurate estimation of cardiac function., Competing Interests: Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the northwest and central Switzerland ethics committee (2023–02188). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images in all Figures. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This study investigated the sexual dimorphism in right ventricle (RV) remodeling in right heart failure susceptible Fischer CDF rats using the pulmonary artery banding (PAB) model. Echocardiography and hemodynamic measurements were performed in adult male and female Fischer CDF rats at 1- or 2-wk post-PAB. RV systolic pressure and RV hypertrophy were significantly elevated in PAB rats compared with sham control at 1- and 2-wk post-PAB; however, no differences were observed between male and female rats. Increase in cardiomyocyte cross-sectional area and RV end-diastolic diameter was observed in male rats compared with female rats at 2-wk post-PAB. Conversely, higher fractional area change and cardiac index were observed in female rats compared with male rats at 2-wk post-PAB. To explore the mechanisms, a focused PCR array was performed and higher expression of angiogenic genes, including sphingosine kinase-1 ( Sphk1 ), was observed in the RV of female rats compared with male rats. Consistent with the higher angiogenic gene expression, female rats had a higher RV vascular density at 2-wk post-PAB compared with male rats. Female RV endothelial cells (RVECs) had better angiogenic ability compared with male cells that was potentiated by estradiol. Furthermore, effect of estradiol on RVECs was inhibited by Sphk1 inhibitor (PF-543). Together, female Fischer CDF rats develop adaptive RV remodeling post-PAB compared with maladaptive remodeling in male rats. Moreover, the adaptive remodeling in female rats is associated with better RV angiogenic response that may result from better angiogenic ability of female RVECs and proangiogenic effects of estradiol through Sphk1. NEW & NOTEWORTHY Female patients with pulmonary hypertension have better right ventricular adaptation compared with male. These sex differences were modeled in right heart failure susceptible Fischer CDF rat using pulmonary artery banding model. Preservation of right ventricular function in female rats is linked to better right ventricular angiogenic response that involves higher intrinsic angiogenic ability of female right ventricular endothelial cells together with the proangiogenic effects of female sex hormone estradiol through sphingosine kinase-1.

Objective(s): This study investigates outcomes of the reverse double switch operation (R-DSO) and ventricular switch, novel approaches for patients with D-looped borderline left hearts that utilize the morphologic right ventricle as the systemic ventricle and the hypoplastic left ventricle as the subpulmonary ventricle., Methods: This retrospective review analyzed early outcomes of children who underwent R-DSO/ventricular switch at a single institution between 2015 and 2023. Our primary end points were right ventricular (RV) function and tricuspid regurgitation. Secondary outcomes included mortality, reoperation, and perioperative complications., Results: Twenty-eight patients underwent either R-DSO (n = 19) or ventricular switch (n = 9). In 19 patients, a decompressing bidirectional cavopulmonary shunt was utilized, creating a reverse 1.5 switch. Median age at R-DSO/ventricular switch was 3.1 years (range, 9 months-12 years). At a median follow-up of 1.0 year (range, 38 days-7.2 years), no mortalities or heart transplants had occurred. Mild-moderate or greater RV dysfunction was detected in 4 patients, and mild-moderate or worse tricuspid regurgitation was also detected in 4 patients. Three patients required reoperations. Preoperative RV ejection fraction <55% was associated with higher incidence of postoperative RV dysfunction., Conclusions: The R-DSO/VS strategy is an alternative to single-ventricle palliation or anatomic biventricular repair in the borderline left heart. Concerns for RV dysfunction and tricuspid regurgitation mandate close monitoring. Patients with preoperative RV dysfunction may be at risk for postoperative RV dysfunction. Further studies with longer follow-up are needed to delineate outcomes in comparison to the Fontan pathway and identify optimal candidates for this novel strategy., Competing Interests: Conflict of Interest Statement Dr Emani is a consultant for Cheisi Pharmaceuticals. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure., Competing Interests: Funding Support and Author Disclosures Dr Rider is supported by a British Heart Foundation Senior Clinical Research Fellowship (FS/SCRF/22/32014). Dr Valkovič is supported by a Sir Henry Dale Fellowship from The Wellcome Trust and Royal Society (221805/Z/20/Z). Both authors acknowledge the support of the British Heart Foundation Center of Research Excellence Oxford. Dr Smiseth is a coinventor of “Method for Myocardial Segment Work Analysis” and holds a patent on “Estimation of Blood Pressure in the Heart;” and has received a speaker honorarium from GE Healthcare. Dr Voigt has received speaker honoraria and/or consultancy fees from GE Healthcare, Philips Healthcare, and TomTec Imaging Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Hypoxia is associated with the onset of cardiovascular diseases including cardiac hypertrophy and pulmonary hypertension. HIF2 (hypoxia inducible factor 2) signaling in the endothelium mediates pulmonary arterial remodeling and subsequent elevation of the right ventricular systolic pressure during chronic hypoxia. Thus, novel therapeutic opportunities for pulmonary hypertension based on specific HIF2 inhibitors have been proposed. Nevertheless, HIF2 relevance beyond the pulmonary endothelium or in the cardiac adaptation to hypoxia remains elusive. Wt1 (Wilms tumor 1) lineage contributes to the heart and lung vascular compartments, including pericytes, endothelial cells, and smooth muscle cells., Methods: Here, we describe the response to chronic hypoxia of a novel HIF2 mutant mouse model in the Wt1 lineage ( Hif2/Wt1 cKO [conditional knockout]), characterizing structural and functional aspects of the heart and lungs by means of classical histology, immunohistochemistry, flow cytometry, echocardiography, and lung ultrasound analysis., Results: Hif2/Wt1 cKO is protected against pulmonary remodeling and increased right ventricular systolic pressure induced by hypoxia, but displays alveolar congestion, inflammation, and hemorrhages associated with microvascular instability. Furthermore, lack of HIF2 in the Wt1 lineage leads to cardiomegaly, capillary remodeling, right and left ventricular hypertrophy, systolic dysfunction, and left ventricular dilation, suggesting pulmonary-independent cardiac direct roles of HIF2 in hypoxia. These structural defects are partially restored upon reoxygenation, while cardiac functional parameters remain altered., Conclusions: Our results indicate that cardiopulmonary HIF2 signaling prevents excessive vascular proliferation during chronic hypoxia and define novel protective roles of HIF2 to warrant stable microvasculature and organ function., Competing Interests: None.

Right ventricular dysfunction (RVD) portends increased death risk for heart failure (HF) and pulmonary arterial hypertension (PAH) patients, regardless of left ventricular function or disease etiology. In both, RVD arises from chronic RV pressure overload and represents advanced cardiopulmonary disease. RV remodeling responses and survival rates of patients, however, differ by sex. Men develop more severe RVD and die at younger ages than women do. Mechanistic details of this sexual dimorphism in RV pressure overload remodeling are incompletely understood. We sought to elucidate the cardiac histologic and molecular pathophysiology underlying the sex-specific RV remodeling phenotypes, maladaptive [decompensated RVD with RV failure (RVF)] versus adaptive (compensated RVD). We subjected male (M-) and female (F-) adult mice to moderate pulmonary artery banding (PAB) for 9 wk. Mice underwent serial echocardiography, cardiac MRI, RV pressure-volume loop recordings, and histologic and molecular analyses. M-PAB developed severe RVD with RV failure (RVF), increased RV collagen deposition and degradation, extracellular matrix (ECM) instability, and recruitment and activation of macrophages. Despite equal severity and chronicity of RV pressure overload, F-PAB had more stable ECM, lacked chronic inflammation, and developed mild RVD without RVF. ECM destabilization and chronic activation of recruited macrophages are associated with maladaptive RV remodeling and RVF in M-PAB. These two RV remodeling phenotypes suggest that adverse ECM remodeling and chronic inflammation are also sex-dependent, thereby contributing to the sexual dimorphism of RV pressure overload remodeling. Further mechanistic studies are needed to assess their pathogenic roles and potential as targets for RVD therapy and RVF prevention. NEW & NOTEWORTHY We compared pressure overload-induced RV remodeling in adult male versus female mice subjected to PAB. This study discovered an association between severe RVD, RVF, ECM instability, and chronic inflammation in pressure-overloaded RV of male PAB mice. These features distinguished maladaptive RV remodeling in male from adaptive RV remodeling in female PAB mice. In male patients with RV pressure overload due to HF or PAH, enhancing ECM stability and countering the recruitment of macrophages may help preserve RV function such that RVF could be prevented or delayed.

Background: To investigate the clinical value of fetal heart quantification (fetal HQ) in the evaluation of right ventricular size, morphology and cardiac function in fetuses with redundancy foramen ovale flap (RFOF)., Methods: 31 fetuses diagnosed with RFOF through echocardiography from September 2021 to December 2023 were selected as the control group, and 62 healthy fetuses that matched the age and gestational period of the pregnant women in the RFOF group were chosen as the control group. Fetal HQ software provided by GE Voluson E10 was employed to automatically track endocardial parameters of the right ventricle in 24 segments., Results: The internal diameter of foramen ovale in RFOF group was significantly smaller than that of normal fetal diameter in control group, with statistical significance (P < 0.05). Comparing the morphological parameters of the fetuses in the RFOF group and the control group, there was no statistically significant difference in the GSI scores (P > 0.05), but the RV-LED of the fetuses in the RFOF group in the segments of 1-24 were higher than the fetuses in the normal control group (both P < 0.05), and the RV-SI was lower than that in the normal control group (all P < 0.05)., Conclusions: The Fetal HQ technique enables accurate localisation of the site of the RFOF foetal lesion by rapid quantitative analysis of morphological and functional parameters of the right ventricle of the foetal heart., Competing Interests: Declarations. Ethics approval and consent to participate: This study was conducted according to the tenets of the Declaration of Helsinki. Informed consent was obtained from each patient. The study protocol was approved by the Medical Ethics Committee of Gansu Provincial Maternity and Child-care Hospital (Approval number 2023–54). All experiments were performed in accordance with relevant guidelines and regulations. Consent for publication: The pregnant mothers provided their written informed consent and related images was obtained from the mother of the fetues. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as a treatment option for patients with severe tricuspid regurgitation (TR). However, randomized trials have not shown a survival benefit, possibly because of the inclusion of patients in an early or too advanced disease stage., Objectives: The authors sought to investigate the association between disease stage and outcomes following T-TEER., Methods: In total, 1,885 patients with significant TR were analyzed, including 585 conservatively treated individuals and 1,300 patients who received T-TEER. Patients were evaluated as part of the prospective EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation) registry and grouped into early, intermediate, and advanced disease stage. Disease stage was based on left and right ventricular function, renal function, and natriuretic peptide levels. The stratification was validated in an external cohort. The primary endpoint was 1-year mortality., Results: Overall, 395 patients (21% [395/1,885]) were categorized as early, 1,173 patients (62% [1,173/1,885]) as intermediate, and 317 patients (17% [317/1,885]) as advanced disease stage. In patients with early and advanced disease, mortality did not differ between interventional and conservative treatment (early-stage HR: 0.78; 95% CI: 0.34-1.80; P = 0.54; advanced stage HR: 1.06; 95% CI: 0.71-1.60; P = 0.78). However, mortality was significantly lower in patients undergoing percutaneous treatment with intermediate disease stage (HR: 0.73; 95% CI: 0.52-0.99; P = 0.03)., Conclusions: Compared to medically treated controls, T-TEER was associated with 1-year survival at intermediate stage disease but not at early or advanced disease stages. The timing of T-TEER with regard to disease stages might be crucial to optimize treatment benefits., Competing Interests: Funding Support and Author Disclosures Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Kresoja has received travel expenses from Edwards Lifesciences. Dr Rottbauer has received speaker honoraria from Edwards Lifesciences and Abbott. Dr Denti has served as a consultant for InnovHeart, Picardia, HVR, and Approxima; and has received speaker honoraria from Abbott and Edwards Lifesciences. Dr Rassaf has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Daiichi-Sankyo. Dr Adamo has received consulting fees in the last 3 years from Abbott Structural Heart and Edwards Lifesciences. Dr von Bardeleben has received institutional grants from Abbott Vascular and Edwards Lifesciences; and has served as a speaker for Abbott Vascular and Edwards Lifesciences. Dr Toggweiler has received personal honoraria from Medtronic, Boston Scientific, Biosensors, Abbott Vascular, Medira, Shockwave, Teleflex, atHeart Medical, Cardiac Dimensions, Polares Medical, Amarin, Sanofi, AstraZeneca, ReCor Medical, and Daiichi-Sankyo; has received institutional research grants from Edwards Lifesciences, Boston Scientific, Fumedica, Novartis, and Boehringer Ingelheim; and holds equity in Hi-D Imaging. Dr Metra has received consulting fees in the last 3 years from Abbott Structural Heart, AstraZeneca, Bayer, Boheringer Ingelheim, Edwards Lifesciences, and Roche Diagnostics. Dr Geisler has received speaker honoraria/research grants from AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Ferrer/Chiesi, Medtronic, and Edwards Lifesciences; none of them was related to this study. Dr Estévez-Loureiro has received speaker fees from Abbott Vascular, Edwards Lifesciences, Boston Scientific, and Venus Medtech. Dr Luedike has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Edwards Lifesciences; and has received research honoraria from Edwards Lifesciences. Dr Lauten has a patent with and is a consultant for TricValve licensed to TricValve. Dr Maisano has received grant and/or research institutional support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, Terumo, and Venus; has received consulting fees and personal and institutional honoraria from Abbott, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex, Venus, Squadra, and Valgen; receives royalty income/IP rights from Edwards Lifesciences; and is a shareholder (including share options) of Magenta, Transseptalsolutions, and 4Tech. Dr Praz has received travel expenses from Edwards Lifesciences, Abbott Vascular, Polares Medical, Medira, and Siemens Healthineers. Dr Kessler has received speaker honoraria from Edwards Lifesciences and Abbott. Dr Heitkemper is an employee of Abbott. Dr Peterman is an employee of Abbott. Dr Kalbacher has received personal fees from Abbott Medical, Edwards Lifesciences, and Pi-Cardia Ltd. Dr Rudolph has received research grants from Abbott Medical, Boston Scientific, and Edwards Lifesciences. Dr Iliadis has received consultant fees and travel expenses from Abbott Medical and Edwards Lifesciences. Dr Hausleiter has received research grant support and speaker honoraria from Edwards Lifesciences. Dr Lurz has received institutional grants from Edwards Lifesciences; and has received honoraria from Innoventrics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Riociguat and balloon pulmonary angioplasty (BPA) improve hemodynamics in inoperable chronic thromboembolic pulmonary hypertension. Importantly, comparative effects of riociguat and BPA on different components of right ventricular (RV) afterload and function remain not fully elucidated., Methods: We conducted a post hoc analysis including patients from the RACE trial (Riociguat Versus Balloon Pulmonary Angioplasty in Non-Operable Chronic Thromboembolic Pulmonary Hypertension) with complete data for the primary end point assessment (49 riociguat and 51 BPA). Symptomatic patients with a residual pulmonary vascular resistance >4 WU received add-on riociguat after BPA (n=18) or add-on BPA after riociguat (n=36) and were included in an ancillary 26-week follow-up study with hemodynamic reassessment at week 52., Results: Cardiac output, stroke volume, and RV afterload improved significantly with riociguat and BPA, and the relative changes in RV afterload from baseline to week 26 were more pronounced in the BPA group (all P <0.001). Change in RV afterload was primarily mediated by decreased mean pulmonary arterial pressure in the BPA group, while increased cardiac output was the main driver in the riociguat group. Key parameters of RV function (RV stroke work and right atrial pressure) improved only in the BPA group. The ancillary follow-up study confirmed that relative change in RV afterload from week 26 to week 52 was more pronounced with add-on BPA, and improved RV function was only observed in the add-on BPA group., Conclusions: Both riociguat and BPA are effective in improving RV afterload in inoperable chronic thromboembolic pulmonary hypertension. However, BPA provided a more substantial impact on RV afterload reduction, and RV function only improved with BPA., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02634203., Competing Interests: Dr Gerges has received compensation for scientific symposia from AstraZeneca, AOPHealth, Cordis, Janssen, and Merck Sharp & Dohme (MSD); speaker fees from AOPHealth, AstraZeneca, Janssen, and Ferrer; and an educational grant from AOPHealth. Dr Jevnikar has received speaker fees from Janssen. Dr Savale has received compensation for scientific symposia from Janssen and MSD, speaker fees from Janssen, and has served as an advisory board member for Janssen. Dr Beurnier has received speaker fees from AstraZeneca and Sanofi Aventis. Dr Sitbon has received speaker fees from AOPHealth, Janssen, Ferrer, and MSD; consultancy fees from Acceleron, Altavant, AOPHealth, Ferrer, Gossamer Bio, Janssen, and MSD, research grants from Acceleron, AOPHealth, Janssen, and MSD; and has served as an advisory board member for Altavant, Gossamer Bio, Janssen, and MSD. Dr Fadel has received speaker fees from MSDe. Dr Boucly has received compensation for scientific symposia from Janssen and MSD; speaker fees from Janssen, MSD, AOPHealth, and Ferrer; and research grants from Acceleron, Janssen, and MSD. Dr Simonneau has received speaker and consultancy fees from Janssen, Bayer, GlaxoSmithKline, MSD, and Pfizer; research grants from Janssen; and has served as a steering committee member for Janssen. Dr Humbert has received speaker fees from Janssen and MSD; consultancy fees from Acceleron, Aerovate, Altavant, AOPHealth, Bayer, Chiesi, Ferrer, Janssen, MSD, MorphogenIX, Shou Ti, Tiakis, and United Therapuetics; research grants from Acceleron, AOPHealth, Janssen, MSD, and Shou Ti; and has served as an advisory board member for Acceleron, Altavant, Janssen, MSD, and United Therapeutics. Dr Montani has received speaker fees from Bayer, Janssen, and MSD; consultancy fees from Acceleron, Janssen, and MSD; and research grants from Acceleron, Janssen, and MSD. Dr Jaïs has received speaker fees from Janssen and MSD; and research grants from Acceleron, Bayer, Janssen, and MSD. The other authors report no conflicts.

Background: Infective endocarditis (IE) poses significant risks following percutaneous pulmonary valve implantation (PPVI) or surgical replacement (PVR)., Aims: This study evaluates the effectiveness of emergency percutaneous treatment in stabilizing patients with severe right ventricular dysfunction or obstructive cardiac shock, allowing for delayed surgical or percutaneous valve replacement., Methods: This retrospective study examines 16 patients (age 19.9 [15.1-43.3] years) with right-sided IE treated with primary percutaneous intervention. Data collected included cardiac diagnosis, valve types, pathogens identified, procedural details, and outcomes., Results: Underlying diagnoses included aortic valve stenosis post-Ross surgery (43%), repaired tetralogy of Fallot (25%), common arterial trunk (18%), and repaired double outlet right ventricle (14%). Valve types varied, with Contegra Ven-Pro (56%) and Melody-valve (25%) being the most common. Diagnosis of IE occurred 66.5 (28.3-87.4) months postlast intervention/surgery, with emergency percutaneous treatment performed 2 (1-17) days postdiagnosis. Clinical presentations included obstructive cardiac shock (50%) and septic shock (25%). Preintervention RVOT velocity was 4.4 (4.2-5) m/s, with severely reduced RV function in 68%. Interventions included balloon dilatation, uncovered or covered stent implantation, and Melody valve implantation. Immediate resolution of RVOT obstruction was achieved in all patients, with significant reductions in RV systolic pressures (mean reduction 42.0 (30.2-50.0) mmHg) and improved RV function. No periprocedural deaths occurred, but one complication was noted. Follow-up included surgical repair (68%) and PPVI (18%). Mortality included one IE relapse and one surgical death., Conclusions: Emergency percutaneous interventions can stabilize patients with RVOT obstruction due to IE, enabling delayed surgical or percutaneous interventions., (© 2024 Wiley Periodicals LLC.)

Background: Pulmonary stenosis (PS) is common in congenital heart disease and an integral finding in Tetralogy of Fallot (TOF). Pulmonary regurgitation (PR) is more commonly found following surgery in repaired TOF. We aimed to evaluate the haemodynamic effects of PS and PR on cardiac physiology in a porcine model using cardiac magnetic resonance-based feature tracking (CMR-FT) deformation imaging., Methods: CMR-FT was performed in 14 pigs before and 10-12 weeks after surgery. Surgery included either pulmonary artery banding to simulate PS (n = 7), or an incision to the pulmonary valve to simulate PR (n = 7). CMR-FT assessment included left and right ventricular global longitudinal (LV/RV GLS) and LV circumferential (GCS) strain and strain rates (SR) as well as left and right atrial reservoir/conduit/booster pump (LA/RA Es, Ee, Ea) strain and SR., Results: RV GLS was significantly reduced following PS compared to PR induction (PS -7.51 vs. PR -23.84, p < 0.001). RV GLS improved after induction of PR (before - 20.50 vs. after - 23.84, p = 0.018) as opposed to PS (before - 11.73 vs. after - 7.51, p = 0.128). Similarly, RA Es (PS 14.22 vs. PR 27.34, p = 0.017) and Ee (PS 8.65 vs. PR 20.51, p = 0.004) were decreased in PS compared to PR with detrimental impact of PS (Es before 23.20 vs. after 14.22, p = 0.018, Ee before 15.04 vs. after 8.65, p = 0.028) but not PR (Es before 31.65 vs. after 27.34, p = 0.176, Ee before 20.63 vs. after 20.51, p = 0.499)., Conclusions: In a porcine model of RV pressure vs. volume overload, increased after- but not preload shows detrimental impact on RV and RA physiology., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Disclosures: None. Grants: The study was funded by grants from the University of Nebraska Foundation and Children’s Hospital and Medical Center Foundation and partially supported by the German Research Foundation (DFG, Grant GO1067/6-1-KU1329/10 − 1, Berlin, Germany., (© 2024. The Author(s).)

Background: Impella RP and RP Flex can provide right ventricular (RV) support in numerous clinical situations. Notably, the redesigned RP Flex allows for an internal jugular approach compared to the femoral venous approach with RP., Aims: We investigated the type and frequency of device-related complications as reported in the US Food and Drug Administration (FDA) Manufacturer and User Facility Experience (MAUDE) for both Impella RP and RP Flex to see if there are any differences., Methods: The MAUDE database was accessed from January 1, 2019 to April 30, 2024, yielding 206 reports pertaining to Impella RP and 64 to RP Flex. Reports were reviewed for device indications, mode of device failure, and device-related complications., Results: The most common indication for Impella RP placement was acute myocardial infarction with RV failure. The most commonly reported failure mode was pump failure. Death was reported in 8.5% and vascular complications in 3.7% of the reports. The most reported device-related complication was hemolysis (18.5%), followed by bleeding requiring transfusion (14.1%), with new dialysis occurring in 3.3% of patients., Conclusions: Our analysis of the MAUDE database showed that device delivery issues, bleeding, and vascular complications accounted for a smaller proportion of reports with Impella RP Flex than with its predecessor. However, device-related thrombosis and pump malfunction accounted for a higher proportion of reports with RP Flex. These data do not reflect the overall incidence of complications, but instead highlight the need for physicians and other healthcare providers to return devices to the manufacturer for inspection when a failure occurs., (© 2024 Wiley Periodicals LLC.)

T1 relaxation time quantification on parametric maps is routinely used in cardiac imaging and may serve as a non-invasive biomarker for diffuse liver disease. In this study, we aimed to investigate the relationship between liver T1 values and cardiac function in patients with congenital heart disease (CHD) and compared patients with a biventricular circulation (BVC) to those with a Fontan circulation (FC). Magnetic resonance images from patients with CHD, obtained between June and December 2023 on a 1.5 T machine, were retrospectively reviewed. The examinations included cardiac cine sequences to assess ventricular mass and volumes, along with liver T1 mapping. T1 values were measured in eight liver segments and were compared with ventricular mass and volumes in patients with BVC and FC. In total, 104 patients (75 with BVC and 29 with FC) were included. T1 values varied significantly among the eight liver segments in both patient groups. In an age-matched comparison, patients with FC had significantly higher T1 values in all liver segments. In patients with BVC and right ventricular (RV) enlargement, a positive correlation between RV volume and T1 values in the right liver lobe was found (R > 0.504, p < 0.033). In patients with FC, the T1 values did not differ between patients with an extracardiac conduit or a lateral tunnel. Liver T1 mapping suggests more severe liver affection in patients with FC compared to those with BVC. It seems a valuable addition to cardiovascular magnetic resonance for patients who are at risk of systemic venous congestion., Competing Interests: Declarations. Ethical approval: The study was approved by the ethics committee of University Hospital Schleswig-Holstein (D 588/24). Consent to participate: Informed consent was obtained from all participants included in this study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Post-operative transesophageal echocardiography (TEE) is standard of care to evaluate for residual disease and quality of surgical repair. The residual lesion score (RLS) as defined by the pediatric heart network explored the impact of residual lesions on outcomes using discharge transthoracic echocardiogram (TTE). In tetralogy of fallot with pulmonary stenosis (TOF/PS), the residual right ventricular outflow tract (RVOT) gradient is one marker of quality of repair. Given peri-operative differences in hemodynamics, this study aims to define the correlation between TEE and discharge TTE RVOT gradient. This single center retrospective study included patients with TOF/PS undergoing primary repair with accompanying perioperative TEE and discharge TTE. TEE and TTE measurements were compared. An RLS based on the type of repair was assigned to the post-operative TEE based on the RVOT doppler velocity. TEE RVOT peak velocity and VTI correlated with TTE RVOT peak velocity (Spearman rank correlation coefficient = 0.62 (p < 0.001)) and VTI (Spearman rank correlation coefficient = 0.66 (p < 0.001)) at time of discharge. Application of RLS at the time of the TEE does not accurately reflect RLS at the time of discharge based on current criteria (p-value based on McNemar's Chi-squared test = 0.24). The ability of post-op TEE measurement to predict need for re-intervention is just as effective as TTE. On ROC analysis, the TEE RVOT peak velocity had similar AUC (0.672) compared to discharge TTE RVOT peak velocity (0.721) on predicting need for re-intervention. After surgical repair of TOF/PS, there is a strong correlation between post-op TEE and discharge RVOT peak velocity. TEE offers a chance to guide immediate re-intervention if needed and may be applied to severe residual post-op RVOT peak velocity. Further studies are needed to identify RLS based on TEE and its relationship to outcomes and intraoperative management., Competing Interests: Declarations. Competing interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The role of right ventricular (RV) dysfunction in pulmonary hypertension (PH) has garnered increasing interest in terms of outcomes. This systematic review and meta-analysis evaluated the prognostic utility of three-dimensional echocardiography (3DE) derived right ventricular ejection fraction (RVEF) in PH. A systematic review and meta-analysis were performed using MEDLINE, Embase, and Scopus databases for publications reporting the hazard ratio (HR) of 3DE-derived RVEF in PH patients for the clinical end-points of composite outcome or all-cause mortality. Nine articles totaling 885 subjects were included, among which 67.23% had pulmonary arterial hypertension (PAH), with the remainder having a range of PH etiologies. The mean value of 3DE-derived RVEF was 35.5 ± 9.07% reflecting impaired RV function. The primary endpoint was all-cause mortality in three studies, while the rest of the studies reported composite outcomes. Follow-up duration ranges from 6 to 44 months. From seven publications, the pooled HR by 3DE-derived RVEF was 0.91 (95% CI: 0.85 to 0.97, p = 0.001; heterogeneity: I 2  = 62%, p = 0.004). In subgroup analysis, 3DE-derived RVEF was a significant prognostic factor for group 1 PH (HR: 0.90, CI: 0.86-0.94; heterogeneity I 2  = 43%, p < 0.0001). From meta-regression analysis, only follow-up duration was found statistically significant with the HR of RVEF in the population (estimate: 0.028, p = 0.026). 3DE-derived RVEF provides important prognostic value in a large population of PH patients, especially for group 1 PH. Further accumulation of evidence is needed to perform a detailed subgroup analysis in each type of PH., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Nature B.V.)

Disorders of the pulmonic valve (PV) receive considerably less attention than other forms of valvular heart disease. Due to the dramatically improved survival of children with congenital heart disease over the last 5 decades, there has been a steady increase in the prevalence of adults with congenital heart disease, which necessitates that clinicians become familiar with the anatomy and the evaluation of right ventricular outflow tract and PV anomalies. A multimodality imaging approach using echocardiography, cardiac computed tomography, and magnetic resonance imaging is essential for a comprehensive evaluation of the anatomy and function of the right ventricular outflow tract, PV, and supravalvular region. As clinical presentation is often insidious with nonspecific symptoms, yet morbidity and mortality associated with severe untreated PV disease are significant, a high index of suspicion coupled with appropriate use of imaging techniques is critical in facilitating timely diagnosis and treatment. In this review, we aim to present a comprehensive approach to the diagnosis of PV disease and associated right ventricular outflow tract or supravalvular pulmonary stenosis, including optimal use of multimodality imaging to facilitate timely diagnosis, optimize therapeutic strategies, enhance postprocedural surveillance, and ultimately improve patient outcomes., Competing Interests: None.

Background: Arterial stiffness is a well-established predictor of cardiovascular events and mortality. However, its relationship with right ventricular (RV) function in patients with coronary artery disease (CAD) remains unclear. We aimed to investigate the association between aortic augmentation index (AIx), a marker of arterial stiffness, and RV dysfunction in CAD patients., Methods: In this cross-sectional study, 121 patients with stable CAD or acute coronary syndrome who underwent coronary angiography were enrolled. AIx was measured using radial artery applanation tonometry. Comprehensive echocardiography was performed to assess RV function using conventional and speckle-tracking derived parameters. Multivariable linear and logistic regression analyses were used to evaluate the relationship between AIx and RV function, adjusting for potential confounders., Results: Patients with high AIx (> 80%, n = 53) had significantly worse RV systolic function compared to those with normal AIx (≤ 80%, n = 68), as evidenced by lower tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV free wall longitudinal strain (RVLS), and RV systolic velocity (RV S') (all P < 0.05). AIx correlated negatively with TAPSE (r=-0.421), FAC (r=-0.376), RVLS (r=-0.428), and RV S' (r=-0.355) (all P < 0.001), and positively with pulmonary artery systolic pressure (r = 0.467, P < 0.001) and pulmonary vascular resistance (r = 0.297, P = 0.001). In multivariable analyses, AIx remained an independent predictor of RV dysfunction (adjusted odds ratio 3.42, 95% confidence interval 1.56-7.51, P = 0.002) after adjusting for age, sex, hypertension, diabetes, dyslipidemia, smoking, left ventricular ejection fraction, and Gensini score., Conclusions: Increased aortic stiffness assessed by AIx is independently associated with RV dysfunction in patients with CAD. This association is evident across multiple echocardiographic parameters of RV systolic function and is independent of traditional cardiovascular risk factors, left ventricular systolic function, and the extent of coronary artery disease. Our findings suggest that arterial stiffness may play a role in the development of RV dysfunction in CAD patients and highlight the potential importance of assessing and targeting arterial stiffness in this population., Competing Interests: Declarations. Ethical approval: This study was approved by the institutional ethics committee of Tehran Heart Center, Tehran University of Medical Sciences (Ethical code: IR.TUMS.IKHC.REC.1402.032). All participants provided written informed consent. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests. Generative AI in scientific writing: While preparing this work, the authors used “Claude 3” AI to check the grammar issues and make the text more narrative. After using this tool, the authors reviewed and edited the content as needed and took full responsibility for the publication’s content., (© 2024. The Author(s).)

Background: We present a case series of right ventricle (RV) rehabilitation after the Starnes procedure in patients with Ebstein anomaly (EA), applying the Cone repair of the tricuspid valve (TV) to achieve 2-ventricle or 1.5-ventricle physiology., Methods: This is a retrospective database analysis from 2 institutions in North America. We included all consecutive cases of Cone repair after the Starnes procedure. The data are expressed as median and interquartile range (IQR)., Results: Eleven patients underwent RV rehabilitation between 2019 and 2023 after initial Starnes palliation at a median age of 27 months (IQR, 20.5 months). All patients were critically ill before their Starnes procedure, and 4 were on extracorporeal membrane oxygenation. Before the Cone repair, the median preoperative regurgitant velocity at the Starnes patch was 1.65 m/s (IQR, 1.3 m/s). During the Cone procedure, 9 patients required a concomitant pulmonary valve repair, of whom 3 needed a transannular monocusp patch. Four patients were successfully rerouted to a 2-ventricle repair, and 7 patients with a previous Glenn achieved 1.5-ventricle circulation. There were no cases of heart block and no deaths. Seven patients had trivial, 3 patients had mild, and 1 patient had moderate tricuspid regurgitation (TR) at a median follow-up of 11 months (IQR, 21.5 months). There was no significant TV stenosis; all patients had good functional status at the last follow-up despite severe RV dysfunction in 1 patient., Conclusions: After the Starnes procedure, the Cone repair allowed RV rehabilitation, resulting in trivial or mild TR at a midterm follow-up. The Starnes procedure is a reproducible technique that no longer commits patients to lifetime single-ventricle physiology., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Right ventricular (RV) strain offers crucial diagnostic insights in cardiovascular and pulmonary disorders. Nonetheless, the absence of established reference values impedes its clinical implementation. Utilizing CMR-feature tracking, age- and gender-dependent RV strains were systematically assessed in 175 heart-healthy Caucasians, 97 females, median 32.5 years. RV global longitudinal strain (GLS) was greater in females than males (median -26.8% (-28.3;-24.1) vs. -24.4 ± 3.0%; p < 0.001), whereby radial and circumferential strain remained comparable. Age subgroups exhibited increased RV-GLS for group B (30-50 years) (-26.0 ± 3.1% vs. -24.4 ± 3.2%; p = 0.011) and group C (> 50 years) (-26.7 ± 2.3% vs. -24.4 ± 3.2%; p < 0.001) compared to group A (< 30 years). High intra-class correlation coefficients (ICC) were exhibited by intrarater variability (ICC = 0.86-0.95) and moderate levels for interrater variability (ICC = 0.50-0.73). CMR-feature tracking provides a fair quantification method of age- and gender-specific normal RV strain values, demonstrating that higher RV-GLS is linked to female gender and advancing age within a healthy Caucasian cohort., Competing Interests: Declarations. Ethics Approval: Ethical approval was obtained from the local ethics committee (Ethikkommission der Medizinischen Fakultät der Ruhr-Universität Bochum, Sitz Ostwestfalen, registration number: 2017–238, with an amendment registration number 2022–924), adhering to the principles outlined in the Declaration of Helsinki's seventh revision of 2013. Informed consent was obtained from all study participants for being included in the study. Conflict of Interest: OMW is an employee of Philips GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024. The Author(s).)

Background: Left bundle branch area pacing (LBBAP) is a new technique for patients with atrioventricular block (AVB) and preserved left ventricular ejection fraction (LVEF), potentially offering better cardiac function than right ventricular pacing (RVP)., Methods: We searched databases and registries for studies that compared LBBAP with RVP in patients with AVB and preserved LVEF. We extracted data on various outcomes and pooled the effect estimates using random-effects models., Results: Our meta-analysis included 14 studies (10 observational and 4 RCTs) involving 3062 patients with AVB. The analysis revealed that the QRS duration was significantly shorter in the LBBAP group compared to the RVP group [MD = -35.56 ms; 95% CI: (-39.27, -31.85), p < 0.00001]. Patients in the LBBAP group also exhibited a significant increase in left ventricular ejection fraction (LVEF) [MD = 5.48%; 95% CI: (4.07%, 6.89%), p < 0.00001], and a significant reduction in left ventricular end-diastolic diameter (LVEDD) compared to RVP [MD = -3.98 mm; 95% CI: (-5.88, -2.09 mm), p < 0.0001]. In terms of clinical outcomes, LBBAP was associated with a significantly lower risk of heart failure hospitalizations (HFHs) compared to RVP [OR = 0.26; 95% CI: (0.16, 0.44), p < 0.0001]. However, no significant differences were observed between the two groups in the implant success rate, pacing impedance, or pacing threshold. The RVP group demonstrated a significantly higher R-wave amplitude increase than the LBBAP group [MD = 0.85 mV; 95% CI: (0.23, 1.46), p = .007]. Lastly, there was no significant difference in the incidence of complications between the two groups [OR = 2.12; 95% CI: (0.29, 15.52), p = 0.46]., Conclusion: LBBAP outperforms RVP in several cardiac function indicators, suggesting it may be a superior pacing method for AVB patients with preserved LVEF. However, the small sample size in studies and the result in heterogeneity call for more research to validate these findings and assess LBBAP's long-term effects., (© 2025 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Background: Right ventricular-to-pulmonary artery (RV-PA) coupling is an important predictor of long-term survival following transcatheter edge-to-edge repair. However, its impact on survival in patients undergoing indirect mitral annuloplasty is unknown. The study aimed to assess the impact of baseline RV-PA coupling on survival following indirect mitral annuloplasty in heart failure patients., Methods: Patients were classified according to baseline RV-PA coupling: TAPSE (tricuspid annular plane systolic excursion)/PASP (pulmonary artery systolic pressure) > 0.55 (group 1), ≤ 0.55 ≥ 0.32 (group 2) and ≤ 0.32 (group 3). Clinical follow-up and RV function were assessed 3 and 12 months following indirect annuloplasty., Results: A TAPSE/PASP > 0.55 was found in 19 patients, while 47 patients showed a TAPSE/PASP ≤ 0.55 > 0.32 and 26 a TAPSE/PASP ≤ 0.32. A significant reduction in vena contracta and regurgitant volume compared to baseline was found in all groups at 3-months and 12-months follow-up. One-year mortality was significantly increased in group 3 compared to the other groups (group 1: 0.95, group 2: 0.91, group 3: 0.77; Log-Rank test p = 0.018). In groups 2 and 3 the TAPSE/PASP significantly improved during the 12-months follow-up, while it remained unchanged in group 1 (group 1: baseline = 0.71 ± 0.03, 12-months = 0.67 ± 0.01; group 2: baseline = 0.43 ± 0.06, 12-months: 0.56 ± 0.04; group 3: baseline = 0.25 ± 0.06, 12-months: 0.4 ± 0.03; p < 0.001)., Conclusions: RV-PA uncoupling before indirect mitral annuloplasty is associated with poor survival. However, Carillon device implantation improved right heart function and RV-PA coupling in patients with severe RV dysfunction at baseline. Therefore, Carillon device implantation can be a valuable option for transcatheter treatment of patients with FMR and right heart failure., (© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Background: Right ventricular (RV) hemodynamic performance determines the prognosis of patients with RV pressure overload. Using ultrafast ultrasound, natural wave velocity (NWV) induced by cardiac valve closure was proposed as a new surrogate to quantify myocardial stiffness., Objectives: This study aimed to assess RV NWV in rodent models and children with RV pressure overload vs control subjects and to correlate NWV with RV hemodynamic parameters., Methods: Six-week-old rats were randomized to pulmonary artery banding (n = 6), Sugen hypoxia-induced pulmonary arterial hypertension (n = 7), or sham (n = 6) groups. They underwent natural wave imaging, echocardiography, and hemodynamic assessment at baseline and 6 weeks postoperatively. The authors analyzed NWV after tricuspid and after pulmonary valve closure (TVC and PVC, respectively). Conductance catheters were used to generate pressure-volume loops. In parallel, the authors prospectively recruited 14 children (7 RV pressure overload; 7 age-matched control subjects) and compared RV NWV with echocardiographic and invasive hemodynamic parameters., Results: NWV significantly increased in RV pressure overload rat models (4.99 ± 0.27 m/s after TVC and 5.03 ± 0.32 m/s after PVC in pulmonary artery banding at 6 weeks; 4.89 ± 0.26 m/s after TVC and 4.84 ± 0.30 m/s after PVC in Sugen hypoxia at 6 weeks) compared with control subjects (2.83 ± 0.15 m/s after TVC and 2.72 ± 0.34 m/s after PVC). NWV after TVC correlated with both systolic and diastolic parameters including RV dP/dt max (r = 0.75; P < 0.005) and RV Ees (r = 0.81; P < 0.005). NWV after PVC correlated with both diastolic and systolic parameters and notably with RV end-diastolic pressure (r = 0.65; P < 0.01). In children, NWV after both right valves closure in RV pressure overload were higher than in healthy volunteers (P < 0.01). NWV after PVC correlated with RV E/E' (r = 0.81; P = 0.008) and with RV chamber stiffness (r = 0.97; P = 0.03)., Conclusions: Both RV early-systolic and early-diastolic myocardial stiffness show significant increase in response to pressure overload. Based on physiology and our observations, early-systolic myocardial stiffness may reflect contractility, whereas early-diastolic myocardial stiffness might be indicative of diastolic function., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Aims: This study explores the clinical application of lung ultrasound scoring(LUS) combined with echocardiography in assessing right heart function in patients undergoing maintenance hemodialysis(MHD) and those with elevated pulmonary artery systolic pressure(PASP), as well as the correlation between LUS and right ventricular(RV) function., Methods: Eighty five patients who underwent MHD combined with elevated PASP, at the First Central Hospital of Baoding City were selected. Divided into three groups based on PASP, and perform echocardiography and lung ultrasound examinations. Compare the right heart function parameters and LUS among the three groups. Using Pearson correlation analysis to examine the relationship between LUS and right heart function parameters. Perform multivariate logistic regression analysis to identify predictive factors for RV systolic dysfunction. A receiver operating characteristic (ROC) curve and calculate the area under the curve(AUC) to compare the diagnostic efficacy of various parameters., Results: Patients undergoing MHD exhibited varying degrees of reduced left ventricular (LV) and RV systolic function. Correlation analysis revealed that Tricuspid annular plane systolic excursion (TAPSE), Fractional area change (FAC), and Tricuspid annular peak systolic velocity(S') were negatively correlated with LUS(r = -0.81, -0.86, -0.69), while Right ventricular free wall longitudinal strain(RVFWLS) was positively correlated with LUS (r = 0.85, P < 0.05). The ROC curve indicated that the combination of LUS and RVFWLS had the highest area under the curve (AUC = 0.963), followed by the combination of LUS and TAPSE (AUC = 0.847), LUS and FAC(AUC = 0.937), and LUS combined with S'(AUC = 0.940). All combinations demonstrated higher AUC values than the individual indicators., Conclusions: Patients with MHD combined with elevated PASP, the RV function parameters are associated with LUS, which may serve as a valuable reference indicator for assessing RV function. The use of LUS to evaluate right heart function in these patients, alongside traditional two-dimensional parameters, holds significant clinical value., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent was obtained from all subjects and all methods were carried out in accordance with relevant guidelines and regulation. All subjects provided written informed consent prior to participation in the study. This study protocol was approved by the Ethics Committee of the Baoding No.1 Central Hospital ([2023]123). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Long-term endurance training is associated with structural, functional, and biochemical markers of cardiac dysfunction in highly trained athletes. Many studies have focused on structural changes in the right ventricle (RV) and few have examined functional adaptation of the right ventricle. This meta-analysis aims to compare the changes in right ventricular systolic function between endurance athletes and controls before and after exercise using speckle tracking echocardiography (STE)., Methods: A comprehensive search of relevant studies published before March 19, 2024 that examined RV systolic function using speckle tracking technology was conducted. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used as pooled statistics. Meta regression was employed to identify sources of heterogeneity and publication bias was evaluated by Egger's test and funnel plots. Sensitivity analysis was performed by removing sources of significant change from the results of a single publication to evaluate the stability of the results., Results: Twenty studies were included with 1186 participants. A fixed effect meta-analysis revealed RV global longitudinal strain (GLS) WMD = 0.40, 95% CI (-0.08 ~ 0.89), p = 0.102 and free wall longitudinal strain (FWLS) WMD = 0.62, 95% CI (0.28 ~ 0.96), p < 0.001, random effect models of RV basal strain WMD = 2.94, 95% CI (2.00 ~ 3.88), p < 0.001 and RV apical strain WMD = -0.79, 95% CI (-1.95, 0.37), p = 0.245 between endurance athletes and controls. In addition, a random-effects meta-analysis revealed significant impairments in RV function when assessed by comparing RV GLS pre-endurance versus post endurance exercise WMD = 2.51, 95% CI (1.634 ~ 3.40), p < 0. 001., Conclusion: The evidence obtained thus far suggests that reporting only global right ventricular strain data may obscure segment-specific adaptation changes, and the use of global and segmental strain analysis may help to identify potential functional changes in the right ventricle while differentiating between normal endurance athletes and non-active controls., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Semilunar valve regurgitation in single ventricular physiology is rare but portends a poor prognosis. Medical therapy is often ineffective particularly in the context of structural valve abnormality, and surgical valve repair or replacement can be associated with poor outcomes. We report an innovative use of a highly occlusive and conformable Gore Septal Occluder for transcatheter treatment of severe native aortic regurgitation in a symptomatic patient with hypoplastic left heart syndrome and severe systemic right ventricular dysfunction, resulting in safe and complete occlusion of the aortic regurgitant orifice and clinical benefit., (© 2024 Wiley Periodicals LLC.)

Background: We aimed to compare computed tomography (CT)-derived myocardial strain between patients with constrictive pericarditis (CP) and a matched healthy control group and to identify factors associated with clinical outcomes after pericardiectomy., Methods: This retrospective study included 65 patients with CP (mean age: 58.9 ​± ​8.0 years) and 65 healthy individuals (mean age: 58.0 ​± ​6.5 years) who underwent multiphase cardiac CT. The type of CP was classified as calcified CP or fibrotic CP. CT-derived strains from four cardiac chambers were compared between the CP and control groups, as well as between different types of CP. Clinical and CT-derived factors associated with adverse outcomes were identified using Cox regression analysis., Results: Compared with the control group, the CP group showed significantly lower values of left atrium (LA) reservoir strain (15.7 ​% vs. 27.4 ​%), right atrium (RA) reservoir strain (15.1 ​% vs. 27.0 ​%), left ventricle (LV) global longitudinal strain (GLS) (-17.0 ​% vs. -19.5 ​%), and right ventricle free wall longitudinal strain (-21.1 ​% vs. -25.9 ​%) (all p ​< ​0.001). Biatrial reservoir strains and LV GLS were significantly lower in those with calcified CP compared to those with fibrotic CP. LA reservoir strain (hazard ratio, 0.91-95 ​% confidence interval, 0.86-0.96- p ​= ​0.001) was an independent prognostic factor for adverse events in patients with CP., Conclusion: Cardiac strain differences in CP were predominantly observed in the LA and RA compared to the healthy control group. Biatrial reservoir strains were specifically impaired in those with calcified CP than in those with fibrotic CP. LA reservoir strain was associated with prognosis in patients with CP following pericardiectomy., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Background: Coronavirus disease 2019 (COVID-19) was declared a global pandemic in 2019. It remains uncertain to what extent COVID-19 effects the heart in heathy individuals. To evaluate the effect of the COVID-19 on cardiac structure and function in middle-aged and older individuals., Methods: A single-centre prospective observational study enroled a total of 124 participants (84 with history of COVID-19 [COVID-19 group] and 40 without a history of COVID-19 [non-COVID group]). All participants underwent echocardiography with speckle tracking to assess cardiac structure and function at rest and during peak exercise., Results: There were no differences in left and right ventricular diastolic function (p ≥ 0.05) between the COVID-19 and non-COVID-19 groups. Participants in COVID-19 group demonstrated higher left ventricular mass (130 ± 39.8 vs. 113 ± 27.2 g, p = 0.008) and relative wall thickness (0.38 ± 0.07 vs. 0.36 ± 0.13, p = 0.049). Left ventricular global longitudinal strain was reduced in the COVID-19 group at rest and at peak-exercise (rest: 18.3 ± 2.01 vs. 19.3 ± 1.53%, p = 0.004; peak exercise: 19.1 ± 2.20 vs. 21.0 ± 1.58%, p ≤ 0.001). However, no difference was seen in resting left ventricular ejection fraction (58 ± 2.89 vs. 59 ± 2.51%, p = 0.565) between groups. Right ventricular fractional area change was reduced in the COVID-19 group (p = 0.012)., Conclusion: Cardiac structural and functional remodelling was observed in middle-aged and older otherwise healthy individuals with a history of COVID-19., (© 2024 The Author(s). Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Background: Although in many patients with dilated cardiomyopathy (DCM), right ventricular systolic dysfunction (RVSD) accompanies left ventricular SD, knowledge about the RVSD prevalence, course, and prognostic significance in DCM remains limited., Aims: We aimed to analyze the prevalence and prognostic significance of longitudinal changes in RV ejection fraction (RVEF) in DCM., Methods: One hundred and two stable DCM patients were included. Heart failure therapy was up-titrated every 3 months, and CMR was performed at baseline and then after 13 (12.2-13.5) months (CMR-1 and CMR-2). RVSD was defined as RVEF <51% in women and <52% in men in CMR-1, while RVEF and LVEF improved if the increase between CMR-1 and CMR-2 was ≥10%. A composite endpoint, including all-cause mortality, heart transplant, left ventricular assistant device, and urgent cardiac hospitalization, was analyzed after 32.6 (26.3-39.4) months., Results: At baseline, RVSD was observed in 76 (75%) patients. Of 66 DCM patients with RVSD who completed CMR-2, 60% experienced an RVEF improvement. All patients without RVSD at baseline maintained normal RV systolic function at 13 months. Baseline RVSD did not affect the composite endpoint (hazard ratio, 1.241; 95% CI, 0.458-3.366; P = 0.67); however, RVEF improvement was independently associated with this outcome (hazard ratio, 0.260; 95% CI, 0.080-0.846; P = 0.03)., Conclusions: Three-quarters of DCM patients exhibited RVSD at baseline, and 60% of them experienced an RVEF improvement following proper heart failure therapy up-titration. While no relationship between outcome and RVSD was observed, RVEF improvement was associated with a 75% reduction in the composite outcome.

Introduction: It remains unclear if pacing induced cardiomyopathy (PICM) may be minimized by standard pacing of the right ventricle (RV) at sites other than the RV apex. The purpose of this study is to compare the relative frequency of PICM in a population of patients paced at either the superficial RV mid septum (RVMS) or RV apex (RVA), and other outcomes that may differ between these sites., Methods and Results: A retrospective evaluation was performed on all patients undergoing pacemaker implantation between 2011 and 2022. Potential study patients were those with Medtronic 3830 superficial RVMS leads placed with septal specific guidance catheters, and any with RVA leads. Patients were included if they had ≥20% RV pacing, available baseline and follow-up measurements of left ventricular ejection fraction (LVEF) at least 6 months postimplantation, and a baseline LVEF ≥50%. PICM was defined as a decline in the LVEF of at least 10%, resulting in LVEF <50%. Patients were excluded for Biventricular devices, and for alternative causes of cardiomyopathy. The study criteria were met in 324 patients, with 220 RVMS and 104 RVA paced patients. PICM occurred in 4.5% of RVMS patients, and 22.1% of RVA patients (p < .001). Additional differences were demonstrated in paced QRS duration (144 ± 15.5 ms in RVMS, 166 ± 19.4 ms in RVA; p < .001); QRS axis (2.3 ± 64.9 in RVMS, -65.2 ± 49.5 in RVA; p < .001), and various qualitative QRS morphologic characteristics., Conclusion: Patients with normal LVEF experienced significantly less PICM with superficial RVMS pacing performed via septal specific guidance catheters than similar counterparts with RVA pacing. Narrower paced QRS duration and less left axis deviation was also demonstrated., (© 2024 Wiley Periodicals LLC.)

Purpose: We sought to investigate the clinical results of preemptive temporary right ventricular assist device (RVAD) placement with left ventricular assist device (LVAD) implantation for anticipated right ventricular failure., Methods: Patients at risk for right ventricular failure were identified by the heart team. After median sternotomy, Protekduo (LivaNova, London, UK) dual-stage cannula was inserted from the right internal jugular vein under fluoroscopy guidance, and advanced into the pulmonary artery to the bifurcation of the main pulmonary artery. This was then connected to the venous drainage from the right atrium for cardiopulmonary bypass (CPB). After LVAD implantation, we connected the Protekduo cannula to the RVAD with oxygenator, and weaned CPB., Results: A total of 17 patients have received BiVAD implantation with this technique. The median age of patients was 55 years [Interquartile range (IQR): 51-63.5] and 94% (16/17) patients were male. 63.6% (7/11) of the patients were INTERMACS profile 1 or 2. Preoperatively, the median pulmonary artery pulsatility index was 4.0 [1.5-4.9] and median right ventricular stroke work index was 454.1 g/m/beat/m 2 [436.5-530.2]. Postoperatively, the oxygenators were removed on median postoperative day (POD) 3.5 [3 - 5]. Patients received mechanical ventilation for a median of 4 days [1.5-12] and RVADs were explanted on median POD 8 [7-19] at bedside with local anesthesia. Median ICU stay was 15 days [11.4-24]. Perioperative complications included delayed sternal closure [54.5% (6/11)], re-exploration for bleeding [18% (2/11)], acute kidney injury [36% (4/11)], and heparin induced thrombocytopenia [18% (2/11)]. 30-day mortality was 0% (0/11) and 1 year survival was 85.9%., Conclusion: Preemptive temporary RVAD implantation strategy for right heart failure post-LVAD showed acceptable clinical outcomes without any 30-day mortality., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background: In patients with significant tricuspid regurgitation, cardiac magnetic resonance imaging (CMR) is the preferred method for the evaluation of right ventricular function and volumes. However validated thresholds are lacking., Aim: The aim of this study was to evaluate CMR assessment of right ventricular volumes in patients with significant (moderate or severe) tricuspid regurgitation, and to define its association with outcomes., Methods: The PRONOVAL study is a retrospective multicentre study using the clinical data warehouse of Greater Paris University Hospitals (AP-HP). Patients were screened for CMR in the PMSI (Programme de médicalisation des systèmes d'information). Hospitalization reports were analysed by natural language processing to include patients with tricuspid regurgitation. Exclusion criteria were left heart valvular disease, heart transplantation and cardiac amyloidosis. Primary outcome was a combined criterion of death or tricuspid surgery., Results: Between September 2017 and September 2021, 151 patients with isolated tricuspid regurgitation were screened. Right ventricular function and volumes were available in 86 (57.0%) CMR reports (the complete CMR group). In the complete CMR group, tricuspid regurgitation was severe in 62 patients (72.1%). Median age was 67.0 years (interquartile range 58.0-75.8). Median right ventricular indexed end-diastolic volume was 98.0 mL/m 2 (interquartile range 66.8-118.5). At 2-year follow-up, six patients (9.2%) had undergone tricuspid valve surgery, and 12 patients (18.5%) had died. Right ventricular indexed end-diastolic volume was associated with death or surgery at 2years, with an area under the receiver operating characteristic curve of 0.76 (95% confidence interval 0.75-0.77) for a threshold of 119mL/m 2 ., Conclusion: Right ventricular indexed end-diastolic volume >119mL/m 2 was found to be an independent indicator of death or surgery in patients with significant tricuspid regurgitation., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Right ventricular (RV) function determines outcomes in RV pressure loading. A better understanding of the time-course and regional distribution of RV remodeling may help optimize targets and timing for therapeutic intervention. We sought to characterize RV remodeling between zero and 6 wk after the initiation of RV pressure loading. Thirty-six rats were randomized to either sham surgery or to pulmonary artery banding (PAB). After echocardiography and conductance catheter studies, groups of rats were euthanized at 1 wk, 3 wk, and 6 wk after sham surgery, or induction of RV pressure loading, for RV histological, RNA, and molecular analysis. A vigorous inflammatory response characterized by increased RV inflammatory cytokines, chemokines, and macrophage markers was observed at 1 wk following PAB. Metabolic changes, transforming growth factor-β (TGF-β)1 canonical signaling, collagenous fibrosis deposition, and apoptosis were already significantly increased by 1 wk after PAB. Genes marking fibroblast activation were upregulated at 1 wk but not at 6 wk post-PAB surgery. Mitochondrial dysfunction was evidenced by increased pyruvate dehydrogenase kinase (PDK) activity and decreased pyruvate dehydrogenase (PDH) phosphorylation significantly at 6-wk post-PAB. These processes preceded the development of overt myocardial hypertrophy and impaired echo parameters of systolic and diastolic function that occurred significantly from 3 wk after PAB. RV myocardial inflammation, metabolic shift, metabolic gene transcription, and profibrotic signaling occur early after initiation of pressure loading when RV pressures are only moderately elevated, before the development of overt myocardial hypertrophy and dysfunction, suggesting that adaptive hypertrophy and maladaptive remodeling occur simultaneously. These results suggest that therapeutic intervention to reduce adverse RV remodeling may be needed earlier and at lower thresholds than currently used. NEW & NOTEWORTHY Exploring the dynamics of right ventricular remodeling: unveiling the intricate interplay between inflammation, metabolic shifts, and fibrotic signaling in response to pressure loading. Through a comprehensive study spanning from initiation to 6 wk post-pressure loading, our research sheds light on the early onset of crucial molecular processes preceding overt hypertrophy and dysfunction. These findings challenge conventional intervention timing, advocating for early, targeted therapeutic strategies to mitigate adverse remodeling in right ventricular pressure loading.

Pulmonary hypertension (PH) is a progressive vascular disease characterized by elevated pulmonary arterial pressure and resistance in the pulmonary vascular bed. It is associated with high morbidity and mortality. Although right heart catheterization (RHC) is the gold standard for diagnosis, noninvasive methods, such as echocardiography, are essential for early detection and management. This study aimed to elucidate the potential of right ventricular outflow tract fractional shortening (RVOT-FS) as a noninvasive diagnostic tool for PH. This single-center observational cohort study was conducted between November 2023 and May 2024. The study included 141 patients referred to the PH clinic (75 with confirmed PH and 66 controls). Echocardiographic measurements were performed using standard protocols, and RVOT-FS was calculated. Hemodynamic parameters were obtained via RHC. RVOT-FS was significantly lower in the PH group (35.71%, IQR: 27.15-43.33) than in the control group (54.50%, IQR: 45.21-69.17) (p < 0.001). RVOT-FS showed negative correlations with mean pulmonary artery pressure (mPAP) (r = - 0.664, p < 0.001), pulmonary vascular resistance (PVR) (r = - 0.526, p < 0.001), and other RHC and RV echocardiographic parameters. ROC analysis demonstrated that RVOT-FS is a reliable parameter for predicting PH, with an area under the curve (AUC) of 0.866. An RVOT-FS value of 44.05% had a sensitivity of 82.7% and specificity of 83.3% for diagnosing PH. This study revealed that RVOT-FS was significantly lower in the PH group than in the control group. The correlations also observed between RVOT-FS and mPAP, PVR, and other RHC and echocardiographic parameters imply its potential clinical utility., Competing Interests: Declarations. Conflicts of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Ventricular catheterization with a pressure-volume (PV) catheter is the gold-standard method for assessing in vivo cardiac function in animal studies, providing valuable "load-independent" indices of systolic and diastolic heart performance. PV studies are commonly performed to elucidate mechanistic insights into cardiovascular disease using surgical and genetically engineered rat and mouse models, but there is considerable heterogeneity in how these studies are performed. Wide variation in protocol design, volume calibration, anesthesia, manipulation of cardiac loading conditions, how load-independent indices of cardiac function are derived, as well as in data analysis and reporting is constraining reliability and reproducibility in the field. The purpose of this manuscript is to combine our collective expertise in performing open- and closed-chest left and right ventricle PV studies in rodents to provide consensus guidelines on how to perform, analyze, and interpret these studies using either conductance or admittance PV catheters. We first review recent methodological reporting in rodent PV studies in this journal and discuss important details required to improve reproducibility within and across PV studies. We then recommend steps to obtain high-quality PV data, from volume calibration to choice of anesthetic agent and acquiring load-independent indices of both systolic and diastolic function. We also consider between- and within-animal variation and recommend how to perform data analysis and visualization. We hope that this consensus paper guides those performing PV studies in rodents and helps align the field with best practices in surgical/analytical methodologies and reporting, facilitating better reliability and reproducibility in the PV field.

Purpose: The underlying mechanism why segmentectomy has demonstrated the non-inferiority to lobectomy in several randomized trials remains unclear. Computed tomography (CT)-measured pulmonary artery (PA) enlargement reflects PA pressure and predicts the prognosis of certain respiratory diseases. We compared the preoperative and postoperative PA diameter to the ascending aorta diameter (PA/A) ratio, investigating its impact on right ventricular function in lung resection., Methods: This retrospective study was conducted in patients with lower-lobe lung tumors who underwent anatomical lung resection between 2017 and 2022. The PA diameter at the bifurcation and the ascending aorta diameter at the same CT image slice were measured preoperatively and postoperatively. We calculated the enlargement of PA/A ratio (PA/A change) and compared lobectomy and segmentectomy., Results: This analysis included 279 patients (235 with lobectomy and 44 with segmentectomy). The PA/A change was significantly greater in patients with lobectomy than segmentectomy (104% vs. 102%, P = 0.02). In the multivariable analysis, airflow obstruction (yes, P = 0.04) and the type of surgery (segmentectomy, P = 0.04) were independent prognostic factors for PA/A change., Conclusions: The PA/A change was greater in lobectomy than in segmentectomy. This change could reflect a burden on right ventricular function after lobectomy.

BACKGROUND: Right ventricular-arterial coupling (RVAC) describes the relationship between right ventricular contractility and pulmonary vascular afterload. Noninvasive surrogates for RVAC using echocardiographic estimates of right ventricular function, such as tricuspid annular plane systolic excursion (TAPSE), have been shown to correlate with invasively measured RVAC and predict clinical outcomes in pediatric pulmonary arterial hypertension. However, given the limitations of TAPSE at accurately estimating right ventricular function in children, we hypothesized that a multivariable estimate of RVAC using right ventricular free-wall longitudinal strain (RVFW-LS) may perform better than those utilizing TAPSE at predicting clinical outcomes. METHODS: In all, 108 children from 2 institutions with pulmonary arterial hypertension underwent hemodynamic catheterization with simultaneous echocardiography. In a retrospective analysis, hybrid (echo and invasive) RVAC metrics included TAPSE/pulmonary vascular resistance (PVRi) and RVFW-LS/PVRi. Noninvasive echocardiographic metrics were TAPSE/echo-derived pulmonary artery systolic pressure (PASP) and RVFW-LS/PASP. RESULTS: RVFW-LS correlated with PVRi (r=0.315, P =0.01), though TAPSE did not (r=0.058, P =0.64). PVRi, PASP, and RVAC metrics declined in patients with worse World Health Organization Functional Class (n=108), while TAPSE and RVFW-LS did not. PVRi, PASP, RVFW-LS/PVRi, TAPSE/PVRi, and RVFW-LS/PASP predicted the outcome variable of transplant or death (area under the curve, 0.771 [ P <0.001], 0.729 [ P =0.004], 0.748 [ P =0.002], 0.732 [ P =0.009], and 0.714 [ P =0.01], respectively), while TAPSE/PASP, RVFW-LS, and TAPSE did not (area under the curve, 0.671, 0.603, and 0.525, respectively). In patients without a history of repaired congenital heart disease (n=88), only RVFW-LS/PASP, PVRi, PASP, and RVFW-LS/PVRi predicted outcomes (area under the curve, 0.738 [ P =0.002], 0.729 [ P =0.01], 0.729 [ P =0.01], and 0.729 [ P =0.015], respectively). CONCLUSIONS: In the pediatric population, baseline PVRi and echo-estimated PASP were strongly associated with adverse clinical outcomes, but TAPSE and RVFW-LS were not. Estimates of RVAC utilizing RVFW-LS were superior to those utilizing TAPSE—however, only marginally additive to PASP and PVRi at predicting the adverse clinical outcome in patients without a history of repaired congenital heart disease. [ABSTRACT FROM AUTHOR]

Background: Exercise capacity is related to mortality and morbidity in heart failure (HF) patients. Determinants of exercise capacity in transthyretin cardiac amyloidosis (ATTR-CA) have not been established., Methods and Results: This single-center study retrospectively evaluated ATTR-CA patients and patients with non-amyloidosis HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) (n=32 and n=51, respectively). In the ATTR-CA group, the median age was 75.5 years (interquartile range [IQR] 71.3-78.8 years), 90.6% were male, and the median left ventricular (LV) ejection fraction was 53.5% (IQR 41.4-65.6%). Cardiopulmonary exercise tests revealed a median peak oxygen consumption and anaerobic threshold of 15.9 (IQR 11.6-17.4) and 10.6 (IQR 8.5-12.0] mL/min/kg, respectively, and ventilatory efficiency (minute ventilation/carbon dioxide production [V̇ E /V̇ CO2 ] slope) of 35.5 (IQR 32.0-42.5). Among exercise variables, V̇ E /V̇ CO2 slope has the greatest prognostic value. Univariate analysis revealed a significant correlation between V̇ E /V̇ CO2 slope and age, LV global longitudinal strain, tricuspid annular plain systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and mixed venous oxygen saturation. In multivariate analyses, the TAPSE/PASP ratio was an independent predictor of V̇ E /V̇ CO2 slope (95% confidence interval -44.5, -10.8; P=0.0067). In non-amyloidosis HFpEF/HFmrEF patients, the TAPSE/PASP ratio was not independently correlated with V̇ E /V̇ CO2 slope., Conclusions: Right ventricular-pulmonary artery coupling estimated by the TAPSE/PASP ratio determines exercise capacity in ATTR-CA patients. This highlights the importance of early therapeutic intervention against underappreciated right ventricular dysfunction associated with ATTR-CA.

Background: Transcatheter tricuspid valve edge-to-edge repair (T-TEER) has been reported to be associated with right ventricular reverse remodeling (RVRR). Data on the temporal evolution of this phenomenon are scarce., Objectives: The aim of this study was to evaluate RVRR over the course of 2-year follow-up after T-TEER using sequential 3-dimensional echocardiograms (3DE)., Methods: The study included T-TEER patients with available 3DE at baseline and discharge. Further follow-ups were scheduled at 1 month, 6 months, as well as 1 and 2 years. The 3DE evaluation included right ventricular volumes (right ventricular end-diastolic volume [RVEDV 3D ]; right ventricular end-systolic volume [RVESV 3D ]), right ventricular ejection fraction (RVEF 3D ), and RV longitudinal strain of the free wall and the septum., Results: The study included 231 patients (median age 82 [IQR: 79-86] years, 48% women). We observed a biphasic pattern of RVRR following T-TEER consisting of early RV volume unloading (phase 1, reduced RVEDV 3D ) and later structural remodeling (phase 2, reduced RVESV 3D ). Whereas RVEDV 3D was significantly reduced early after the procedure (-9.7% from baseline to discharge; P < 0.001), RVESV 3D remained unchanged at 1-month follow-up. Reduction in RVESV 3D was observed at 6-month follow-up for the first time (-5.4% from baseline to 6-month follow-up; P < 0.001). Reduction in both RVEDV 3D and RVESV 3D peaked at 1-year follow-up and remained stable until 2 years after T-TEER. RV function declined early after T-TEER and gradually increased over the course of follow-up (RVEF 3D at baseline 42.2% ± 8.9%, discharge 31.1% ± 9.4%, 2-year follow-up 41.6% ± 8.9%). The 3D RV longitudinal strain of the septum and 3D RV longitudinal strain of the free wall developed analogously., Conclusions: RVRR following T-TEER occurs in 2 stages and involves early RV unloading (reduction in RVEDV 3D ) and later structural RVRR (reduction in RVESV 3D ) with an improvement in RVEF., Competing Interests: Funding Support and Author Disclosures Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Näbauer has received speaker fees from Abbott Vascular and Edwards Lifesciences. Prof Hausleiter has received research support and speaker honoraria from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Right ventricular (RV) stroke volume (SV) can be calculated via Doppler echocardiography at multiple sites in the right chambers. However, the agreement between the calculated SVs at these sites is unknown. We aimed to assess the repeatability, reliability, and precision of the distal right ventricular outflow tract diameter (RVOTD), the mid-pulmonary artery diameter (MPAD), the right ventricular outflow tract velocity time integral (VTI), and the mid-pulmonary artery velocity time integral (MPAVTI). Additionally, we evaluated the agreement between RVOTSV and MPASV., Methods: Four observers each evaluated approximately 100 patients (n = 406). Basic measurements were made over three cardiac cycles, and the repeatability, reliability, and precision of the measurements were calculated. The agreement between the two methods was presented as intraclass correlation coefficients., Results: The repeatability coefficient ranges for RVOTD, MPAD, RVOTVTI, and MPAVTI were 2-3 mm, 2-4 mm, 2.1-2.8 cm, and 2.4-4.1 cm, respectively. The minimal detectable change ranges for these variables were 2-4 mm, 2-5 mm, 2.2-3.0 cm, and 2.6-4.3 cm, respectively. The respective precision ranges for RVOTD, MPAD, RVOTVTI, and MPAVTI were 2.7-4.7%, 2.4-5.4%, 5.0-7.4%, and 5.4-9.2%. There were significant correlations and agreements between MPASV and RVOTSV, with the Pearson correlation coefficient ranging from 0.63 to 0.89 (P < 0.001). The intraclass correlation coefficient ranged from 0.56 to 0.89 (P < 0.001), although there was a significant bias of 1.9-11.3 mL (P < 0.001)., Conclusions: The RVOTD, MPAD, RVOTVTI, and MPAVTI measurements were repeatable, reliable, and precise. The agreement between RVOTSV and MPASV ranged from fair to excellent, although significant bias, along with a wide limit of agreement, was observed. Consequently, these methods cannot be used interchangeably., Competing Interests: Declarations. Ethics approval and consent to participate: The institutional review board approved the research proposal (Research Ethics Committees of Tehran Heart Center, approval identification code: IR.TUMS.THC.REC.1402.042) in compliance with the 1964 Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from all participants in the study population. Research Ethics Committee of Tehran Heart Center: Haleh Aahraf-Talesh, Farzad Masoud-Kabir, Mohammadjafar Habibzadeh, Mohsen Aslanbeigi, Arash Jalai, Hamidreza Namazi, Monirsadat Akhlagi, Said-Hossein Ahmadi-Tafti, Ebrahim Nematipour-Gasemabadi, Kaveh Hosseini-Machakposhti, Mojtaba Salarifar, Somayeh Kalaeinia. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction/objectives: To compare conventional and three-dimensional (3D) echocardiographic indices of right ventricular (RV) systolic function in dogs with various stages of myxomatous mitral valve disease (MMVD), classified according to the 2009 guidelines of the American College of Veterinary Internal Medicine (ACVIM), with those from normal dogs., Animals: Seventy-eight unsedated dogs (22 healthy controls, 23 ACVIM stage B1 MMVD, 20 ACVIM stage B2 MMVD, and 13 ACVIM stage C MMVD) were included in the study., Materials and Methods: All dogs underwent conventional and 3D echocardiography. Three-dimensional RV end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) were recorded. Right ventricular EDV, ESV, and SV were indexed to bodyweight. Echocardiographic variables were compared across groups using a Kruskal-Wallis test with subsequent post hoc analysis using Dunn's method for multiple comparisons between groups. A P-value of <0.05 was considered significant., Results: Right ventricular EDV was smaller in stage B1 (P=0.012), stage B2 (P=0.035), and stage C (P=0.004) dogs than in controls. Stage B2 (P=0.003) and stage C (P<0.001) dogs had smaller RV ESV than controls. Stage B1 dogs had smaller RV SV than controls (P=0.012). Right ventricular EF was greater in stage C dogs than in controls (P=0.003) and in stage B1 (P=0.017) dogs., Conclusions: Several 3D echocardiographic indices of RV systolic function differ between dogs with advanced MMVD when compared with normal dogs. Further investigation is required to determine if these differences have clinical implications., Competing Interests: Conflict of Interest Statement The authors do not have any conflicts of interest to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Right ventricular (RV) donor-recipient sizing has been demonstrated to be a sensitive predictor for mortality after heart transplantation. We sought to understand the relationship between donor-recipient RV mass (RVM) ratio and pulmonary vascular resistance (PVR) on outcomes after heart transplantation., Methods: Adult heart transplant recipients from the United Network for Organ Sharing database were included (N = 42,594). The influence of RVM ratio and PVR on 1-year mortality was assessed by logistic regression after multivariable adjustment., Results: Among transplant recipients, median PVR was 2.4 Wood units (WU) (range, 1.7-3.3 WU) and median RVM ratio was 1.2 (1.0-1.3). Without considering PVR, RVM ratio was highly associated with postoperative dialysis (odds ratio [OR], 0.49; P < .001) and 1-year mortality (OR, 0.64; P < .001). Without considering RVM ratio, PVR was highly associated with 1-year mortality (OR, 1.05; P < .001), but not postoperative dialysis (OR, 0.98; P = .156). When considering both RVM ratio and PVR, the risk associated with each remained significant, but PVR did not modify the effect of RVM ratio on 1-year mortality (RVM ratio × PVR: OR, 0.99; P = .858). To maintain a consistent predicted 1-year mortality, RVM ratio would need to increase by 0.12 for each WU increase in PVR. Secondary analyses found that a 1 WU change in PVR was associated with an 11% increase in mortality risk in RVM ratio mismatched patients (RVM ratio < 1; P = .001), but only a 5% increase in RVM ratio matched patients (RVM ratio ≥ 1; P = .003)., Conclusions: RVM ratio and recipient PVR are independent predictors of 1-year mortality. Still, a larger RV mass may be utilized to mediate the effects of an elevated PVR., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Biventricular pacing (BIV) is the gold standard for cardiac resynchronization therapy (CRT). Thirty percent of patients do not respond to CRT. Conduction system pacing (CSP) represents a viable alternative. Interventricular conduction delay (IVCD), as electrical desynchrony marker, is a CRT response predictor. The aim of this study was to determine the incidence of CRT responders by selecting the best approach between BIV and CPS based on intraoperative IVCD measurement in patients with HFrEF and LBBB., Methods: Ninety-six patients were randomly assigned in a 1:1 ratio to either a standard BIV group(control group, CG) or a group where the CRT approach was determined based on IVCD evaluation(study group, SG). If the right ventricular sensed electrogram (RVs)-left ventricular sensed electrogram (LVs) interval was ≥100 ms, the lead was left in its original position; otherwise, the LV lead was removed, and CSP was performed instead. Clinical, EKG, and echocardiographic features have been assessed pre- and 6 months post-implant. Echocardiographic and clinical responder were evaluated., Results: Thirty-seven percent of patients in the SG underwent CSP, as the operative algorithm. The incidence of CRT responders was significantly higher in the SG (echocardiographic criterion: 92.5% vs. 69.8%, p:.009; clinical criterion 87.5% vs. 62.8%, p:.014). The SG showed a significantly greater difference in EF between pre- and post-implant as well as reduced end-diastolic and systolic volumes. Univariate and multivariate regression analysis indicated that enrollment in the SG was the only factor associated with CRT response., Conclusion: Intraoperative assessment of IVCD could help determine the optimal CRT approach between BIV and CSP, leading to a significant improvement in the rate of CRT responders., (© 2024 Wiley Periodicals LLC.)

Introduction: The Medtronic Micra VR and Abbott AVEIR VR are the leadless pacemakers (LPM) currently available in the United States (US). Micra VR employs fixation tines and the AVEIR VR uses an active fixation helix. Micra VR requires fixation before electrical measurements are obtained, while R-waves may be mapped by AVEIR VR without fixation. Little comparative data is available for these LPMs. Accordingly, we compared the incidences of procedure-related major adverse clinical events (MACE) and device problems in the US for Micra VR and AVEIR VR during 2022-2024., Methods: We searched the FDA's Manufacturer and User Facility Device Experience (MAUDE) database for US reports of MACE and device problems that were filed from April 2022 to December 2023 for AVEIR VR, and from June 2022 to April 2024 for Micra VR. Totals for US-registered LPM implants were obtained from the manufacturers' product performance reports., Results: During the study period, 5990 AVEIR VR and 10 940 Micra VR implants were registered in the US. We found 305 MAUDE reports for AVEIR VR (5.1%), versus 541 MAUDE reports for Micra VR (4.9%) (p = .702). The incidence of MACE was 0.72% (43/5990) for AVEIR VR versus 0.59% (65/10 940) for Micra VR, (p = .387). The incidences of procedure-related death, cardiac perforation. cardiac arrest, emergency pericardial drainage or reparative surgery were similar for both LPMs (p > .05). Micra VR had more unacceptable thresholds requiring LPM replacement compared to AVEIR VR (95;0.9% vs. 24;0.4%; p = .001). AVEIR VR had a statistically higher incidence of device dislodgement during (32) and after (21) implant compared to Micra VR (53 (0.9%) vs. 46 (0.4%), p < .001)., Conclusions: Micra VR and AVEIR VR have similar procedural safety profiles, including the incidences of death and perforation. However, device problems differed significantly, possibly related to their design differences. Compared to Micra VR, AVEIR VR appears to have an advantageous threshold measurement capability but is more prone to device dislodgement., (© 2024 Wiley Periodicals LLC.)

We aimed to evaluate the effect of exercise echocardiography (EE) on Right ventricular (RV) deformation parameters in asymptomatic patients with severe rheumatic mitral stenosis (MS) (mitral valve area ≤ 1.5 cm 2 , stage C) and to determine the relation between symptoms and severity of MS. 38 rheumatic MS patients in stage C underwent EE. 20 Patients were defined; as an exercise intolerance group who couldn't reach a maximum heart rate according to their age during exercise due to developing dyspnea The remaining 18 patients who reached a maximum heart rate without dyspnea were defined; as an exercise tolerance group. RV echocardiographic parameters at baseline and peak exercise were compared between the groups. While RV global strain (RV GLS) (21.02 ± 3.33 vs. 21.92 ± 3.03) and RV free wall longitudinal strain (RV FWLS) (23.41 ± 5.66 vs. 25.08 ± 5.00) at baseline were similar in both groups (P = 0.390 P = 0.343), RV GLS (23.38 ± 4.30 vs. 26.05 ± 3.24) and RV FWLS (24.24 ± 5.78 vs. 28.05 ± 4.62) at peak exercise were reduced in exercise intolerance group (P = 0.040 P = 0.033). The best correlations were found between exercise capacity and RV FWLS at baseline and peak exercise in all MS patients (respectively; r = 0.627 P < 0.001; r = 0.697 P < 0.001). RV mechanics has approved the reliability of EE in patients with asymptomatic patients with severe MS. During exercise RV contractile reserve could diminish in MS patients with stage C who develop dyspnea. Moreover, since our study has a close relationship between exercise capacity and RV mechanics, using RV mechanics during exercise echocardiography may be useful for risk stratification in MS patients with severe MS., Competing Interests: Declarations. Ethical approval: The study was conducted with the Declaration of Helsinki and approved by the Institutional Ethics Committee. All patients signed informed consent. Institutional and financial support: None. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objectives . The aim was to demonstrate a reliable ex vivo method to test the function of the whole heart. Design . Pigs of varying sizes (44-80 kg) were exposed to dose response of adrenaline. Blood pressures and cardiac output were measured. The explanted hearts were tested in a novel ex vivo system to see if we could replicate the in vivo values at maximal adrenaline stimulation. The perfusion solution was STEEN Solution™ with erythrocytes and continuous infusion of essential drugs. In contrast to normal body circulation which is sequential, the heart evaluation system is divided into left and right heart circuits which are operating in parallel, making it possible to test the right and left heart individually or as a whole. The system provides coronary flow measurements. The nonlinear dynamic resistances are constructed to stabilize systolic and diastolic pressures in a broad range and independently from cardiac output. It is important for the functional evaluation to avoid pumping help for the heart; therefore, atrial vortexes are constructed to minimize pump flow directionality and energy from entering atria. Results. Ex vivo evaluation was able to match the maximal in vivo effect of adrenaline on cardiac output and blood pressures. After 2 h of evaluation, the blood gases and lactate were normal and free haemoglobin was zero. Autopsy of the hearts showed no macroscopic pathology. Conclusions. The system is able to give a reliable functional evaluation of the heart ex vivo .

Background: Considering the limited information available on right cardiac remodelling during gestation, we aimed to characterise the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of perinatal CV risk (CVR) factors on these processes., Methods: This prospective cohort was recruited at two tertiary centres during 2019-2022, including 51 healthy pregnant women and 79 with perinatal CVR factors. Participants were evaluated by transthoracic echocardiography during pregnancy (1st[1T] and 3rd[3T] trimesters) and postpartum (one-month[PP1], six-months[PP2], and one-year postpartum[PP3]). Generalised linear mixed-effects models were used for statistical analysis., Results: Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions was observed throughout pregnancy, normalising at PP2 values similar to PT1. This anatomical postpartum recovery was accompanied by an increase of RV global longitudinal strain, being statistically significant in perinatal CVR group. Interestingly, at 3T, this group revealed lower RV and RA strain compared to healthy participants. Despite both groups maintained preserved RV systolic function from 1T to PP3, a significant reduction of TAPSE and tricuspid S' velocity was observed at PP1. Concomitantly, all participants showed a significant increase of E/A at the same time-point, suggesting the recovery of diastolic deterioration seen from 1T to 3T that was persistingly higher in the perinatal CVR group througout the postpartum. Constant pulmonary artery systolic pressure (PASP) was documented throughout follow-up time, showing consistently higher values in the perinatal CVR group. All these echocardiographic index changes were within the normality range., Conclusion: This study described subtle right cardiac changes within the normal/physiological range, recovering six-months after delivery. Coexisting perinatal CVR factors seem to affect the magnitude of RV diastolic function changes, PASP and myocardial deformation without any impact on other RV systolic function indexes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Children with repaired tetralogy of Fallot (rToF) often have pulmonary regurgitation with right ventricular (RV) dilatation and dysfunction, whereas less is known about the effect on the left ventricle (LV). The aim was to investigate LV haemodynamic variables derived from non-invasive pressure-volume loops in children with rToF and how they compare to controls and previous research on adults., Materials and Methods: Ten children with rToF and pulmonary regurgitation (12 years [10-13], 6 males) and 10 age- and sex-matched healthy controls (12 years [10-14], 6 males) underwent brachial blood pressure in conjunction with cardiac magnetic resonance imaging. Pressure-volume loops were derived by brachial blood pressure together with LV volumes throughout the cardiac cycle in short-axis cine images yielding several haemodynamic variables, including arterial elastance. The RV endocardial border was delineated in end-diastole and end-systole., Results: Children with rToF and pulmonary regurgitation had larger RV end-diastolic volume (136 [114-156]) than controls (100 [94-112] ml/m 2 ; p  = 0.0015) and smaller LV end-diastolic volume (83 [58-91] ml/m 2 ) than controls (101 [92-110] ml/m 2 ; p  = 0.002). Arterial elastance was higher in children with rToF (1.5 [1.3-2.7] mmHg/ml) than in controls (1.1 [1.0-1.5] mmHg/ml; p  = 0.02). Heart rate was higher in children with rToF (77 [74-81] bpm) than in controls (69 [65-75] bpm; p  = 0.027)., Conclusion: Children with rToF had higher arterial elastance and heart rate than controls, likely due to increased sympathetic tone to compensate for impaired LV filling following pulmonary regurgitation. If this contributes to increased risk of adverse cardiovascular and cerebrovascular events remains to be studied.