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BACKGROUND: Magnetic resonance imaging is more often used to confirm the presence of pectus excavatum and assess compression changes in the heart at this level. AIM: To evaluate pectus excavatum preoperatively according to magnetic resonance imaging findings. MATERIALS AND METHODS: A retrospective evaluation of chest magnetic resonance imaging data of 38 patients (male, n=30; female, n=8) was performed. The average age was 19.9 years (±9 years).Cardiac magnetic resonance imaging was performed on a 1.5-T General Electric Optima MR450w GEM scanner with 2D-FIESTA-C pulse sequences, as well as functional assessment of the left and right ventricles. Parameters for surgical treatment of pectus excavatum were as follows: the Haller index, correction index, and sternum rotation angle. Statistical analysis of the relationship between the Haller index, correction index, and sternum rotation angle and ejection fraction of the right ventricle was conducted. A p-value 0.05 was considered significant. RESULTS: Moderate and severe pectus excavatum were found in 92% of the cases. No significant Pearson correlation was obtained between the Haller index and right ventricular ejection fraction (inspiratory and expiratory ejection fraction, p=0.777 and 0.798, respectively). The mean right ventricular ejection fraction was 46%. A correlation was noted between the Haller index and the correction index (p 0.05). The rotation angle of the sternum, which required modification of surgical intervention, was detected in 44.7% of patients. CONCLUSION: Magnetic resonance imaging is an informative diagnostic method for pectus excavatum pectus excavatum without radiation exposure and enables detailed preoperative assessment. A correlation was noted between the Haller index and the correction index (p 0.05). Magnetic resonance imaging revealed a decrease in the ejection fraction of the right ventricle.

Background: The right ventricle (RV) plays a pivotal role in cardiovascular diseases and 3-dimensional echocardiography (3DE) has gained acceptance for the evaluation of RV volumes and function. Recently, a new artificial intelligence (AI)–based automated 3DE software for RV evaluation has been proposed and validated against cardiac magnetic resonance. The aims of this study were three-fold: (i) feasibility of the AI-based 3DE RV quantification, (ii) comparison with the semi-automatic 3DE method and (iii) assessment of 2-dimensional echocardiography (2DE) and strain measurements obtained automatically. Methods: A total of 203 subject (122 normal and 81 patients) underwent a 2DE and both the semi-automatic and automatic 3DE methods for Doppler standard, RV volumes and ejection fraction (RVEF) measurements. Results: The automatic 3DE method was highly feasible, faster than 2DE and semi-automatic 3DE and data obtained were comparable with traditional measurements. Both in normal subjects and patients, the RVEF was similar to the two 3DE methods and 2DE and strain measurements obtained by the automated system correlated very well with the standard 2DE and strain ones. Conclusions: results showed that rapid analysis and excellent reproducibility of AI-based 3DE RV analysis supported the routine adoption of this automated method in the daily clinical workflow. [ABSTRACT FROM AUTHOR]

Although cardiac computed tomography angiography (CCTA) assessment of right ventricular dysfunction (RVD) is feasible, the incremental prognostic value remains uncertain in patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This study sought to determine the incremental clinical utility of RVD identification by CCTA while accounting for clinical and echocardiographic parameters. Patients who underwent multiphasic ECG-gated functional CCTA using dual-source system for routine TAVR planning were evaluated. Biphasic contrast protocol injection allowed for biventricular contrast enhancement. CCTA-based RVD was defined as right ventricular ejection fraction (RVEF) ​< ​50%. The association of CCTA-RVD with all-cause mortality and the composite outcome of death or heart failure hospitalization after TAVR was evaluated and examined for its incremental utility beyond clinical risk assessment and echocardiographic parameters. A total of 502 patients were included (median [IQR] age, 82 [77 to 87] years; 56% men) with a median follow-up of 22 [16 to 32] months. Importantly, 126 (25%) patients were identified as having RVD by CCTA that was not identified by echocardiography. CCTA-defined RVD predicted death and the composite outcome in both univariate analyses (HR for mortality, 2.15; 95% CI, 1.44–3.22; p ​< ​0.001; HR for composite outcome, 2.11; 95% CI, 1.48–3.01; p ​< ​0.001) and in multivariate models that included clinical risk factors and echocardiographic findings (HR for mortality, 1.74; 95% CI, 1.11–2.74; p ​= ​0.02; HR for composite outcome, 1.63; 95% CI, 1.09–2.44; p ​= ​0.02). Functional CCTA assessment pre-TAVR correctly identified 25% of patients with RVD that was not evident on 2D echocardiography. The presence of RVD on CCTA independently associates with clinical outcomes post-TAVR. TOC summary: This study evaluated the presence of right ventricular dysfunction (RVD) by functional cardiac computed tomography angiography (CCTA) in 502 patients undergoing routine evaluation for transcatheter aortic valve replacement. CCTA-RVD was defined as right ventricular ejection fraction <50%, and was tested for its prognostic value beyond conventional risk factors and echocardiography. In our study, 25% of patients have RVD on CT that was not present on 2D echocardiography. CT-RVD provides independent prognostic value that is incremental to conventional clinical and echocardiographic characteristics, and therefore should be considered in routine risk stratification of patients with severe AS. [ABSTRACT FROM AUTHOR]

We report an initial investigation of a subtraction-based method to estimate right ventricle ejection fraction (RVEF) from ECG-gated planar equilibrium radionuclide angiography (ERNA) data. Twenty-six consecutive patients referred for scintigraphic evaluation of cardiac function prior to chemotherapy had ECG-gated first-pass (FP) imaging and ERNA imaging performed following the same radiotracer injection. RVEF was computed from FP images (RVEFFP) and separately from ERNA images (RVEFERNA). Standard methods for computing ejection fractions were used to obtain RVEFFP values. RVEFERNA values were obtained using harmonic subtraction of the left ventricular contribution from a biventricular region of interest contoured on the equilibrium images acquired in the shallow right anterior oblique projection. Clinically acquired chest CT data were used to derive information regarding the relative position of the left and right ventricle and about the presence of pulmonary artery enlargement. Computation of RVEFERNA was successful for each of the 26 patients. Computation of RVEFFP failed for four patients. For the 22 patients for which RVEF was computed using both methods, the average RVEFFP was 49% and the average RVEFERNA was 51%, with coefficients of variation of 11 and 7.5%, respectively. Low RVEFERNA values were associated with pulmonary artery dilation. Estimation of RVEFERNA, using a harmonic subtraction-based method of computation is clinically feasible and accurate in the patient population studied. The results support further investigation in patients with frank heart failure. [ABSTRACT FROM AUTHOR]

. The objective was to assess the serial change of the cardiac function after blood transfusion in patients with chronic anaemia. According to a previous study, transfusion would adjust the ejection fraction to the advantage of cardiac function in chronic anaemia patients, and thus the serial change of the cardiac function in a certain period should be evaluated after transfusion in patients with chronic anaemia. In a prospective study, ejection fraction (EF) was determined before and ≤ 6 h, 24 h and 72 h after transfusion in 32 patients with chronic anaemia, and the results were compared and analysed. In the left ventricle (LV), the four EFs noted before and ≤ 6 h, 24 h and 72 h after transfusion did not significantly differ between one another. In the right ventricle (RV), the EF 72 h after transfusion significantly increased in comparison with the pretransfusion value (P = 0·043). Transfusion of small amounts of RBC did not significantly change the LVEF up to 72 h in patients with transfusion-dependent chronic anaemia; whether it might change the RVEF 72 h after transfusion deserves further investigation. [ABSTRACT FROM AUTHOR]

Aims: Iron deficiency (ID) is a frequent finding in patients with chronic and acute heart failure (AHF) along the full spectrum of left ventricular ejection fraction (LVEF). Iron deficiency has been related to ventricular systolic dysfunction, but its role in right ventricular function has not been evaluated. We sought to evaluate whether ID identifies patients with greater right ventricular dysfunction in the setting of AHF., Methods and Results: We prospectively included 903 patients admitted with AHF. Right systolic function was evaluated by tricuspid annular plane systolic excursion (TAPSE) and the ratio TAPSE/pulmonary artery systolic pressure (TAPSE/PASP). Iron deficiency was defined, according to European Society of Cardiology criteria, as serum ferritin <100 mg/dL (absolute ID) or ferritin 100-299 mg/dL and transferrin saturation (TSAT) <20% (functional ID). The relationships among the exposures with right ventricular systolic function were evaluated by multivariate linear regression analyses. The mean age of the sample was 74.3 ± 10.6 years, 441 (48.8%) were female, 471 (52.2%) exhibited heart failure with preserved ejection fraction, and 677 (75.0%) showed ID. The mean LVEF, TAPSE, and TAPSE/PASP were 49 ± 15%, 18.6 ± 3.9 mm, and 0.45 ± 0.18, respectively. The median (interquartile range) amino-terminal pro-brain natriuretic peptide was 4015 (1807-8775) pg/mL. In a multivariable setting, lower TSAT and ferritin were independently associated with lower TAPSE (P < 0.05 for both comparisons). Transferrin saturation (P = 0.017), and not ferritin (P = 0.633), was independently associated with TAPSE/PASP., Conclusion: In AHF, proxies of ID were associated with right ventricular dysfunction. Further studies should confirm these findings and evaluate the pathophysiological facts behind this association., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)