Abstract 19738: Classifying Right Ventricular Dysfunction: an Echocardiographic Algorithm
Introduction: Quantitative echocardiographic (echo) assessment of right ventricular (RV) function remains challenging. Our objective was to evaluate echo parameters of RV systolic performance relative to cardiac magnetic resonance (cMR) ejection fraction (EF); and outline an echo algorithm for identifying RV systolic dysfunction.
Methods: Echo and cMR obtained at pre-implant and 6 month follow up of pts enrolled in the Melody® transcatheter pulmonary valve (Medtronic, Minneapolis, MN) trial, were evaluated. Image analyses was performed by blinded observers. Echo RV parameters [Myocardial Performance Index (MPI), apical Fractional Area Change (FAC), and RV longitudinal strain (LS), global & segmental)] were compared to cMR RV EF. Uni- & multi-variate receiver operator characteristic (ROC) analyses were used to identify parameters and algorithms to identify RV systolic dysfunction (cMR EF < 40%).
Results: 125 paired echo/cMR exams were analyzed. Mean cMR RV EF was 42% ± 13%, 51 had RV EF < 40%. Echo parameters showing significant correlation with cMR EF appear in the Table. Multivariate ROC analysis showed enhanced predictive value if 3 cut-off points of FAC, MPI and global LS were combined (Table & Figure).
Conclusion: Several echo parameters showed significant correlations with cMR RV EF. RV FAC was the best predictor -values < 38% indicating EF <40%. Predictive value was maximized by combining cut-off points for FAC, RV global LS, and MPI into a 3-variable algorithm. When 3 cut-off points were “violated”; PPV for EF <40% was 70%. Such multivariable algorithms may provide more clinical utility than single variable assessments, but require validation in additional cohorts.
Author Disclosures: J.T. Poterucha: None. A.M. Kelle: None. E. Gillis: None. M.Y. Qureshi: None. J.P. Cheatham: Consultant/Advisory Board; Modest; Consultant. Proctor, and P.I. T.K. Jones: Other Research Support; Modest; Medtronic. Consultant/Advisory Board; Modest; Medtronic. E.M. Zahn: Consultant/Advisory Board; Modest; Medtronic. Other; Modest; Proctor for Medtronic. W. Hellenbrand: Consultant/Advisory Board; Modest; Medtronic. Other; Modest; Proctor Medtronic. D.B. McElhinney: Consultant/Advisory Board; Modest; Medtronic. Other; Modest; Proctor Medtronic. P.A. Araoz: None. B.W. Eidem: None. P.W. O’Leary: None.
- © 2014 by American Heart Association, Inc.