Search Results (3)

Introduction: Right-ventricular-to-pulmonary artery (RV-PA) coupling, measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), has emerged as a predictor factor in patients undergoing transcatheter aortic valvular replacement (TAVR). Right ventricular longitudinal shortening fraction (RV-LSF) outperformed TAPSE as a prognostic parameter in several diseases. We aimed to compare the prognostic ability of two RV-PA coupling parameters (TAPSE/PASP and the RV-LSF/PASP ratio) in identifying MACE occurrences. Method: A prospective and single-center study involving 197 patients who underwent TAVR was conducted. MACE (heart failure, myocardial infarction, stroke, and death within six months) constituted the primary outcome. ROC curve analysis determined cutoff values for RV-PA ratios. Multivariable Cox regression analysis explored the association between RV-PA ratios and MACE. Results: Forty-six patients (23%) experienced the primary outcome. No significant difference in ROC curve analysis was found (RV-LSF/PASP with AUC = 0.67, 95%CI = [0.58–0.77] vs. TAPSE/PASP with AUC = 0.62, 95%CI = [0.49–0.69]; p = 0.16). RV-LSF/PASP < 0.30%.mmHg⁻¹ was independently associated with the primary outcome. The 6-month cumulative risk of MACE was 59% (95%CI = [38–74]) for patients with RV-LSF/PASP < 0.30%.mmHg⁻¹ and 17% (95%CI = [12–23]) for those with RV-LSF/PASP ≥ 0.30%.mmHg⁻¹; (p < 0.0001). Conclusions: In a contemporary cohort of patients undergoing TAVR, RV-PA uncoupling defined by an RV-LSF/PASP < 0.30%.mmHg⁻¹ was associated with MACE at 6 months. Full article

Introduction: Right ventricular systolic dysfunction (RVsD) increases acute respiratory distress syndrome mortality in COVID-19 infection (CARDS). The RV longitudinal shortening fraction (RV-LSF) is an angle-independent and automatically calculated speckle-tracking parameter. We explored the association between RV-LSF and 30-day mortality in CARDS patients. Methods: Moderate-to-severe CARDS patients hospitalized at Amiens University Hospital with transesophageal echocardiography performed within 48 h of intensive care unit admission were included. RVsD was defined by an RV-LSF of <20%. The patients were divided into two groups according to the presence of RVsD. Using multivariate Cox regression, clinical and echocardiographic risk factors predicting 30-day mortality were evaluated. Results: Between 28 February 2020 and 1 December 2021, 86 patients were included. A total of 43% (n = 37/86) of the patients showed RVsD and 22% (n = 19/86) of the patients died. RV-LSF was observed in 26 (23.1–29.7)% of the no-RVsD function group and 16.5 (13.7–19.4)% (p < 0.001) of the RVsD group. Cardiogenic shock (n = 7/37 vs. 2/49, p = 0.03) and acute cor pulmonale (n = 18/37 vs. 10/49, p = 0.009) were more frequent in the RVsD group. The 30-day mortality was higher in the RVsD group (15/37 vs. 4/49, p = 0.001). In a multivariable Cox model, RV-LSF was an independent mortality factor (HR 4.45, 95%CI (1.43–13.8), p = 0.01). Conclusion: in a cohort of moderate-to-severe CARDS patients under mechanical ventilation, RVsD defined by the RV-LSF was associated with higher 30-day mortalities. Full article

Since the prediction of the seismic response of structures is highly uncertain, the need for the probabilistic approach is clear, especially for the estimation of critical seismic response parameters. Considering the uncertainties present in the material and geometric form of reinforced concrete (RC) structures, reliability analyses using the Finite Element Method (FEM) were performed in the context of Performance-Based Earthquake Engineering (PBEE). This study presented and compared the possibilities of nonlinear modelling of the reinforced concrete (RC) planar frame and its reliability analysis using different numerical methods, Mean-Value First-Order Second-Moment (MVFOSM), First-Order Reliability Method (FORM), Second-Order Reliability Method (SORM) and Monte Carlo simulation (MCS). The calibrated numerical models used were based on the previous experimental test of a planar RC frame subjected to cyclic horizontal load. Numerical models were upgraded by random variable (RV) parameters for reliability analysis purposes and, using implicit limit state function (LSF), pushover analyses were performed by controlling the horizontal inter-storey drift ratio (IDR). Reliability results were found to be sensitive to the reliability analysis method. The results of reliability analysis reveal that, in a nonlinear region, after exceeding the yield strength of the longitudinal reinforcement, the cross-sectional geometry parameters were of greater importance compared to the parameters of the material characteristics. The results also show that epistemic (knowledge-based) uncertainties significantly affected dispersion and on the median estimate parameter response. The MCS sampling method is recommended, but the First-Order Reliability Method (FORM) applied on a response model can be used with good accuracy. Reliability analysis using the FEM proved to be suitable for the direct implementation of geometric and material nonlinearities to cover epistemic (knowledge-based) uncertainties. Full article