Legend of figures
Figure_1
2D transthoracic echocardiogram on admission, PSAX view at MV level showing interventricular septal flattening on diastole due to RV volume overload
Figure_2
Transthoracic echocardiogram with continuous wave doppler (CWD) interrogation across the tricuspid valve on admission showing RV systolic pressure (RVSP) of 66 mm Hg with severe pulmonary hypertension
Figure_3
2D transthoracic echocardiogram with color doppler on admission, A2C view showing a central jet of severe grade IV MR
Figure_4
2D transthoracic echocardiogram with color doppler on admission, PLAX view demonstrating severe grade IV MR (before starting ARNi)
Figure_5
2D transthoracic echocardiogram with color doppler on admission, modified RV view depicting a central jet of severe grade IV TR
Figure_6
2D transthoracic echocardiogram with color doppler on admission, A4C view demonstrating severe grade IV TR and severe grade IV MR
Figure_7
Transthoracic echocardiogram with pulsed wave doppler (PWD) interrogation across hepatic Vein on admission illustrating hepatic vein systolic flow reversal due to severe TR
Figure_8
Transthoracic echocardiogram with pulsed wave doppler (PWD) interrogation across mitral valve on admission showing restrictive pattern grade III diastolic dysfunction
Figure_9
Transthoracic echocardiogram with tissue doppler imaging (TDI) interrogation across mitral valve annulus (septal mitral annulus) on admission showing reduced mitral annular velocity with high E/E’ ratio of 36
Figure_10
Baseline 12-leads Electrocardiogram (ECG) showing sinus rhythm with wide QRS complex and Interventricular conduction delay with increased duration of QRS complex ≥ 125 ms
Figure_11
X-ray chest (Antero-posterior) on hospital admission showing pulmonary congestion with cephalization of the pulmonary vessels, Kerley B lines with the ”bat wing” pattern and patchy shadowing with increased cardiac size
Figure_12
Transthoracic echocardiogram showing LV Ejection fraction improvement to 45% by biplane method of disks (modified Simpson’s) after two weeks of starting Sacubitril/Valsartan
Figure_13
2D transthoracic echocardiogram, A2C view showing reduction of MR severity to grade II after two weeks of starting Sacubitril/Valsartan
Figure_14:
2D transthoracic echocardiogram, A4C view showing marked reduction of severe grade IV TR to mild grade I TR
Figure_15
Transthoracic echocardiogram with continuous wave doppler (CWD) interrogation across the tricuspid valve two weeks after starting Sacubitril/Valsartan, showing RV systolic pressure (RVSP) dramatically improved to 30 mm Hg compared to 66 mm Hg on admission
Figure_16
Transthoracic echocardiogram with pulsed wave doppler (PWD) interrogation across mitral valve after initiating ARNi, showing improved LV diastolic function to grade I compared to grade III on admission