A GPS Map for Pulmonary Hypertension: A Review of Imaging Modalities

Abstract

Pulmonary hypertension (PH) is a lethal disease with a prevalence of 10-20 % in the general population. The current gold standard diagnosis approach is right heart catheterization, directly detecting pulmonary artery pressure. Imaging for PH patients plays an important role in the etiological diagnosis and evaluation of right heart (RV) function, which is a key determinant of morbidity and mortality in PH patients. Currently, echocardiography is the first-line imaging modality for screening PH and evaluating RV function. CMRI is the gold standard method to evaluate RV function. MDCT, radionuclide ventriculography and pulmonary angiography are mostly used in the differential diagnosis of the cause of PH. In this review article, we also mention several newly studied imaging modalities, such as three-dimensional echocardiography, intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which showed promise for early diagnosis of PH.

The Role of Echocardiography in the Evaluation of Pulmonary Arterial Hypertension

“…As with other RV measurements, FAC is plagued by suboptimal visualization of the RV chamber and endocardium and therefore has relatively high inter‐ and intra‐observer variability . Despite these limitations, it has been shown to correlate with RV ejection fraction (EF) as determined by cardiovascular magnetic resonance imaging and has also been shown to predict survival . Furthermore, FAC is an independent risk predictor of heart failure, sudden death, stroke, and/or mortality after myocardial infarction …”

“…39 Despite these limitations, it has been shown to correlate with RV ejection fraction (EF) as determined by cardiovascular magnetic resonance imaging 12 and has also been shown to predict survival. 6 Furthermore, FAC is an independent risk predictor of heart failure, sudden death, stroke, and/or mortality after myocardial infarction. 40 Tricuspid annular plane systolic excursion: Tricuspid annular plane systolic excursion (TAPSE), representing systolic displacement of the tricuspid annulus toward the RV apex, has been shown to closely correlate with RVEF ( Fig.…”

“…Myocardial strain is defined as the change in distance between 2 points divided by the initial length, and strain rate is its derivative. 6 Wall motion measurements obtained by conventional echocardiography (displacement and velocity) cannot separate active from passive movement of a myocardial segment, but strain and strain rate imaging are able to make this distinction. 56 Speckle tracking echocardiography (STE) enables objective and quantitative evaluation of regional and global myocardial function.…”

“…Despite its central diagnostic role, RHC is invasive and expensive and cannot practically be performed on all patients. Two‐dimensional (2D) transthoracic Doppler echocardiography, in contrast, is noninvasive, affordable, and readily available . Its contribution to the diagnostic workup of PAH has been a subject of much attention and debate.…”

“…Two-dimensional (2D) transthoracic Doppler echocardiography, in contrast, is noninvasive, affordable, and readily available. 6 Its contribution to the diagnostic workup of PAH has been a subject of much attention and debate. Numerous echocardiographic parameters have been investigated, yet a consensus is lacking regarding the overall utility of echocardiography in PAH.…”