Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Fernández‐Friera, Leticia; García‐Álvarez, Ana; Guzmán, Gabriela; Bagheriannejad-Esfahani, Fatemeh; Malick, Waqas; Nair, Ajith; Fuster, Valentín; García, Mario J.; Sanz, Javier

doi:10.1136/hrt.2010.216101

Cited by 29 publications

(22 citation statements)

References 33 publications

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“…Vogel-Claussen et al 29 found a significant correlation between MR-derived measurement RV septomarginal trabeculation mass, VMI (VMI = RV mass/LV mass), and RHC-documented PH hemodynamics. Fernandez-Friera et al 30 showed a regional difference in RV function and volumes as a result of chronic PH. They found that apical RV dysfunction appeared to occur even in the presence of normal global RV ejection fraction (RVEF) in patients with PH, in association with an increase in apical RV ESV.…”

Section: Resultsmentioning

confidence: 98%

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Right Ventricular Reverse Remodeling after Pulmonary Endarterectomy: Magnetic Resonance Imaging and Clinical and Right Heart Catheterization Assessment

et al. 2014

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The objective of this study was to assess the effect of pulmonary endarterectomy (PEA) on right ventricular (RV) reverse remodeling using magnetic resonance imaging (MRI) and to correlate MRI findings with clinical and hemodynamic outcomes postsurgery. We performed a retrospective analysis in 72 patients undergoing PEA surgery in whom MRI and right heart catheterization (RHC) were performed preoperation and 3 months postoperation. RV volumes and mass were assessed by MRI. Continuous variables were expressed as means, changes were compared with a paired t test, and associations between the variables were explored using Pearson correlation coefficients. The mean age was 57 years, and 51% were male. Both RV end-diastolic volume (EDV; 176-117 mL; P < 0.001) and RV end-systolic volume (ESV; 129-64 mL; P < 0.001) reduced significantly following PEA. Preoperative pulmonary artery pressure (PAP) correlated moderately with ESV (r ¼ 0.46, P < 0.001). Postoperatively, PAP correlated with EDV (r ¼ 0.45, P < 0.001) and ESV (r ¼ 0.44, P < 0.001). Moderate correlation was present between hemodynamic parameters: PAP, pulmonary vascular resistance, and right atrial pressure with pre-and postoperation endsystolic and end-diastolic RV mass (P < 0.001). RHC and MRI measurements of cardiac output and RV volumes were significantly different (P < 0.001). In conclusion, RV reverse remodeling, as measured by improvement in RV volumes and mass by MRI, was observed for 3 months in patients who underwent PEA surgery. This is the largest series of patients with pre-and post-PEA MRI assessment so far reported. MRI detects changes in parameters reflecting cardiac remodeling and pulmonary clearance, but measurements are significantly different from those of RHC.

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Section: Resultsmentioning

confidence: 98%

“…(2) Some of the studies presented in this review [27][28][29][30][31][32] significantly correlating MR-derived parameters with RHC-measured hemodynamics and FC need to be validated in larger studies hypertension. Concomitant tricuspid regurgitation might explain the differences between RV systolic volume and pulmonary forward flow.…”

Section: Resultsmentioning

confidence: 99%

Right Ventricular Reverse Remodeling after Pulmonary Endarterectomy: Magnetic Resonance Imaging and Clinical and Right Heart Catheterization Assessment

et al. 2014

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“…The author and colleagues found that basal RV ejection fraction (RVEF) did not differ between patients with mild or moderate PH. However, they showed that patients with moderate PH had significantly lower apical RVEF, with an apical RVEF<50% that was more sensitive than global RV dysfunction for the detection of PH [41]. In a study by López-Candalez et al using TDI and TDI derived strain in patients with severe PH, they found apical longitudinal strain most predictable for adverse outcome in those patients [42].…”

Section: Discussionmentioning

confidence: 97%

Impact of Untreated Obstructive Sleep Apnea on Left and Right Ventricular Myocardial Function and Effects of CPAP Therapy

et al. 2013

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BackgroundObstructive sleep apnea (OSA) has deteriorating effect on LV function, whereas its impact on RV function is controversial. We aimed to determine the effect of OSA and continuous positive airway pressure (CPAP) treatment on left and right ventricular (LV, RV) function using transthoracic echocardiography (TTE) and 2 dimensional speckle tracking (2D ST) analysis of RV deformation capability.Methods and Results82 patients with OSA and need for CPAP therapy were prospectively enrolled and underwent TTE at study inclusion and after 6 months of follow up (FU). Multivariate regression analysis revealed an independent association between baseline apical right ventricular longitudinal strain (RV-Sl), BMI and the severity of OSA (apical RV-Sl: P = 0.0002, BMI: P = 0.02). After CPAP therapy, LV functional parameters (LVEF: P<0.0001, LV performance index: P = 0.03, stroke volume: P = 0.042), and apical RV-Sl (P = 0.001) improved significantly. The effect of CPAP therapy was related to severity of OSA (LVEF: AHI 5–14, 66.4±8.8%, 68.5±10.6% [P = ns]; AHI 15–30∶59.8±7.7%, 68.6±9.3% [P = 0.002]; AHI>30∶54.1±12.4%, 68.2±13.6%[P<0.0001]; apical RV-Sl: AHI 5–14: −17.3±8.7%, −16.0±10.8% [P = ns], AHI 15–30: −9.8±6.0%, −15.4±10.9% [P = 0.028], AHI>30: −6.3±5.7%, −17.9±11.2% [P<0.0001]).ConclusionsOSA seems to have deteriorating effect on LV and RV function. We found a beneficial effect of CPAP on LV and RV functional parameters predominately in patients with severe OSA. 2D speckle tracking might be of value to determine early changes in global and regional right ventricular function.

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“…Both our group and Dambrauskaite et al [21][22][23] have previously shown that apical strain is related to disease severity in iPAH. Furthermore, Fernandez-Friera et al 24 demonstrated reduced apical RV ejection fraction-by magnetic resonance imaging-in adult iPAH patients. As apical remodeling and decreased longitudinal deformation were also found in PS-with normal global systolic RV function-it might be a sensitive echocardiographic marker of RV dysfunction.…”

Section: Rv Regional Remodeling and Functionmentioning

confidence: 99%

Regional right ventricular remodeling and function in children with idiopathic pulmonary arterial hypertension vs those with pulmonary valve stenosis: Insights into mechanics of right ventricular dysfunction

et al. 2017

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Background Right ventricular (RV) pressure overload in the context of pulmonary stenosis (PS) has a much better prognosis than in the context of idiopathic pulmonary arterial hypertension (iPAH), which may be related to differences in global and regional RV remodeling and systolic function. We compared RV mechanics in children with PS to those with iPAH, aiming to identify mechanisms and markers of RV dysfunction. Methods Eighteen controls, 18 iPAH and 16 PS patients were retrospectively studied. Age, BSA, and sex distribution were comparable. Two‐dimensional echocardiography, blood flow and tissue Doppler, and longitudinal RV deformation were analyzed. ANCOVA—including RV systolic pressure (RVSP) and length as covariates—was used to compare patient groups. Results RV systolic pressure was higher in iPAH vs PS (96.8±25.4 vs 75.4±18.9 mm Hg, P=.011). Compared to controls, PS patients showed mild dilation (P<.01) and decreased longitudinal deformation (P<.001) at the RV apex. Compared to both PS and controls, iPAH patients showed marked spherical RV dilation (P<.001), reduced global, RV free wall and septal longitudinal deformation (iPAH −22.07%±4.35% vs controls −28.18%±1.69%; −9.98%±4.30% vs −17.45%±2.52%; P<.001) and RV postsystolic shortening (P<.001). RV transverse shortening (radial performance) was increased in PS (31.75%±10.35%; P<.001) but reduced in iPAH (−1.62%±11.11% vs controls 12.00%±7.74%; P<.001). Conclusion Children with iPAH demonstrate adverse global and regional RV remodeling and mechanics compared to those with PS. Mechanisms of RV systolic dysfunction in iPAH include decreased longitudinal deformation, decreased or absent transverse shortening, and postsystolic shortening. These markers may be useful to identify children at risk of RV failure.

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Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance

Abstract: Apical dysfunction appears to occur before global RVEF decreases in chronic PH, potentially constituting an early and sensitive marker of RV dysfunction in this setting.

Cited by 29 publications

References 33 publications

Right Ventricular Reverse Remodeling after Pulmonary Endarterectomy: Magnetic Resonance Imaging and Clinical and Right Heart Catheterization Assessment

Right Ventricular Reverse Remodeling after Pulmonary Endarterectomy: Magnetic Resonance Imaging and Clinical and Right Heart Catheterization Assessment

Impact of Untreated Obstructive Sleep Apnea on Left and Right Ventricular Myocardial Function and Effects of CPAP Therapy

Regional right ventricular remodeling and function in children with idiopathic pulmonary arterial hypertension vs those with pulmonary valve stenosis: Insights into mechanics of right ventricular dysfunction

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