Diagnostic and prognostic value of echocardiography in pulmonary arterial hypertension

Abstract

geometry unaltered) in a patient with high VTI TR (ie, high RV systolic pressure and relatively low RA pressure) yield a high LAI RV which indicates good adaptation to load (RV ability to increase systolic pressure without relevant RV dilation and without RA pressure increase suggesting good RV contractile function) and the potential of RV to improve its performance after reduction of afterload. A large area relative to long-axis length (spherical dilation) despite a relatively low VTI TR yields a low LAI RV indicating poor adaptation to load (excessive RV dilation despite low RV pressure-load) suggesting a reduced myocardial contractility. In potential transplant candidates with PAH, LAI RV reduction of >20% of the baseline value already before the onset of the first signs for RV failure was found to be a predictor of right heart failure and transplant-free survival. 6 We believe that further efforts in testing the diagnostic value of composite variables which incorporate measures of RV geometry, function and loading will considerably improve the reliability of non-invasive monitoring of the RV in both patients with PAH and those predisposed to that disease.

Reply to “Diagnostic and prognostic value of echocardiography in pulmonary arterial hypertension”

“…We read with interest the Letter to the Editor "diagnostic and prognostic value of echocardiography in pulmonary arterial hypertension" by Dandel and Hetzer. 1 Their excellent comment highlights that parameters of right ventricular (RV) systolic function such as the tricuspid annular plane systolic (TAPSE) and the tricuspid annular peak systolic velocity (S 0 ) decrease with increasing pulmonary vascular resistance (PVR), and that-at a constant level of PVR-the magnitude of TAPSE and S 0 reduction depends on the degree of RV contractility impairment. 1 The newly developed RV end-systolic base/apex (RVES b/a) ratio inversely correlated with echocardiographic RV/LV endsystolic diameter ratio (ρ = −0.450, P = 0.001) and invasive mPAP (ρ = −0.415, P = 0.012), but did not correlate with the RV systolic function parameters TAPSE and S 0 in our study.…”

“…1 Their excellent comment highlights that parameters of right ventricular (RV) systolic function such as the tricuspid annular plane systolic (TAPSE) and the tricuspid annular peak systolic velocity (S 0 ) decrease with increasing pulmonary vascular resistance (PVR), and that-at a constant level of PVR-the magnitude of TAPSE and S 0 reduction depends on the degree of RV contractility impairment. 1 The newly developed RV end-systolic base/apex (RVES b/a) ratio inversely correlated with echocardiographic RV/LV endsystolic diameter ratio (ρ = −0.450, P = 0.001) and invasive mPAP (ρ = −0.415, P = 0.012), but did not correlate with the RV systolic function parameters TAPSE and S 0 in our study. 2 As suggested by Dandel and Hetzer we herein assessed the correlation between RVES b/a ratio and the indexed PVR (PVRi), which was found to be significant (ρ = −0.571, P < 0.001).…”

“…In agreement with our recent findings and recommendations, [2][3][4] Dandel and Hetzer suggest to use the RVES b/a ratio in combination with more established measures of RV function, and the authors explain the advantages of a multi-parameter analysis to assess myocardial changes under pathological conditions (as evident in PAH), where parallel measurements of the load-dependency of RV size, geometry, and pump function prove useful for a detailed RV evaluation. 1 Other integrative approaches using different combinations of parameters also included data on RV afterload. In this regard, especially the interesting data of Di Maria et al, 5 introducing the "RV stroke work" as a combined parameter of stroke volume and load, seems to be highly promising.…”

Impact of Asthma Phenotypes on Myocardial Performance and Pulmonary Hypertension in Children and Adolescents With Moderate to Severe Persistent Asthma

“…Tissue Doppler imaging (TDI) and pulse wave Doppler have emerged as non-invasive diagnostic modalities to assess cardiac functions and to detect subclinical myocardial dysfunctions in different clinical studies, including obesity, cytotoxic-induced cardiomyopathy, congenital heart diseases and pulmonary hypertension [11,12]. Also, it has good repeatability and reproducibility, as reported in many studies like Puleo et al [13], Daniel et al [14], and Cui et al [15].…”