Differential right ventricular regional function and the effect of pulmonary hypertension: three-dimensional echo study

Calcutteea, Avin; Chung, Robin; Lindqvist, Per; Hodson, Margaret E.; Henein, Michael Y.

doi:10.1136/hrt.2010.208900

Cited by 56 publications

(50 citation statements)

References 27 publications

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“…These "flow poor" characteristics of the apical region support recent 3-D echo findings (3). Calcutteea et al (3) observed that the apical region of the RV chamber contributed less to overall RV contraction than the inflow and outflow regions and proposed that the RV apex could have an important role in maintaining the RV intracavitary circulation other than contraction. The present 4-D flow data suggest that the Residual Volume outlines the functional periphery of the RV chamber, in particular the apical region, and provide a fluid-fluid interface that influences the routes of the other more exchanging flow components.…”

Section: Discussionmentioning

confidence: 99%

“…Scan parameters included the following: VENC ϭ 100 cm/s, flip angle ϭ 8°, echo time ϭ 3.7 ms, repetition time ϭ 6.3 ms, receiver bandwidth ϭ 334 Hz/pixel, parallel imaging (SENSE) speed-up factor ϭ 2, and k-space segmentation factor ϭ 2. The acquired temporal resolution was 49.2 ms, and the spatial resolution was 3 ϫ 3 ϫ 3 mm 3 . The field-of-view (230 ϫ 230 -274 ϫ 274 mm 2 ) and slab thickness (84 -114 mm) were adjusted for each subject to cover both ventricles.…”

Section: Methodsmentioning

confidence: 99%

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4-D blood flow in the human right ventricle

Fredriksson

Zajac²,

Eriksson³

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

113

115

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Right ventricular (RV) function is a powerful prognostic indicator in many forms of heart disease, but its assessment remains challenging and inexact. RV dysfunction may alter the normal patterns of RV blood flow, but those patterns have been incompletely characterized. We hypothesized that, based on anatomic differences, the proportions and energetics of RV flow components would differ from those identified in the left ventricle (LV) and that the portion of the RV inflow passing directly to outflow (Direct Flow) would be prepared for effective systolic ejection as a result of preserved kinetic energy (KE) compared with other RV flow components. Three-dimensional, time-resolved phase-contrast velocity, and balanced steady-state freeprecession morphological data were acquired in 10 healthy subjects using MRI. A previously validated method was used to separate the RV and LV end-diastolic volumes into four flow components and measure their volume and KE over the cardiac cycle. The RV Direct Flow: 1) followed a smoothly curving route that did not extend into the apical region of the ventricle; 2) had a larger volume and possessed a larger presystolic KE (0.4 Ϯ 0.3 mJ) than the other flow components (P Ͻ 0.001 and P Ͻ 0.01, respectively); and 3) represented a larger part of the end-diastolic blood volume compared with the LV Direct Flow (P Ͻ 0.01). These findings suggest that diastolic flow patterns distinct to the normal RV create favorable conditions for ensuing systolic ejection of the Direct Flow component. These flowspecific aspects of RV diastolic-systolic coupling provide novel perspectives on RV physiology and may add to the understanding of RV pathophysiology. cardiac disease; interventricular function; kinetic energy; phase-contrast magnetic resonance imaging; pump physiology RIGHT VENTRICULAR (RV) FUNCTION has important prognostic impact on both acquired and congenital cardiac diseases (10). The RV may be affected by primary right-sided pathological conditions, such as pulmonary hypertension, congenital heart disease, or cardiomyopathy, or secondarily involved in states with left ventricular (LV) dysfunction (5, 28).Accurate measurement of RV volume and function is the focus of investigations using many modalities (14,18,(23)(24). The most widely employed clinical technique for RV morphological and functional assessment is two-dimensional echocardiography (14, 23), but its accuracy is limited by the complex crescent shaped geometry of the RV and by its location behind the sternum (14, 18). Magnetic resonance imaging (MRI) offers more detailed, three-dimensional (3-D) anatomy and can improve RV volume assessment (11). The dynamic functional status of the RV, which is significantly impacted by respiratory events and loading conditions, remains challenging and inexact (11).The anatomic structures of the heart and the intracardiac blood flow are highly interdependent, and changes in flow due to altered cardiac shape or function may in turn influence structural remodeling (13,21,29). Three-dimensional, timereso...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

4-D blood flow in the human right ventricle

Fredriksson

Zajac²,

Eriksson³

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

113

115

View full text Add to dashboard Cite

show abstract

“…The flow path from RV inflow to outflow followed a gradual curvature through the basal and middle parts of the ventricle, reflecting the RV anatomy with separated inflow and outflow tracts. The apical region was found to not participate as much in flow exchange, supporting previous 3D echocardiographic findings observing that the apical region of the RV contributed less to overall RV contraction than the inflow and outflow regions (151). The visualizations in Paper I suggest that the Residual volume outlines the functional periphery of the RV, in particular the apical region, providing a fluid-fluid interface that influences the routes of the other more exchanging flow components, potentially facilitating the smooth redirection of inflowing blood towards the outflow tract while preserving its KE (152).…”

Section: Physiological Considerationssupporting

confidence: 75%

Blood flow specific assessment of ventricular function: Visualization and quantification using 4D flow CMR

Fredriksson¹

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“…33 Although the effects of chronic pressure overload are most obviously seen in the RV, mechanical dyssynchrony leads to biventricular dysfunction and LV remodeling. The presence of elevated RV pressures leads to dyssynchronous ventricular contraction and leftward ventricular septal bowing, which has been characterized by 2D and 3D echocardiography, 28 speckle-tracking echocardiography, 34 TDI, 35 and MRI. 36 Interventricular dyssynchrony may be the result of delayed activation in regions of the RV due to intraventricular conduction disturbances via mechanisms reviewed above.…”

Section: Interventricular Dyssynchrony and Ventricular Interdependencementioning

confidence: 99%

Is Cardiac Resynchronization Therapy for Right Ventricular Failure in Pulmonary Arterial Hypertension of Benefit?

et al. 2014

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Pulmonary arterial hypertension is a manifestation of a group of disorders leading to pulmonary vascular remodeling and increased pulmonary pressures. The right ventricular (RV) response to chronic pressure overload consists of myocardial remodeling, which is in many ways similar to that seen in left ventricular (LV) failure. Maladaptive myocardial remodeling often leads to intraventricular and interventricular dyssychrony, an observation that has led to cardiac resynchronization therapy (CRT) for LV failure. CRT has proven to be an effective treatment strategy in subsets of patients with LV failure resulting in improvement in LV function, heart failure symptoms, and survival. Current therapy for pulmonary arterial hypertension is based on decreasing pulmonary vascular resistance, and there is currently no effective therapy targeting the right ventricle or maladaptive ventricular remodeling in these patients. This review focuses on the RV response to chronic pressure overload, its effect on electromechanical coupling and synchrony, and how lessons learned from left ventricular cardiac resynchronization might be applied as therapy for RV dysfunction in the context of pulmonary arterial hypertension.Keywords: pulmonary hypertension, pulmonary arterial hypertension, right ventricular failure, dyssynchrony, cardiac resynchronization therapy. Pulmonary arterial hypertension is a manifestation of a group of disorders that cause pulmonary vascular remodeling, alterations in pulmonary vascular resistance, and reduced compliance. Ultimately, increased pulmonary pressures may induce alterations in right ventricular structure and function. Current therapy is largely based on targeting biochemical pathways to decrease pulmonary vascular resistance. Despite this, the final common pathway for many patients remains right ventricular failure and death. Although left ventricular (LV) failure has been well characterized, leading to multiple therapies with proven mortality benefit, less is known about the failing right ventricle (RV). In fact, early evaluation of the role of RV function in disease states (i.e., RV free wall infarction/ ablation, Fontan physiology, or lung transplantation) suggested that the RV was highly adaptable and perhaps superfluous to overall cardiac function in the absence of sustained pulmonary arterial hypertension. However, recent improvements in imaging and technology, including strain imaging, tissue Doppler imaging (TDI), and magnetic resonance imaging (MRI) have led to a better understanding of the adaptation of the RV to chronic pressure overload.Many similarities between RV and LV failure have been observed, including changes in mechanical function, RV global and myocyte structure and function, 2 myocardial blood flow, 3 and electrophysiologic properties. 4 In a limited number of mechanical interventions in the pulmonary circulation (lung transplantation and pulmonary artery endarterectomy), RV reverse remodeling has been noted, suggesting a reversible component to RV remodeling related t...

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Differential right ventricular regional function and the effect of pulmonary hypertension: three-dimensional echo study

Cited by 56 publications

References 27 publications

4-D blood flow in the human right ventricle

4-D blood flow in the human right ventricle

Blood flow specific assessment of ventricular function: Visualization and quantification using 4D flow CMR

Is Cardiac Resynchronization Therapy for Right Ventricular Failure in Pulmonary Arterial Hypertension of Benefit?

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