Diminished Aortic Excursion in Chronic Thromboembolic Pulmonary Hypertension

Kimura, Bruce J.; Parise, Charles M.; Strachan, G. Monet; Auger, William R.; Madani, Michael M.; Daniels, Lori B.; Blanchard, Daniel G.

doi:10.1111/echo.12252

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…A recent study suggests that changes in RV outflow tract dimension may affect left atrial filling and compliance in CTEPH [17]. A proposed explanation is that the mediastinal space between the sternum and the spine is relatively fixed: an increase in RV and RV outflow tract size may limit normal expansion of the left atrium.…”

Section: Discussionmentioning

confidence: 99%

Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension

Marston

Auger

Madani

et al. 2014

Cardiovasc Ultrasound

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BackgroundImpaired left ventricular diastolic filling is common in chronic thromboembolic pulmonary hypertension (CTEPH), and recent studies support left ventricular underfilling as a cause. To investigate this further, we assessed left atrial volume index (LAVI) in patients with CTEPH before and after pulmonary thromboendarterectomy (PTE).MethodsForty-eight consecutive CTEPH patients had pre- & post-PTE echocardiograms and right heart catheterizations. Parameters included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac index, LAVI, & mitral E/A ratio. Echocardiograms were performed 6 ± 3 days pre-PTE and 10 ± 4 days post-PTE. Regression analyses compared pre- and post-PTE LAVI with other parameters.ResultsPre-op LAVI (mean 19.0 ± 7 mL/m2) correlated significantly with pre-op PVR (R = -0.45, p = 0.001), mPAP (R = -0.28, p = 0.05) and cardiac index (R = 0.38, p = 0.006). Post-PTE, LAVI increased by 18% to 22.4 ± 7 mL/m2 (p = 0.003). This change correlated with change in PVR (765 to 311 dyne-s/cm5, p = 0.01), cardiac index (2.6 to 3.2 L/min/m2, p = 0.02), and E/A (.95 to 1.44, p = 0.002).ConclusionIn CTEPH, smaller LAVI is associated with lower cardiac output, higher mPAP, and higher PVR. LAVI increases by ~20% after PTE, and this change correlates with changes in PVR and mitral E/A. The rapid increase in LAVI supports the concept that left ventricular diastolic impairment and low E/A pre-PTE are due to left heart underfilling rather than inherent left ventricular diastolic dysfunction.

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Section: Discussionmentioning

confidence: 99%

Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension

Marston

Auger

Madani

et al. 2014

Cardiovasc Ultrasound

View full text Add to dashboard Cite

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“…Intubated patients with modified cardiac hemodynamics. Chronic thrombo-embolism that will reduce aortic root excursion [ 14 ]. Large pericardial or pleural effusions from any cause with hemodynamic effects.…”

Section: Methodsmentioning

confidence: 99%

Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study

et al. 2018

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BackgroundHeart failure (HF), is a major public health issue globally. Echocardiography is cost–effective in the diagnosis in expert hands. This study was conducted to estimate the usefulness of Aortic Root Systolic Excursion (ARSE) as a simple and accurate measure to estimate Left Ventricular (LV) function.MethodsThis was a cross-sectional echocardiographic study among adults aged ≥ 18 years, with or without heart failure, in sinus rhythm, and with no LV out–let obstruction. We studied the correlations of ARSE with some selected indices of LV Systolic Functions. We determined optimal cut–offs of ARSE in detecting LV dysfunction. We generated a simple regression equation to best estimate LV ejection fraction according to the modified Simpson method.ResultsOverall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p<0.001), and lowest for the ITV method (r = 0.319, p<0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, with an AUROC of 91.6%.The logarithmic regression equation was best in predicting LV ejection fraction (AUC: 60.2%), followed by the power model (AUC: 56.7%), and the linear model (AUC: 53.6%).ConclusionARSE correlated well with LV systolic function. The cut–off ≤ 6.5 mm suggest LV systolic dysfunction. LV Ejection Fraction was best estimated with the generic equation: LVEF (%) = 29 x In [ARSE].

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Focused Cardiac Ultrasonography in the Emergent Patient

2014

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Diminished Aortic Excursion in Chronic Thromboembolic Pulmonary Hypertension

Abstract: Aortic excursion is diminished in the right ventricular pressure overload of CTEPH. This impaired motion of the aortic root may influence systolic expansion of the left atrium, and may contribute to the impaired left atrial diastolic filling patterns often seen in patients with CTEPH.

Cited by 4 publications

References 14 publications

Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension

Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension

Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study

Focused Cardiac Ultrasonography in the Emergent Patient

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