Echocardiographic Parameters in Patients with Pulmonary Arterial Hypertension: Correlations with Right Ventricular Ejection Fraction Derived from Cardiac Magnetic Resonance and Hemodynamics

Yang, Tao; Yu, Liang; Zhang, Yan; Gu, Qing; Guo, Chen; Ni, Xin; Lv, Xiu Zhang; Liu, Fei; Xiong, Chang-ming; He, Jian

doi:10.1371/journal.pone.0071276

Cited by 31 publications

(34 citation statements)

References 25 publications

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“…These changes could be effectively attenuated by SAA treatment. Second, SAA treatment effectively reduced MCT-induced lung parenchymal injury and collagen deposition, thereby protecting the myocardium against hyper- [28,29] . Several echocardiographic parameters have been used as reliable indicators in previous studies, including PAAT and PV max [30,31] .…”

Section: Discussionmentioning

confidence: 99%

Salvianolic acid A attenuates vascular remodeling in a pulmonary arterial hypertension rat model

Chen¹,

Yuan²,

Zhang³

et al. 2016

Acta Pharmacol Sin

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Aim:The current therapeutic approaches have a limited effect on the dysregulated pulmonary vascular remodeling, which is characteristic of pulmonary arterial hypertension (PAH). In this study we examined whether salvianolic acid A (SAA) extracted from the traditional Chinese medicine 'Dan Shen' attenuated vascular remodeling in a PAH rat model, and elucidated the underlying mechanisms. Methods: PAH was induced in rats by injecting a single dose of monocrotaline (MCT 60 mg/kg, sc). The rats were orally treated with either SAA (0.3, 1, 3 mg·kg -1 ·d -1 ) or a positive control bosentan (30 mg·kg -1 ·d -1 ) for 4 weeks. Echocardiography and hemodynamic measurements were performed on d 28. Then the hearts and lungs were harvested, the organ indices and pulmonary artery wall thickness were calculated, and biochemical and histochemical analysis were conducted. The levels of apoptotic and signaling proteins in the lungs were measured using immunoblotting. Results: Treatment with SAA or bosentan effectively ameliorated MCT-induced pulmonary artery remodeling, pulmonary hemodynamic abnormalities and the subsequent increases of right ventricular systolic pressure (RVSP). Furthermore, the treatments significantly attenuated MCT-induced hypertrophic damage of myocardium, parenchymal injury and collagen deposition in the lungs. Moreover, the treatments attenuated MCT-induced apoptosis and fibrosis in the lungs. The treatments partially restored MCT-induced reductions of bone morphogenetic protein type II receptor (BMPRII) and phosphorylated Smad1/5 in the lungs. Conclusion: SAA ameliorates the pulmonary arterial remodeling in MCT-induced PAH rats most likely via activating the BMPRII-Smad pathway and inhibiting apoptosis. Thus, SAA may have therapeutic potential for the patients at high risk of PAH.

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Section: Discussionmentioning

confidence: 99%

Salvianolic acid A attenuates vascular remodeling in a pulmonary arterial hypertension rat model

Chen¹,

Yuan²,

Zhang³

et al. 2016

Acta Pharmacol Sin

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“…(Fukuda, Tanaka, 2011, Yang et al , 2013 The difference might be attributed to differences in patients' backgrounds, but the exact reason is unknown. Both TAPSE and RV FAC provide information on global RV function, but do not include potentially important regional variations in contractility and do not assess contraction synchronicity.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

et al. 2014

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Aims: Echocardiography is widely used for screening of pulmonary hypertension (PH). More recently developed two-dimensional speckle-tracking echocardiography (2D-STE) can assess regional deformation of the myocardium and is useful for detecting left ventricular dysfunction. However, its usefulness to assess right ventricular (RV) dysfunction is not clear. Therefore, the aim of this study was to investigate the ability of peak systolic strain (PSS) and post-systolic strain index (PSI) at the RV free wall determined by 2D-STE to detect PH.Main methods: Thirty-six images (27 images from PH patients, nine from patients with connective tissue disease without PH) obtained by 2D-STE were analysed. We investigated the relationship between RV hemodynamics measured by right heart catheterization and PSS, PSI and other echocardiographic parameters reflecting RV overload including RV end-diastolic diameter (RVDd) and tricuspid valve regurgitant pressure gradient (TRPG).Key findings: PSS, PSI, RVDd and TRPG were all correlated with mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR). Furthermore, when PSS and MPAP were measured twice, the change in PSS was correlated with the change in MPAP (r=0.633, p=0.037). Multivariate logistic regression analysis identified PSS as the only independent factor associated with MPAP≥35 mmHg [odds ratio (OR), 1.616; 95% confidence interval (CI) 1.017-2.567; p=0.042] and PVR≥400 dyne·sec·cm -5 (OR, 1.804; 95% CI 1.131-2.877; p=0.013). Furthermore, the optimal PSS cut-off value to detect an elevated MPAP and PVR was -20.75%, based on receiver operating characteristic curve analysis.Significance: PSS of the RV free wall might serve as a useful non-invasive 2 indicator of PH.

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“…69 A decline in RVEF is predictive of mortality and correlates with worsening functional class. 70,71 RV volumes acquired with 3D TTE correlate considerably better than 2D TTE with the reference standard of cardiovascular MRI, but in the past this has been limited by suboptimal image quality. 72 In patients with dilated RV, the exclusion of the free wall from the imaging sector can lead to inaccuracy of RV volumes.…”

mentioning

confidence: 99%

The Right Ventricle under Pressure: Evaluating the Adaptive and Maladaptive Changes in the Right Ventricle in Pulmonary Arterial Hypertension using Echocardiography (2013 Grover Conference Series)

2015

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The importance of the right ventricle (RV) in pulmonary arterial hypertension (PAH) has been gaining increased recognition. This has included a reconceptualization of the RV as part of an RV-pulmonary circulation interrelated unit and the observation that RV function is a major determinant of prognosis in PAH. Noninvasive imaging of RV size and function is critical to the longitudinal management of patients with PAH, and continued understanding of the pathophysiology of pulmonary vascular disease relies on the response of the RV to pulmonary vascular remodeling. Echocardiography, in particular the newer echocardiographic measurements and techniques, allows easy, readily accessible means to assess and follow RV size and function.Keywords: imaging, three-dimensional echocardiography, tricuspid annular plane systolic excursion, right heart failure, right ventricular function. Pulmonary arterial hypertension (PAH) is characterized by severe remodeling of distal pulmonary arterioles due to a complex interplay between genetic and molecular factors.1,2 This remodeling is characterized by intimal hyperplasia, vasoconstriction, medial hypertrophy, and the development of plexiform lesions, all of which contribute to and result in higher pulmonary artery pressure. The prevalence of PAH is 7-15 individuals per million people. 3,4 A diagnosis of PAH is initially suggested by symptoms including dyspnea, syncope, and exertional intolerance and is usually evaluated first with echocardiography. 5 Echocardiography may suggest elevated pulmonary artery pressures (PAPs) and help formulate a working hypothesis regarding the etiology of the presumed pulmonary hypertension (PH), but right heart catheterization remains essential to provide final hemodynamic classification of PH and, with that knowledge in hand, to guide appropriate World Health Organization (WHO) PH group-specific therapy. 6 Once the diagnosis of PAH is established (mean PAP ≥ 25 mmHg and pulmonary capillary wedge pressure ≤ 15 mmHg), most clinicians rely on a combination of frequent clinical evaluations and echocardiography to follow therapeutic response and to give insight into the effects of elevated PAP on the structure and function of the right ventricle (RV). The right ventricle's adaptation or maladaptation to the increased afterload is often a sign of the severity of PH. 7The relevance of the relationship between the RV and the pulmonary circulation in PAH has been gaining increased recognition.8 As a pump, the RV generates the same stroke volume as the left ventricle (LV) with onefourth the stroke work because of the lower resistance of the normal pulmonary vasculature. 9 The RV is thin walled, with the free wall measuring 2-5 mm, and contains onesixth the muscle mass of the LV. 9 It is a crescent-shaped chamber with a high capacitance and a greater ability to handle changes in preload than in afterload. When chronically exposed to increased afterload, the RV can adapt with myocardial hypertrophy, since increase in wall pressure leads to increase in ...

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Echocardiographic Parameters in Patients with Pulmonary Arterial Hypertension: Correlations with Right Ventricular Ejection Fraction Derived from Cardiac Magnetic Resonance and Hemodynamics

Cited by 31 publications

References 25 publications

Salvianolic acid A attenuates vascular remodeling in a pulmonary arterial hypertension rat model

Salvianolic acid A attenuates vascular remodeling in a pulmonary arterial hypertension rat model

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

The Right Ventricle under Pressure: Evaluating the Adaptive and Maladaptive Changes in the Right Ventricle in Pulmonary Arterial Hypertension using Echocardiography (2013 Grover Conference Series)

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