Morphologic and Functional Remodeling of the Right Ventricle in Pulmonary Hypertension by Real Time Three Dimensional Echocardiography

Grapsa, Julia; Gibbs, J. Simon R.; Dawson, David M.; Watson, Geoffrey; Patni, Ravi; Athanasiou, Thanos; Punjabi, Prakash P; Howard, Luke; Nihoyannopoulos, Petros

doi:10.1016/j.amjcard.2011.10.054

Cited by 46 publications

(37 citation statements)

References 24 publications

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“…The septal contribution differs from patients with volume loaded rV such as patients with pulmonary regurgitation or atrial septal defects where the septum moves towards the right side in systole [11,13,25,26]. The movement of septum towards the left in our study is in concordance with earlier studies with pressure loaded rV [16,[27][28][29]. SV long% was decreased on the left side in patients with PH compared to controls, but did not differ on the right side between patients and controls (Table 3; Fig.…”

Section: Resultssupporting

confidence: 82%

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Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Ostenfeld

Stephensen

Steding‐Ehrenborg

et al. 2016

Int J Cardiovasc Imaging

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59 ± 9 %, p < 0.0001 and p < 0.01, respectively). This decrease did not differ in patient with ejection fraction (eF) >50 % and <50 % (p = 0.5) and was compensated for by increased lV lateral contribution to lVSV in patients (49 ± 13 % vs. 37 ± 7 %, p = 0.001). Septal motion contributed less to lVSV in patients (5 ± 8 %) compared to controls (8 ± 4 %, p = 0.05). rV aVPD was lower in patients (12.0 ± 3.6 mm vs. 21.8 ± 2.2 mm, p < 0.0001) but longitudinal and lateral contribution to rVSV did not differ between patients (78 ± 17 % and 29 ± 16 %) and controls (79 ± 9 % and 31 ± 6 % p = 0.7 for both) explained by increased rV cross sectional area in patients. lV function is affected in patients with PH despite preserved global lV function. The decreased longitudinal contribution and increased lateral contribution to lVSV was not seen in the rV, contrary to previous findings in patients with volume loaded RVs. Abstract To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (rV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMr). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (rHC) and CMr. CMr from 33 healthy adults (13 females) were used as controls. left ventricular (lV) atrioventricular plane displacement (aVPD) and corresponding longitudinal contribution to lVSV was lower in patients (10.8 ± 3.2 mm and 51 ± 12 %) compared to controls (16.6 ± 1.9 mm and 1 3 1244 int J Cardiovasc imaging (2016) 32:1243-1253 trols. The control group has been described in a previous study [11]. The regional ethical review board approved the study and written informed consent was obtained from all patients and healthy volunteers prior to CMr examination. Keywords Right heart catheterizationinvasive measurements were obtained during rHC with a triple-lumen Swan-ganz catheter in supine position and in local anesthesia. Pressures of pulmonary artery (PaP), right atrium, right ventricle and pulmonary artery wedge as well as cardiac output using thermodilution were measured. Precapillary PH was characterized by elevated mean pulmonary arterial pressure (mPaP) ≥25 mmHg and pulmonary artery wedge pressure ≤15 mmHg at normal or reduced cardiac output. Systemic pressure was available using a cuff and sphygmomanometer. Cardiac magnetic resonance imagingImage acquisition all subjects underwent CMr imaging in the supine position and images were acquired during end-expiratory breath-hold covering the entire heart, including both ventricles and atria. a 1.5 Tesla magnetic resonance imaging scanner was used for all studies (Philips achieva, Best, The netherlands). Steady state free precession cine images were ...

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Section: Resultssupporting

confidence: 82%

“…Yet all patients had precapillary PH. i t has been suggested that the genesis of PH may lead to diverse remodeling of rV [27,35]. Our study was not designed to accommodate a differentiation of these factors.…”

Section: Limitationsmentioning

confidence: 99%

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Ostenfeld

Stephensen

Steding‐Ehrenborg

et al. 2016

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

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“…125 It was recently shown that adult patients with some forms of PH had more dilated, hypertrophied, and poorly functioning RVs than adults with other forms. 126 The use of 3D echocardiography has been validated for the measurement of RV volumes and EF, which correlated well with those variables determined by MRI imaging in a pediatric population. 127 Validation of 3D echocardiographic assessment in children with complex CHD, including a small LV, has been performed, 128 while sufficient data in children with PH are scant.…”

Section: D Echocardiographymentioning

confidence: 95%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

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“…All echoes were analyzed by an observer blinded to the clinical history and patients outcomes. A range of echocardiographic parameters [15][16][17][18][19][20][21][22][23][24][25] was measured by 1 observer (J.G.). Intraobserver variability was assessed for all echocardiographic parameters on a 100 patients randomly sampled from the population.…”

Section: Echocardiographymentioning

confidence: 99%

“…[3][4][5][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] All patients also underwent left and right heart catheterization. Diagnostic criteria for precapillary PH were based on the current European guidelines, 1 which included a combination of invasive hemodynamic measures (mean pulmonary arterial pressure of ≥25 mm Hg at rest, pulmonary arterial wedge pressure ≤15 mm Hg and pulmonary vascular resistance (PVR)>3 Wood units) 1,2 and echocardiographic parameters such as tricuspid regurgitant (TR) velocity >2.6 m/s for patients below the age of 60 years or >2.9 m/s when older than 60 years or >2.8 m/s in obese patients (body mass index >30).…”

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confidence: 99%

Echocardiographic and Hemodynamic Predictors of Survival in Precapillary Pulmonary Hypertension

Grapsa

Nunes

Tan

et al. 2015

Circ: Cardiovascular Imaging

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Consecutive patients with precapillary PH referred to the National Pulmonary Hypertension Service at Hammersmith Hospital between Background-In this study, we looked at the prognostic value of echocardiographic and hemodynamic measures in a large cohort of patients with precapillary pulmonary hypertension before and after initiation of treatment. were independent predictors of mortality. High pulmonary vascular resistance and right atrial pressure by invasive hemodynamic measurements were independent predictors of mortality (HR, 1.084; 95% confidence interval, 1.041-1.130, and 1.079, respectively; 95% confidence interval, 1.049-1.111; P<0.001 for both), whereas patients with a higher cardiac index had better survival overall (HR, 0.384; 95% confidence interval, 0.307-0.481; P<0.001). Conclusions-Right ventricular dysfunction, moderate-severe tricuspid regurgitation, low cardiac index, and raised right atrial pressure were associated with poor survival for both pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertensive disease patients. The severity of tricuspid regurgitation, myocardial performance index, presence of pericardial effusion, pulmonary vascular resistance, cardiac index, and right atrial pressure may be used to stratify risk of death. (Circ Cardiovasc Imaging. 2015;8:e002107.

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Morphologic and Functional Remodeling of the Right Ventricle in Pulmonary Hypertension by Real Time Three Dimensional Echocardiography

Cited by 46 publications

References 24 publications

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

Echocardiographic and Hemodynamic Predictors of Survival in Precapillary Pulmonary Hypertension

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