Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension

Wolferen, S A van; Marcus, J. Tim; Boonstra, Anco; Marques, Koen M.; Bronzwaer, Jean G.F.; Spreeuwenberg, Marieke; Postmus, Pieter E.; Vonk‐Noordegraaf, Anton

doi:10.1093/eurheartj/ehl477

Cited by 669 publications

(604 citation statements)

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“…another reason could be the rV hypertrophy in patients with PH [right ventricular mass index (rVMi), 32 ± 16 g/m 2 ] compared to healthy subjects and to patients with volume loaded rVs (rVMi , 22 ± 15 g/m 2 , previously unpublished data) [11]. The rV hypertrophy in our study is in concordance with earlier studies [6,34]. This suggests, that the remodeling of the rV in PH patients may differ compared to patients with volume loaded rVs.…”

Section: Resultssupporting

confidence: 91%

“…rV function and stroke volume (SV) are of prognostic value in these patients [2,[4][5][6]. SV is generated from different regional contributions of ventricular function; the longitudinal component caused by longitudinal shortening and atrioventricular plane displacement (aVPD) as well as the radial inward motion of the epicardial walls [7].…”

Section: Introductionmentioning

confidence: 99%

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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: 91%

Section: Introductionmentioning

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

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“…We corrected our MRI parameters where appropriate for body surface area (BSA), as reported elsewhere in the literature. 1 …”

Section: Mri Acquisitionmentioning

confidence: 99%

Longitudinal and Transverse Right Ventricular Function in Pulmonary Hypertension: Cardiovascular Magnetic Resonance Imaging Study from the ASPIRE Registry

et al. 2015

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Right ventricular (RV) function is a strong predictor of outcome in cardiovascular diseases. Two components of RV function, longitudinal and transverse motion, have been investigated in pulmonary hypertension (PH). However, their individual clinical significance remains uncertain. The aim of this study was to determine the factors associated with transverse and longitudinal RV motion in patients with PH. In 149 treatment-naive patients with PH and 16 patients with suspected PH found to have mean pulmonary arterial pressure of <20 mmHg, cardiovascular magnetic resonance imaging was performed within 24 hours of right heart catheterization. In patients with PH, fractional longitudinal motion (fractional tricuspid annulus to apex distance [f-TAAD]) was significantly greater than fractional transverse motion (fractional septum to free wall distance [f-SFD]; P = 0.002). In patients without PH, no significant difference between f-SFD and f-TAAD was identified (P = 0.442). Longitudinal RV motion was singularly associated with RV ejection fraction independent of age, invasive hemodynamics, and cardiac magnetic resonance measurements (P = 0.024). In contrast, transverse RV motion was independently associated with left ventricular eccentricity (P = 0.036) in addition to RV ejection fraction (P = 0.014). In conclusion, RV motion is significantly greater in the longitudinal direction in patients with PH, whereas patients without PH have equal contributions of transverse and longitudinal motion. Longitudinal RV motion is primarily associated with global RV pump function in PH. Transverse RV motion not only reflects global pump function but is independently influenced by ventricular interaction in patients with PH.Keywords: pulmonary hypertension, magnetic resonance imaging, right ventricle. Right ventricular (RV) dysfunction is considered a key determinant of adverse outcomes in several cardiopulmonary disease states. RV dilatation 1-3 and progressive reduction in RV ejection fraction (RVEF) predicts mortality in patients with pulmonary arterial hypertension (PAH). 1,3 In addition, RV dysfunction predicts mortality in patients following myocardial infarction 4,5 and in nonischemic cardiomyopathy. 6 The transverse and longitudinal components of RV function have been studied previously in patients with pulmonary hypertension (PH). 7,8 However, there are conflicting data regarding the importance of transverse and longitudinal shortening in relation to global RV function in PH. Longitudinal shortening measured using tricuspid annular plane systolic excursion (TAPSE) has been shown to be a strong predictor of adverse outcomes in patients with PH, 9,10 and it has been postulated that longitudinal motion, rather than transverse motion, is the main determinant of RVEF in both healthy subjects and patients with PH. 8 In direct contrast, Kind et al. 7 demonstrated a stronger association between transverse RV motion and RVEF than between longitudinal RV motion and RVEF in patients with PH. Moreover, Mauritz et al. 11 identi...

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“…Cardiac MRI can be used to assess RV ejection fraction (RVEF) [7]. A decreased stroke volume, increased RV end-diastolic volume and decreased RVEF at MRI predict a poor outcome in patients with PAH [5,8,9]. However, cardiac MRI is not widely available in all centres, and its use may be limited by intensive and time-consuming data acquisition and analysis, with significant technical support and expertise needed.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension

et al. 2014

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Right ventricle ejection fraction (RVEF) evaluated with magnetic resonance imaging is a strong determinant of patient outcomes in pulmonary arterial hypertension. We evaluated the prognostic value of RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change 3-6 months after initiating pulmonary arterial hypertension-specific therapy.In a prospective cohort of newly diagnosed patients with idiopathic, heritable or anorexigen-associated pulmonary arterial hypertension, RVEF was measured at baseline (n=100) and 3-6 months after initiation of therapy (n=78). After a median follow-up of 4.1 years, 41 deaths occurred, including 35 from cardiovascular causes. Patients with a (median) baseline RVEF >25% had better survival than those with a RVEF <25% using Kaplan-Meier analysis ( p=0.010). RVEF at baseline was an independent predictor of all-cause and cardiovascular mortality in adjusted Cox regression model ( p=0.002 and p=0.007, respectively; HR 0.93 for both). Patients with stable or increased RVEF at 3-6 months had a trend for improved all-cause survival (HR 2.43, p=0.086) and had less cardiovascular mortality (HR 3.25, p=0.034) than those in whom RVEF decreased despite therapy.RVEF assessed with conventional planar equilibrium radionuclide angiography at baseline and change in RVEF 3-6 months after therapy initiation independently predict outcomes in patients with pulmonary arterial hypertension. @ERSpublications RVEF assessed with CPERA at baseline, and its changes on therapy, independently predict outcome in patients with PAH http://ow.ly/DsCS4

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Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension

Cited by 669 publications

References 40 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

Longitudinal and Transverse Right Ventricular Function in Pulmonary Hypertension: Cardiovascular Magnetic Resonance Imaging Study from the ASPIRE Registry

Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension

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