Right heart size and function significantly correlate in patients with pulmonary arterial hypertension – a cross-sectional study

Fischer, Lukas; Benjamin, Nicola; Blank, Norbert; Egenlauf, Benjamin; Fischer, Christine; Harutyunova, Satenik; Koegler, Maria; Lorenz, H.-M.; Marra, A; Nagel, Christian; Xanthouli, Panagiota; Bossone, Eduardo; Grünig, Ekkehard

doi:10.1055/s-0039-1677985

Cited by 4 publications

(10 citation statements)

References 16 publications

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“…Finding specific changes in dimensions of the heart over the course of PAH may improve the diagnosis and treatment process and contribute to preventing or delaying PAH complications [10]. Moreover, this knowledge may also help to better understand the pathophysiology of PAH and heart failure.…”

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confidence: 99%

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model

et al. 2020

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Background: Aim of this study was to assess changes in cardiac morphometric parameters at different stages of pulmonary arterial hypertension (PAH) using a monocrotaline-induced rat model. Methods: Four groups were distinguished: I-control, non-PAH (n = 18); II-early PAH (n = 12); III-end-stage PAH (n = 23); and IV-end-stage PAH with myocarditis (n = 7).Results: Performed over the course of PAH in vivo echocardiography showed significant thickening of the right ventricle free wall (end-diastolic dimension), tricuspid annular plane systolic excursion reduction and decrease in pulmonary artery acceleration time normalized to cycle length. No differences in end-diastolic left ventricle free wall thickness measured in echocardiography was observed between groups. Significant increase of right ventricle and decrease of left ventricle systolic pressure was observed over the development of PAH. Thickening and weight increase (241.2% increase) of the right ventricle free wall and significant dilatation of the right ventricle was observed over the course of PAH (p < 0.001). Reduction in the left ventricle free wall thickness was also observed in end-stage PAH (p < 0.001). Significant trend in the left ventricle free wall weight decrease was observed over the course of PAH (p < 0.001, 24.3% reduction). Calculated right/left ventricle free wall weight ratio gradually increased over PAH stages (p < 0.001). The reduction of left ventricle diameter was observed in rats with end-stage PAH both with and without myocarditis (p < 0.001).Conclusions: PAH leads to multidimensional changes in morphometric cardiac parameters. Right ventricle morphological and functional failure develop gradually from early stage of PAH, while left ventricle changes develop at the end stages of PAH.

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confidence: 99%

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model

et al. 2020

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“…Of the 913 records initially identified, 56 23–78 studies with a total of 1730 patients were included in the qualitative synthesis (Figure 1). Of these 56 studies, 23 23–45 studied subpulmonary RV reserve in patients with repaired TOF, 19 46–64 assessed systemic RV reserve, and 14 65–78 assessed subpulmonary RV reserve with or without RV‐pulmonary arterial coupling in patients with PAH.…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacologic stress with continuous infusion of incremental dose of dobutamine was employed in 22 studies 23–33,46–52,65–68 . On the other hand, exercise stress with either bicycle 34–45,53–64,69–76 or treadmill exercise testing 77,78 was used in 34 studies.…”

Section: Resultsmentioning

confidence: 99%

“…Cardiac magnetic resonance was used to measure RV volumes, 26–28,30,31,41,43,48–52,54,56,58,59,68,72 FAC, 42 EF, 27,30–33,41,43,48–52,56,59,68,72 cardiac index, 27,29,42,49,51,58,68 wall thickening and motion, 57 and RNA had been used to quantify RV EF 60–64,78 . Right heart catheterization provided measurements of RV cardiac output, end‐systolic and ‐diastolic pressures and elastance, 33,44,45,65 and pulmonary arterial haemodynamics 44,45,65,67,69,73–76 …”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies, 65–78 which included 558 patients with PAH, assessed subpulmonary RV functional reserve and pulmonary vascular reserve during stress (Table 3). The mean age of patients ranged from 38 to 57 years.…”

Section: Resultsmentioning

confidence: 99%

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Systolic and diastolic functional reserve of the subpulmonary and systemic right ventricles as assessed by pharmacologic and exercise stress: A systematic review

Cheng

Cheung

2022

Echocardiography

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We performed a systematic review of the literature on the assessment of subpulmonary and systemic right ventricular (RV) functional reserve during pharmacological and exercise stress in congenital heart patients and patients with pulmonary arterial hypertension (PAH). Literature search was conducted using PubMed, EMBASE, and MEDLINE from their inception up to August 2020. Of 913 records identified, 56 studies with a total of 1730 patients were included. Of the 56 studies, 23 assessed subpulmonary RV functional reserve in repaired tetralogy of Fallot patients, 19 assessed systemic RV reserve in patients with transposition of the great arteries (TGA) after atrial switch and those with congenitally corrected TGA, and 14 assessed subpulmonary RV research in patients with PAH. Pharmacological and exercise stress was used, respectively, in 22 and 34 studies. The main findings were (1) impairment of RV systolic and diastolic functional reserve, (2) associations between impaired functional reserve and worse baseline functional parameters, and (3) prognostic implications of RV systolic functional reserve on clinical outcomes in patients with volume and/or pressure‐loaded subpulmonary and systemic right ventricles. Further studies are required to establish the incremental value of incorporating stress studies of RV systolic and diastolic function in the clinical management algorithm of congenital heart patients and patients with PAH.

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Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

et al. 2022

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Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are progressive diseases that can lead to right heart failure and death. Right ventricular dysfunction, hypertrophy and maladaptive remodelling are consequences of increased right ventricular (RV) afterload in PAH and CTEPH and are indicative of long-term outcomes. Because RV failure is the main cause of morbidity and mortality in PAH and CTEPH, successful treatments should lead to improvements in RV parameters. Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of PAH and inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy. This review examines the current evidence showing the effect of riociguat on the right ventricle, with particular focus on remodelling, function and structural parameters in preclinical models and patients with PAH or CTEPH.

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Right heart size and function significantly correlate in patients with pulmonary arterial hypertension – a cross-sectional study

Cited by 4 publications

References 16 publications

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model

Systolic and diastolic functional reserve of the subpulmonary and systemic right ventricles as assessed by pharmacologic and exercise stress: A systematic review

Riociguat and the right ventricle in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

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