Right Ventricular Function in Heart Failure With Preserved Ejection Fraction

Mohammed, Selma F.; Hussain, Imad; AbouEzzeddine, Omar F.; Takahama, Hiroyuki; Kwon, Susan H.; Forfia, Paul R.; Roger, Véronique L.; Redfield, Margaret M.

doi:10.1161/circulationaha.113.008461

Cited by 405 publications

(325 citation statements)

References 43 publications

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“…20 We also quantified right ventricular function by calculating right ventricular fractional area change (RV FAC) and tricuspid annular plane systolic excursion (TAPSE). 17 Right ventricular function was categorized as reduced if RV FAC was <35%.…”

Section: Right Ventricular Function and Rv-pa Couplingmentioning

confidence: 99%

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

et al. 2016

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Pulmonary pulse wave transit time (pPTT), defined as the time for the systolic pressure pulse wave to travel from the pulmonary valve to the pulmonary veins, has been reported to be reduced in pulmonary arterial hypertension (PAH); however, the underlying mechanism of reduced pPTT is unknown. Here, we investigate the hypothesis that abbreviated pPTT in PAH results from impaired right ventricular-pulmonary artery (RV-PA) coupling. We quantified pPTT using pulsed-wave Doppler ultrasound from 10 healthy age-and sexmatched controls and 36 patients with PAH. pPTT was reduced in patients with PAH compared with controls. Univariate analysis revealed the following significant predictors of reduced pPTT: age, right ventricular fractional area change (RV FAC), tricuspid annular plane excursion (TAPSE), pulmonary arterial pressures (PAP), diastolic pulmonary gradient, transpulmonary gradient, pulmonary vascular resistance, and RV-PA coupling (defined as RV FAC/mean PAP or TAPSE/mean PAP). Although the correlations between pPTT and invasive markers of pulmonary vascular disease were modest, RV FAC (r = 0.64, P < 0.0001), TAPSE (r = 0.67, P < 0.0001), and RV-PA coupling (RV FAC/mean PAP: r = 0.72, P < 0.0001; TAPSE/mean PAP: r = 0.74, P < 0.0001) had the strongest relationships with pPTT. On multivariable analysis, only RV FAC, TAPSE, and RV-PA coupling were independent predictors of pPTT. We conclude that shortening of pPTT in patients with PAH results from altered RV-PA coupling, probably occurring as a result of reduced pulmonary arterial compliance. Thus, pPTT allows noninvasive determination of the status of both the pulmonary vasculature and the response of the RV in patients with PAH, thereby allowing monitoring of disease progression and regression.Keywords: pulse wave velocity, right ventricular-pulmonary artery coupling, echocardiography. Pulmonary arterial hypertension (PAH) is a lethal disease, characterized by pathological pulmonary vascular remodeling, that leads to elevated pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR), decreased pulmonary arterial compliance, and eventual right ventricular failure and death.1,2 Growing evidence suggests that pulmonary arterial compliance plays a critical role in the pathogenesis of PAH and right ventricular failure. 3 Decreased pulmonary arterial compliance causes premature reflection of waves from the distal pulmonary vasculature, leading to increased pulsatile right ventricular afterload and altered right ventricular-pulmonary artery (RV-PA) coupling. 3-5 Both loss of pulmonary arterial compliance and impaired RV-PA coupling are clinically important, because they are associated with increased mortality in patients with pulmonary hypertension. 6-11Pulse wave velocity, defined as the velocity of pressure waves traveling through the arterial system, correlates inversely with arterial compliance in the systemic circulation.12 With decreasing compliance, pulse wave velocity increases, and the time taken by the pressure wave to travel between...

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Section: Right Ventricular Function and Rv-pa Couplingmentioning

confidence: 99%

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

et al. 2016

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“…1 We agree that tricuspid annular plane systolic excursion (TAPSE), like any method of cardiac shortening (LV ejection fraction, RV ejection fraction, etc), is load dependent and influenced by RV afterload, a parameter related to but inadequately reflected by pulmonary artery systolic pressure (PASP). To address these limitations, we adjusted all analyses of the prognostic implications of RV dysfunction (by TAPSE or semiquantitative assessment) for PASP.…”

Section: Correspondencementioning

confidence: 67%

“…Therefore, we have also incorporated semiquantitative assessment of RV function into our analysis. 1 In terms of superiority of semiquantitative RV function assessment compared with TAPSE, we also find this intriguing. We speculate that integrative assessment of RV contractility in different vectors captures more information on RV function than a single measure of longitudinal excursion and, when abnormal, likely reflects more significant RV dysfunction.…”

mentioning

confidence: 69%

Response to Letter Regarding Article, “Right Ventricular Function in Heart Failure With Preserved Ejection Fraction: A Community-Based Study”

2015

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CorrespondenceWe thank Dr Guazzi for his interest in and insightful comments about our study of right ventricular (RV) dysfunction in heart failure (HF) with preserved ejection fraction. 1 We agree that tricuspid annular plane systolic excursion (TAPSE), like any method of cardiac shortening (LV ejection fraction, RV ejection fraction, etc), is load dependent and influenced by RV afterload, a parameter related to but inadequately reflected by pulmonary artery systolic pressure (PASP). To address these limitations, we adjusted all analyses of the prognostic implications of RV dysfunction (by TAPSE or semiquantitative assessment) for PASP.1 The TAPSE/PASP ratio is another method to assess the interaction of RV function and afterload and had prognostic value in HF of both types.2 Indeed, in our study, TAPSE and PASP were each associated with poor prognosis, with the combination of the worst tertiles of each conferring the worst prognosis.1 Similarly, when we analyzed data by the TAPSE/PASP ratio, the lowest TAPSE/ PASP tertile (ratio ≤0.3) had the worst survival (79% mortality at 8 years). Of note, our findings are consistent with those of a smaller study that assessed the relationship between RV fractional area change and invasively measured PASP in HF with preserved ejection fraction.3 These findings are also in agreement with the outcomes of the lowest TAPSE/PASP ratio group observed by Guazzi et al. 2As we have emphasized in our article, because of challenges with RV function assessment, no single parameter of RV function will likely adequately quantify the complexity of RV contractility. Therefore, we have also incorporated semiquantitative assessment of RV function into our analysis.1 In terms of superiority of semiquantitative RV function assessment compared with TAPSE, we also find this intriguing. We speculate that integrative assessment of RV contractility in different vectors captures more information on RV function than a single measure of longitudinal excursion and, when abnormal, likely reflects more significant RV dysfunction. TAPSE may be an earlier but less specific measure of RV dysfunction in HF with preserved ejection fraction.We clarify that we have only used 2-dimensional TAPSE (ie, we have not combined 2-dimensional and M-mode measurements). We acknowledge that echocardiography is operator and subject dependent and that technical challenges may limit the accuracy and prognostic value of echocardiographic variables. Nonetheless, adjusted for PASP and clinical factors, the presence of RV dysfunction was potently associated with adverse events, including mortality, cardiovascular mortality, and first or total HF hospitalizations in HF with preserved ejection fraction. DisclosuresNone. Selma F. Mohammed, MBBS, PhDDivision

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“…14 Previous studies have reported that RV dysfunction is associated with worse clinical outcomes in patients with chronic systolic heart failure, 14 ventricular tachycardia, 21 implantable cardioverter defibrillators, 22 acute decompensated heart failure, 23 or heart failure with preserved EF, 24 implying that RV dysfunction is a sign of disease progression.…”

Section: Mechanism Of Rv Dysfunction In Ticmentioning

confidence: 99%

Diagnostic Value of Right Ventricular Dysfunction in Tachycardia-Induced Cardiomyopathy Using Cardiac Magnetic Resonance Imaging

Okada

Nakajima

Morita

et al. 2016

Circ J

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Background: Predicting tachycardia-induced cardiomyopathy (TIC) in patients presenting with left ventricular (LV) dysfunction and tachyarrhythmias remains challenging. We assessed the diagnostic value of early right ventricular (RV) dysfunction to predict TIC using cardiac magnetic resonance (CMR) imaging. Methods and Results:A total of 102 consecutive patients with newly diagnosed LV dysfunction and atrial tachyarrhythmias were examined. Patients whose LV ejection fraction (EF) improved to ≥50% during a 1-year follow-up were diagnosed with TIC, and with dilated cardiomyopathy (DCM) in those whose did not improve. CMR was performed at a median of 23 days after admission, and the TIC and DCM patients exhibited different distributions of EF and end-diastolic volume (EDV) between the LV and RV (both P<0.001, ANCOVA). TIC patients had significantly lower RVEF/LVEF ratio (1.01±0.23 vs. 1.36±0.31, P<0.001) and higher RVEDV/LVEDV ratio (0.96±0.21 vs. 0.73±0.19, P<0.001) compared with DCM patients, suggesting that RV systolic dysfunction and RV dilatation were observed in TIC. In the multivariate analysis, age, RVEF/LVEF ratio, and RVEDV/LVEDV ratio were significant predictors of TIC, and RVEF/LVEF ratio of <1.05 most highly predicted TIC with a sensitivity of 69.1% and specificity of 91.5% (area under the curve 0.860). Conclusions:Among patients with newly diagnosed LV dysfunction and atrial tachyarrhythmias, age and coexistence of RV dysfunction was a strong predictor of TIC. (Circ J 2016; 80: 2141 -2148

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Right Ventricular Function in Heart Failure With Preserved Ejection Fraction

Cited by 405 publications

References 43 publications

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

Pulmonary Pulse Wave Transit Time is Associated with Right Ventricular–Pulmonary Artery Coupling in Pulmonary Arterial Hypertension

Response to Letter Regarding Article, “Right Ventricular Function in Heart Failure With Preserved Ejection Fraction: A Community-Based Study”

Diagnostic Value of Right Ventricular Dysfunction in Tachycardia-Induced Cardiomyopathy Using Cardiac Magnetic Resonance Imaging

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