Right Ventricular Plasticity and Functional Imaging

Brittain, Evan L.; Hemnes, Anna R.; Keebler, Mary; Lawson, Mark V.; Byrd, Benjamin F.; DiSalvo, Thomas G.

doi:10.4103/2045-8932.101407

Cited by 24 publications

(19 citation statements)

References 190 publications

(296 reference statements)

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“…Patients in the lowest tertile at diagnosis had the greatest improvement in RVSWI after treatment, reflecting the well-described ability of the right ventricle to recover function with removal of load stress (18,19). Although signs and symptoms of RV dysfunction at diagnosis are often recognized by treating physicians, quantification of low RVSWI at diagnosis may help clinicians identify patients at risk for poor outcomes and the greatest potential benefit from aggressive therapy.…”

Section: Discussionmentioning

confidence: 97%

Prostanoids But Not Oral Therapies Improve Right Ventricular Function in Pulmonary Arterial Hypertension

Brittain

Pugh

Wheeler

et al. 2013

JACC: Heart Failure

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Objectives We hypothesized that RV stroke work index (RVSWI) and pulmonary capacitance (PC) would increase after treatment for pulmonary arterial hypertension (PAH) and that prostanoids would have a stronger effect than oral therapy. Background Right ventricular (RV) function is a major determinant of outcome in patients with PAH. Little is known about the response of RV function or its hemodynamic determinants to PAH-specific therapy. Methods We reviewed hemodynamic and health data on 58 patients from an institutional registry and analyzed changes in hemodynamics between diagnostic and first repeat catheterization after initiation of therapy for PAH. Results RVSWI and PC increased significantly after therapy (p = 0.007 and 0.02, respectively). Improvement in RV function was limited to patients treated with prostanoid-only therapy (p = 0.04); no improvement was found in patients treated with oral therapy (p = 0.25). Patients with the poorest baseline RV function (lowest tertile) had the greatest improvement post-therapy (p = 0.005 and < 0.001 vs. middle and highest tertiles). The major determinant of RVSWI was change in stroke volume (rs = 0.54, p < 0.001), indicating RVSWI is an accurate reflection of RV function. Conclusion RV function improves after therapy with regimens including prostanoids but not oral-only regimens. Patients with the least compensated RV function at diagnosis may derive the most benefit from therapy. Larger studies are needed to determine whether changes in RVSWI after therapy are associated with outcomes.

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Section: Discussionmentioning

confidence: 97%

Prostanoids But Not Oral Therapies Improve Right Ventricular Function in Pulmonary Arterial Hypertension

Brittain

Pugh

Wheeler

et al. 2013

JACC: Heart Failure

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“…9,31,32 Structurally, the healthy RV is an anterior, thin-walled, trabeculated, crescent-shaped structure with a complex geometry that wraps around the ellipsoid LV and has been delineated anatomically into the inlet, the trabeculated apex, and the infundibulum. The RV contracts in a peristolic ("bellows") motion, 9 which is the result of contraction from predominantly longitudinal muscle fibers. The structure and orientation of the RV in the anterior chest, as well as its unique shape, have made it challenging to fully characterize the RV by 2D echocardiography.…”

Section: Assessment Of Rv Structurementioning

confidence: 99%

“…This septal flattening may in turn negatively affect LV filling and RV perfusion from decreased peak LV pressures. 9 …”

Section: Abnormal Interventricular Wall Motion As a Sign Of Ventriculmentioning

confidence: 99%

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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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“…In humans, echocardiographic assessment of RV size and pulmonary hypertension is particularly challenging due to the retrosternal position and irregular shape of the RV 6 . Rodent models have the added challenges of small size and extremely rapid heart rates (300–700 beat/min).…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic Assessment of the Right Heart in Mice

Brittain

Penner

West

et al. 2013

JoVE

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Transgenic and toxic models of pulmonary arterial hypertension (PAH) are widely used to study the pathophysiology of PAH and to investigate potential therapies. Given the expense and time involved in creating animal models of disease, it is critical that researchers have tools to accurately assess phenotypic expression of disease. Right ventricular dysfunction is the major manifestation of pulmonary hypertension. Echocardiography is the mainstay of the noninvasive assessment of right ventricular function in rodent models and has the advantage of clear translation to humans in whom the same tool is used. Published echocardiography protocols in murine models of PAH are lacking. In this article, we describe a protocol for assessing RV and pulmonary vascular function in a mouse model of PAH with a dominant negative BMPRII mutation; however, this protocol is applicable to any diseases affecting the pulmonary vasculature or right heart. We provide a detailed description of animal preparation, image acquisition and hemodynamic calculation of stroke volume, cardiac output and an estimate of pulmonary artery pressure.

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Right Ventricular Plasticity and Functional Imaging

Cited by 24 publications

References 190 publications

Prostanoids But Not Oral Therapies Improve Right Ventricular Function in Pulmonary Arterial Hypertension

Prostanoids But Not Oral Therapies Improve Right Ventricular Function in Pulmonary Arterial 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)

Echocardiographic Assessment of the Right Heart in Mice

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