Right ventricular relative wall thickness as a predictor of outcomes and of right ventricular reverse remodeling for patients with pulmonary hypertension

Sano, Hiroyuki; Tanaka, Hidekazu; Motoji, Yoshiki; Fukuda, Yuko; Mochizuki, Yasuhide; Hatani, Yutaka; Matsuzoe, Hiroki; Hatazawa, Keiko; Shimoura, Hiroyuki; Ooka, Junichi; Ryo-Koriyama, Keiko; Nakayama, Keiichi I.; Matsumoto, Kensuke; Emoto, Noriaki; Hirata, Ken‐ichi

doi:10.1007/s10554-016-1004-z

Cited by 17 publications

(20 citation statements)

References 33 publications

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“…Results of off-line readings were forwarded to an external contract research organisation in order to merge with the clinical data of the riociguat trials. A clinically significant improvement of right heart size was defined as a ≥ 15% reduction RA or RV area [12].…”

Section: Methodsmentioning

confidence: 99%

Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study)

Marra

Halank²,

Benjamin

et al. 2018

Respir Res

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BackgroundRiociguat is a soluble guanylate cyclase stimulator approved for pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTPEH). The objective of this study was to evaluate right heart size and function assessed by echocardiography during long term treatment with riociguat.MethodsPatients who started riociguat treatment (1.0–2.5 mg tid) within the trials phase II, PATENT, PATENTplus, EAS, CHEST and continued treatment for 3–12 months were included in this study. Echocardiography was analysed off-line at baseline, after 3, 6 and 12 months by investigators who were blinded to clinical data. Last and baseline observation carried forward method (LOCF, BOCF) were performed as sensitivity analysis.ResultsSeventy-one patients (45% PAH, 55% CTEPH; 53.5% female; 60 ± 13 years, mean pulmonary arterial pressure 46 ± 10 mmHg, mean PVR 700 ± 282dynes·sec·cm-5) were included. After 6 months, RA and RV area, RV thickness tricuspid regurgitation velocity showed a significant reduction. After 12 months, patients receiving riociguat therapy showed a significant reduction in right atrial (− 2.6 ± 4.4 cm2, 95% CI -3.84, − 1.33; p < 0.001, n = 49) and right ventricular (RV) area (− 3.5 ± 5.2 cm2, 95% CI -5.1, − 1.9; p < 0.001; n = 44), RV thickness (− 0.76 ± 2.2 mm, 95% CI -1.55, 0.03; n = 32), and a significant increase in TAPSE (2.95 ± 4.78 mm, 95% CI 1.52, 4.39; n = 45) and RV fractional area change (8.12 ± 8.87 mm, 95% CI 4.61, 11.62; n = 27).Both LOCF and BOCF showed similar results but lower effect sizes.ConclusionPatients under long-term treatment with riociguat show significantly reduced right heart size and improved RV function in PAH and CTEPH. Further controlled prospective studies are needed to confirm these results.

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Section: Methodsmentioning

confidence: 99%

Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study)

Marra

Halank²,

Benjamin

et al. 2018

Respir Res

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“…The high afterload then leads to further CO reduction and compensatory RV dilation, while maladaptive RV remodeling causes further thinning due to wall stretching, resulting in a vicious cycle and RV dysfunction. Our group recently reported that RV‐RWT is an independent parameter for predicting mid‐term RV reverse remodeling, and is associated with long‐term posttreatment survival of PH patients . Moreover, incremental changes in RV‐RWT proved to be of significant value for prediction of survival, and the combined assessment of RV‐RWT and mid‐term RV reverse remodeling resulted in more accurate prediction of outcome for PH patients.…”

Section: Discussionmentioning

confidence: 96%

“…Standard echocardiographic measurements were obtained according to the current guidelines of the American Society of Echocardiography/European Association of Cardiovascular Imaging . In addition, the assessment of RV relative wall thickness (RV‐RWT) was calculated from RV free wall thickness/basal RV linear dimensions at end‐diastole according to the current guidelines of the American Society of Echocardiography/European Association of Cardiovascular Imaging . Digital data were transferred to dedicated offline software (EchoPAC version BTO8; GE Vingmed Ultrasound AS) for subsequent offline speckle‐tracking analysis.…”

Section: Methodsmentioning

confidence: 99%

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Echocardiography during preload stress for evaluation of right ventricular contractile reserve and exercise capacity in pulmonary hypertension

et al. 2018

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Objectives Pulmonary hypertension (PH) is characterized by marked and sustained elevation of pulmonary vascular resistance and pulmonary artery pressure, and subsequent right‐sided heart failure. Right ventricular (RV) function and exercise capacity have been recognized as important prognostic factors for PH. Our aim was to investigate RV contractile reserve and exercise capacity during a leg‐positive pressure (LPP) maneuver. Methods The study population comprised 43 PH patients and 17 normal controls. All patients underwent echocardiography at rest and during LPP stress. Exercise capacity was assessed by 6‐minute walk distance for PH patients. RV relative wall thickness was calculated from dividing by RV free wall thickness by basal RV linear dimensions at end‐diastole. RV function was calculated by averaging peak speckle‐tracking longitudinal strain from the RV free wall. RV contractile reserve was assessed as the difference in RV free wall strain at rest and during LPP stress. Changes in left ventricular stroke volume (ΔSV) during LPP stress were also calculated. Results ΔSV and RV contractile reserve of PH patients were significantly lower than of controls (3.6 ± 6.0 mL vs 8.5 ± 2.3 mL, and 8.2 ± 11.9% vs 14.5 ± 6.6%; both P < 0.01). RV contractile reserve of PH patients with ΔSV <3.3 mL was significantly lower than of PH patients with ΔSV >3.3 mL (3.9 ± 13.2% vs 12.3 ± 8.9%; P = 0.02). ΔSV had also significant correlation with 6‐minute walk distance (r = 0.42, P = 0.006). Multivariate regression analysis showed that RV relative wall thickness was an independent determinant parameter of ΔSV during LPP stress for PH patients (β = 3.2, P = 0.003). Conclusions Preload stress echocardiography in response to LPP maneuver, a noninvasive and easy‐to‐use procedure for routine clinical use, proved to be useful for the assessment of RV contractile reserve and exercise capacity of PH patients.

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“…Lastly prior studies have demonstrated RV size and function to be a critical prognostic indicator in pulmonary arterial hypertension (PAH) and congenital heart disease. 7,8,9,10 Despite the role of the RV in stratification of prognosis, non-invasive evaluation of the RV remains challenging due to several key anatomic factors.…”

Section: Right Ventricle Backgroundmentioning

confidence: 99%

Multimodality Imaging of the Right Ventricle

Abouzeid

Shah

Johri

et al. 2017

Curr Treat Options Cardio Med

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Opinion Statement Right ventricular (RV) structure and function is clinically important in a wide range of conditions. While conventional echocardiography (echo) methods are widely used, its limitations in RV assessment due its complex geometry are well recognized. New applications of traditional echo methods as well as emerging echo techniques including 3-dimensional (3D) echo and speckle tracking strain have the potential to overcome limitations of conventional echo though widespread clinical use remains to be seen. Volumetric methods using cardiac magnetic resonance (CMR) and computed tomography (CT) provide accurate assessment of RV function without geometric assumptions. In addition, tissue characterization imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV beyond structure and function alone and has clinical applications for diagnosis and prognosis in a broad range of pathologies. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. The complementary role of each modality for the RV as well as emerging evidence for the use of each imaging method in diagnosis and management of RV pathologies are outlined in this study.

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Right ventricular relative wall thickness as a predictor of outcomes and of right ventricular reverse remodeling for patients with pulmonary hypertension

Cited by 17 publications

References 33 publications

Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study)

Right ventricular size and function under riociguat in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (the RIVER study)

Echocardiography during preload stress for evaluation of right ventricular contractile reserve and exercise capacity in pulmonary hypertension

Multimodality Imaging of the Right Ventricle

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