Right Ventricular Strain Curve Morphology and Outcome in Idiopathic Pulmonary Arterial Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and under-recognized complication of acute pulmonary embolism (PE). Forty consecutive patients with acute PE (Group 1), predominantly female (22, 55%) with a mean age of 69 ± 15 years, were matched for demographic data with 40 healthy subjects (Group 2), 40 systemic hypertension patients (Group 3) and 45 prevalent idiopathic pulmonary arterial hypertension (IPAH) patients (Group 4). The baseline evaluation included physical examination, NYHA/WHO functional class, right heart catheterization (RHC) limited to IPAH patients, echocardiographic assessment and systemic arterial stiffness measurement by cardio-ankle vascular index (CAVI). Patients with PE underwent an echocardiographic evaluation within 1 month from hospital discharge (median 27 days; IQR 21–30) to assess the echo-derived probability of PH. The CAVI values were significantly higher in the PE and IPAH groups compared with the others (Group 1 vs. Group 2, p < 0.001; Group 1 vs. Group 3, p < 0.001; Group 1 vs. Group 4, p = ns; Group 4 vs. Group 2, p < 0.001; Group 4 vs. Group 3, p < 0.001; Group 2 vs. Group 3, p = ns). The predicted probability of echocardiography-derived high-risk criteria of PH increases for any unit increase of CAVI (OR 9.0; C.I.3.9–20.5; p = 0.0001). The PE patients with CAVI ≥ 9.0 at the time of hospital discharge presented an increased probability of PH. This study highlights a possible positive predictive role of CAVI as an early marker for the development of CTEPH.

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“…Intraobserver and interobserver variability for echocardiographic measurements was previously reported by our group [ 26 , 27 , 28 , 29 , 30 ].…”

Section: Methodsmentioning

confidence: 71%

Peripheral Arterial Stiffness in Acute Pulmonary Embolism and Pulmonary Hypertension at Short-Term Follow-Up

Papa

Miotti

Manzi

et al. 2021

JCM

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“…Speckle tracking echocardiography has more recently emerged and shown promising RV contractility evaluation results. Although regional and global 2D strains are load and angle-dependent measurements [42], several clinical studies in pulmonary hypertension have shown their prognostic value with an acceptable inter and intraobserver variability [43]. In systemic RV, the prognostic value of 2D strain may be limited by the great heterogeneity in terms of RV shape.…”

Section: Discussionmentioning

confidence: 99%

Reliability of echocardiographic parameters of the systemic right ventricle systolic function: A prospective multicentre study

Pommier

Bredy

Abassi

et al. 2021

Archives of Cardiovascular Diseases Supplements

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Background: Systemic right ventricle (RV) is a rare and complex form of congenital heart disease (CHD) with a prognosis related to RV dysfunction and impaired physical capacity. Routine follow-up relies on echocardiography, however the prognostic value of echocardiography parameters remains under debate. Real-life patient follow-up involves different ultrasound systems. We aimed to evaluate echocardiography parameters' reliability in systemic RV, in terms of reproducibility, using vendor-independent software, and in terms prediction of physical capacity impairment. Methods: Adult patients with D-transposition of the great artery (d-TGA) who underwent atrial switch or with congenitally corrected TGA (cc-TGA) were included in this multicentre prospective study. Current echocardiography parameters were analysed using TomTec-Arena™ software. Intraclass correlation coefficients (ICC) assessed inter-and intraobserver reliability. Associations between the most reproducible echocardiography parameters and exercise capacity (peak VO2, VE/VCO2 slope) were explored. Results: A total of 47 patients were included in the study (87% d-TGA, median age 36.4 AE 8 years). Conventional and 2D strain echocardiography parameters indicated the existence of a RV dysfunction (TAPSE ¼ 12.8 AE 3.1 mm; RV free wall longitudinal 2D strain ¼ -13.6 AE 3.9%). Good reproducibility (ICC>0.75) for both intra and interobserver variability was observed in 8 RV echocardiography parameters. Only the TAPSE was significantly associated with peak VO2 (r ¼ 0.4, P ¼ 0.02). Conclusions: In this prospective study mimicking real-life echocardiography follow-up of systemic RV, TAPSE, RV free wall longitudinal 2D strain and peak systolic S wave, were the most reproducible echocardiography parameters. However, only the TAPSE was associated with peak VO2.

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“…Moreover, a recent meta-analysis confirmed that the global RV LSS measured using 3D and 2D echocardiography has potential as a predictor of survival in patients with PH [58]. Recently, RV-strain-derived post-systolic patterns that reflect the RV diastolic function have been identified to be clinically meaningful and increase the prognostic power for clinical worsening [59].…”

Section: Echocardiographic Evaluation Of Right Ventricular Function and Its Prognostic Relevance In Pahmentioning

confidence: 95%

Echocardiography in Pulmonary Arterial Hypertension: Is It Time to Reconsider Its Prognostic Utility?

Farmakis

Demerouti

Karyofyllis

et al. 2021

JCM

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Pulmonary arterial hypertension (PAH) is characterized by an insult in the pulmonary vasculature, with subsequent right ventricular (RV) adaptation to the increased afterload that ultimately leads to RV failure. The awareness of the importance of RV function in PAH has increased considerably because right heart failure is the predominant cause of death in PAH patients. Given its wide availability and reduced cost, echocardiography is of paramount importance in the evaluation of the right heart in PAH. Several echocardiographic parameters have been shown to have prognostic implications in PAH; however, the role of echocardiography in the risk assessment of the PAH patient is limited under the current guidelines. This review discusses the echocardiographic evaluation of the RV in PAH and during therapy, and its prognostic implications, as well as the potential significant role of repeated echocardiographic assessment in the follow-up of patients with PAH.

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Right Ventricular Strain Curve Morphology and Outcome in Idiopathic Pulmonary Arterial Hypertension

Cited by 37 publications

References 22 publications

Peripheral Arterial Stiffness in Acute Pulmonary Embolism and Pulmonary Hypertension at Short-Term Follow-Up

Peripheral Arterial Stiffness in Acute Pulmonary Embolism and Pulmonary Hypertension at Short-Term Follow-Up

Reliability of echocardiographic parameters of the systemic right ventricle systolic function: A prospective multicentre study

Echocardiography in Pulmonary Arterial Hypertension: Is It Time to Reconsider Its Prognostic Utility?

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