Utility of Right Ventricular Tei Index in the Noninvasive Evaluation of Chronic Thromboembolic Pulmonary Hypertension Before and After Pulmonary Thromboendarterectomy

Blanchard, Daniel G.; Malouf, Philip; Gurudevan, Swaminatha V.; Auger, William R.; Madani, Michael M.; Thistlethwaite, Patricia A.; Waltman, Thomas J.; Daniels, Lori B.; Raisinghani, Ajit; DeMaria, Anthony N.

doi:10.1016/j.jcmg.2008.10.012

Cited by 104 publications

(70 citation statements)

References 24 publications

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“…Although the isovolumic phases of IVCT and IVRT are slightly longer when measured by TDI versus pulsed Doppler, it has been shown that TDI-determined Tei index (Fig. 3a) correlates well with the Tei index determined by flow Doppler, and thus represents a simple method of assessing RV myocardial performance with the advantage of simultaneous recording of systolic and diastolic velocity patterns [85,86].…”

Section: Myocardial Imaging Echocardiographymentioning

confidence: 86%

Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography

Vitarelli

Terzano

2009

Heart Fail Rev

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RV performance is difficult to evaluate, given its geometry, interrelationship with the left ventricle, and sensitivity to alterations in pulmonary pressure. This article focuses on some of the challenges related to the assessment of RV function in the setting of the RV's unique anatomic, physiologic, conventional and newer echocardiographic aspects, and therapeutic implications. The majority of proposed methods of echocardiographic assessment of RV function are based on volumetric approximations of the RV. Such approaches have inherent limitations, first as volume-related measures such as EF are load dependent, second because of the complex geometry of the RV. The issue of RV geometry is usually overcome using geometry-independent parameters such as tricuspid annular excursion and the Tei index. The recent introduction of real-time three-dimensional echocardiography and myocardial imaging echocardiography (tissue Doppler imaging, 1D-strain and 2D-strain echocardiography) implied a great progress in echocardiography. Tissue Doppler imaging allows the quantitative assessment of RV systolic and diastolic function by means of measurement of myocardial velocities. Strain measurements have been shown to correlate well with sonomicrometry segment length measurements both in the inflow and outflow tract of the RV and under different loading conditions. Other findings have been reported in chronic and acute clinical settings. Standard and novel echocardiographic methods of assessment of RV size and performance can help clinicians in the treatment of acute and chronic RV failure and contribute to a better understanding of the peculiar chamber-related functional mechanisms in the context of ventricular interdependent independency.

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Section: Myocardial Imaging Echocardiographymentioning

confidence: 86%

Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography

Vitarelli

Terzano

2009

Heart Fail Rev

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“…Czernik et al [14] noted that RV MPI declined steadily in preterm non-BPD infants in the first 4 weeks, but remained elevated in those who subsequently developed BPD. It also correlates with PVR derived from invasive cardiac catheterisation [18]. TAPSE is a measure of RV contractile function and provides an estimate of longitudinal shortening [19,20].…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Infants with Bronchopulmonary Dysplasia: Association with Respiratory Sequelae

et al. 2016

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Background: While cor pulmonale has been noted in infants with bronchopulmonary dysplasia (BPD), information on right ventricular (RV) function is limited. Objective: To assess RV function in infants with severe BPD and ascertain correlation with respiratory outcomes. Methods: We prospectively assessed RV function using tissue Doppler imaging (TDI), 2D fractional area change (FAC), M-mode tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index (MPI) using echocardiography. Additionally, we compared RV function with preterm infants with no BPD. Results: Eighteen preterm infants with severe BPD were enrolled at 36 weeks' gestation. Higher E/E' (r = 0.78, p < 0.0001) and lower FAC (r = 0.8, p < 0.0001) showed strong correlations with the subsequent duration of respiratory support. Correlations with TDI isovolumic velocity and Tei index were significant (-0.69, p = 0.002 and 0.58, p = 0.011, respectively). On comparison with infants with no BPD, TDI peak systolic velocities (0.06 ± 0.01 vs. 0.09 ± 0.01 m/s, p < 0.0001), peak isovolumic systolic velocities (0.05 ± 0.009 vs. 0.07 ± 0.008 m/s, p < 0.0001) and RV FAC (31 ± 4.7 vs. 36 ± 3.6%, p = 0.019) were significantly lower. Cardiac relaxation was impaired [higher TDI E/E' ratio (9.6 ± 1.8 vs. 5.2 ± 0.5, p < 0.0001) and higher RV MPI (0.33 ± 0.03 vs. 0.25 ± 0.03, p < 0.0001)]. Conclusions: Impaired RV performance in the infants with severe BPD at 36 weeks' corrected gestation correlated with a longer duration of subsequent respiratory support.

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“…RVMPI has been evaluated for the assessment of LV and RV function in heart failure and PH. [26][27][28][30][31][32][33] Myocardial deformation parameters of the RV free wall, such as strain and strain rate, have been proposed as load-and heart motion-independent measures of RV function. [34][35][36] It has been suggested that echocardiographic indexes of RV function, including TAPSE, RVMPI, RVFAC, and IVA, are related to RV-PV coupling (E es /E a ) rather than to E es alone.…”

mentioning

confidence: 99%

Right Ventricle in Acute and Chronic Pulmonary Embolism (2013 Grover Conference Series)

2014

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Venous thromboembolism (VTE) encompasses deep-vein thrombosis and pulmonary embolism (PE). It is the third-most-frequent cardiovascular disease, with an overall annual incidence of 1-2 per 1,000 population. Chronic thromboembolic pulmonary hypertension (CTEPH) is regarded as a late sequela of PE, with a reported incidence varying between 0.1% and 9.1% of those surviving acute VTE. Right ventricular (RV) function is dependent on afterload. The most precise technique to describe RV function is invasive assessment of the RV-to-pulmonary vascular coupling. However, assessments of RV afterload (i.e., steady and pulsatile flow components and their product, the RC-time) may be useful hemodynamic surrogates of coupling. RV load is different in acute and chronic PE. In acute PE, more than 60% occlusion of the crosssectional area of the pulmonary artery within a short period of time leads to abrupt hemodynamic collapse. If the time of occlusion is limited to ∼15 seconds, significant decreases in fractional area change, tricuspid annulus systolic excursion, and RV free-wall deformation (strain) occur, with the latter showing significant postsystolic shortening. These changes have similarities to ischemic stunning, and they recover within minutes. In CTEPH, studies of pulmonary vascular resistance (PVR) and pulmonary arterial compliance demonstrated low RC-times that were further lowered after pulmonary endarterectomy (PEA). Immediate postoperative PVR was the only predictor of long-term survival/freedom from lung transplantation, suggesting that the effect of PEA on opening vascular territories to flow outweighs its effect on proximal stiffness. This review summarizes the current knowledge on vascular and intrinsic RV adaptation to VTE, including CTEPH, and the role of imaging.Keywords: right ventricle, hemodynamics, pulmonary heart disease, pulmonary embolism. Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism (PE).It is the third-most-frequent cardiovascular disease, with an overall annual incidence of 1-2 per 1,000 population. Chronic thromboembolic pulmonary hypertension (CTEPH) is regarded as a late sequela of PE. Right ventricular (RV) function is an important determinant of long-term outcome in patients with acute PE and CTEPH. In these conditions, the right ventricle (RV) is subjected to abnormal and increased loading that varies in timing, magnitude, and duration. Consequently, RV dysfunction and pulmonary hypertension (PH) are variably present at initial presentation of acute PE. After an episode of PE, pulmonary hemodynamics and RV function normalize within a few weeks in the majority of patients. CTEPH results from persistence of thrombotic obstructions in the pulmonary vasculature in the presence of significant positive and obliterative vascular remodeling and chronic elevation in pulmonary pressures. CTEPH leads to a progressive increase in RV afterload, causing RV dysfunction and eventually RV failure and death. The condition is underdiagnosed, and the true ...

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Utility of Right Ventricular Tei Index in the Noninvasive Evaluation of Chronic Thromboembolic Pulmonary Hypertension Before and After Pulmonary Thromboendarterectomy

Cited by 104 publications

References 24 publications

Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography

Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography

Right Ventricular Function in Infants with Bronchopulmonary Dysplasia: Association with Respiratory Sequelae

Right Ventricle in Acute and Chronic Pulmonary Embolism (2013 Grover Conference Series)

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