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Kimura K, Daimon M, Morita H, Kawata T, Nakao T, Okano T, Lee SL, Takenaka K, Nagai R, Yatomi Y, Komuro I. Evaluation of Right Ventricle by Speckle Tracking and Conventional Echocardiography in Rats With Right Ventricular Heart Failure. Int Heart J 2015; 56:349-53. [DOI: 10.1536/ihj.14-367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Koichi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masao Daimon
- Department of Laboratory Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Translational Research for Healthcare and Clinical Science, Graduate School of Medicine, The University of Tokyo
| | - Takayuki Kawata
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tomoko Nakao
- Department of Laboratory Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tomoko Okano
- Department of Laboratory Medicine, Graduate School of Medicine, The University of Tokyo
| | - Seitetsu L. Lee
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsu Takenaka
- Department of Nihon University School of Medicine, Itabashi Hospital
| | | | - Yutaka Yatomi
- Department of Laboratory Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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102
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Shiino K, Sugimoto K, Yamada A, Takada K, Kawai H, Sugimoto K, Takahashi H, Takagi Y, Iwase M, Ozaki Y. Usefulness of right ventricular basal free wall strain by two-dimensional speckle tracking echocardiography in patients with chronic thromboembolic pulmonary hypertension. Int Heart J 2014; 56:100-4. [PMID: 25742946 DOI: 10.1536/ihj.14-162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recently two-dimensional (2D) speckle tracking echocardiography (STE) derived from right ventricular (RV) free wall has been shown to be a very useful tool for the estimation of RV performance. The purpose of this study was to examine whether RV basal free wall strain can detect increased mean pulmonary arterial pressure (mPAP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We investigated a total of 126 patients with CTEPH (mean age, 56 ± 12 years). They underwent echocardiography and right heart catheter examination. 2D STE-derived longitudinal strain was measured by placing 2 regions of interests (ROIs) on the RV basal free wall in RV-focused apical 4-chamber view. Peak strain (RV-PS) was acquired between the 2 ROIs. Conventional echocardiographic RV parameters (RV fractional area change, RV myocardial performance index, tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, and tricuspid regurgitant pressure gradient) were evaluated as well. Right heart catheterization was performed on the day following of echocardiographic evaluation. Among RV echo parameters, RV-PS showed the best correlation with mPAP (r = 0.75, P < 0.0001). Receiver operating characteristic analysis revealed that a cut-off value of RV-PS -20.8% could detect mPAP ≧ 25 mmHg (sensitivity 78%, specificity 93%, area under the curve 0.90, P < 0.001). RV basal free wall strain was a useful tool for the non-invasive detection of increased mPAP in patients with CTEPH.
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Affiliation(s)
- Kenji Shiino
- Department of Cardiology, Fujita Health University School of Medicine
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103
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Knight DS, Grasso AE, Quail MA, Muthurangu V, Taylor AM, Toumpanakis C, Caplin ME, Coghlan JG, Davar J. Accuracy and reproducibility of right ventricular quantification in patients with pressure and volume overload using single-beat three-dimensional echocardiography. J Am Soc Echocardiogr 2014; 28:363-74. [PMID: 25499839 PMCID: PMC4346278 DOI: 10.1016/j.echo.2014.10.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 11/23/2022]
Abstract
Background The right ventricle is a complex structure that is challenging to quantify by two-dimensional (2D) echocardiography. Unlike disk summation three-dimensional (3D) echocardiography (3DE), single-beat 3DE can acquire large volumes at high volume rates in one cardiac cycle, avoiding stitching artifacts or long breath-holds. The aim of this study was to assess the accuracy and test-retest reproducibility of single-beat 3DE for quantifying right ventricular (RV) volumes in adult populations of acquired RV pressure or volume overload, namely, pulmonary hypertension (PH) and carcinoid heart disease, respectively. Three-dimensional and 2D echocardiographic indices were also compared for identifying RV dysfunction in PH. Methods A prospective cross-sectional study was performed in 100 individuals who underwent 2D echocardiography, 3DE, and cardiac magnetic resonance imaging: 49 patients with PH, 20 with carcinoid heart disease, 11 with metastatic carcinoid tumors without cardiac involvement, and 20 healthy volunteers. Two operators performed test-retest acquisition and postprocessing for inter- and intraobserver reproducibility in 20 subjects. Results: RV single-beat 3DE was attainable in 96% of cases, with mean volume rates of 32 to 45 volumes/sec. Bland-Altman analysis of all subjects (presented as mean bias ± 95% limits of agreement) revealed good agreement for end-diastolic volume (−2.3 ± 27.4 mL) and end-systolic volume (5.2 ± 19.0 mL) measured by 3DE and cardiac magnetic resonance imaging, with a tendency to underestimate stroke volume (−7.5 ± 23.6 mL) and ejection fraction (−4.6 ± 13.8%) by 3DE. Subgroup analysis demonstrated a greater bias for volumetric underestimation, particularly in healthy volunteers (end-diastolic volume, −11.9 ± 18.0 mL; stroke volume, −11.2 ± 20.2 mL). Receiver operating characteristic curve analysis showed that 3DE-derived ejection fraction was significantly superior to 2D echocardiographic parameters for identifying RV dysfunction in PH (sensitivity, 94%; specificity, 88%; area under the curve, 0.95; P = .031). There was significant interobserver test-retest bias for RV volume underestimation (end-diastolic volume, −12.5 ± 28.1 mL; stroke volume, −10.6 ± 23.2 mL). Conclusions Single-beat 3DE is feasible and clinically applicable for volumetric quantification in acquired RV pressure or volume overload. It has improved limits of agreement compared with previous disk summation 3D echocardiographic studies and has incremental value over standard 2D echocardiographic measures for identifying RV dysfunction. Despite the ability to obtain and postprocess a full-volume 3D echocardiographic RV data set, the quality of the raw data did influence the accuracy of the data obtained. The technique performs better with dilated rather than nondilated RV cavities, with a learning curve that might affect the test-retest reproducibility for serial RV studies.
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Affiliation(s)
- Daniel S Knight
- University College London Medical School, Royal Free Campus, London, United Kingdom; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom; UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom.
| | - Agata E Grasso
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Michael A Quail
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Vivek Muthurangu
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Andrew M Taylor
- UCL Centre for Cardiovascular Imaging, University College London, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - J Gerry Coghlan
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Joseph Davar
- Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
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Abstract
Chronic obstructive pulmonary disorder (COPD) is a systemic disease that affects the cardiovascular system through multiple pathways. Pulmonary hypertension, ventricular dysfunction, and atherosclerosis are associated with smoking and COPD, causing significant morbidity and poor prognosis. Coupling between the pulmonary and cardiovascular system involves mechanical interdependence and inflammatory pathways that potentially affect the entire circulation. Although treatments specific for COPD-related cardiovascular and pulmonary vascular disease are limited, early diagnosis, study of pathophysiology, and monitoring the effects of treatment are enhanced with improved imaging techniques. In this article, we review recent advancements in the imaging of the vasculature and the heart in patients with COPD. We also explore the potential mechanism of coupling between the progression of COPD and vascular disease. Imaging methods reviewed include specific implementations of computed tomography, magnetic resonance imaging, dual-energy computed tomography, positron emission tomography, and echocardiography. Specific applications to the proximal and distal pulmonary vasculature, as well as to the heart and systemic circulation, are also discussed.
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105
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Right Ventricular Geometry and Function in Pulmonary Hypertension: Non-Invasive Evaluation. Diseases 2014. [DOI: 10.3390/diseases2030274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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106
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Gökdeniz T, Kalaycıoğlu E, Boyacı F, Aykan AÇ, Gürsoy MO, Hatem E, Börekçi A, Karabag Y, Altun S. The BODE Index, a Multidimensional Grading System, Reflects Impairment of Right Ventricle Functions in Patients with Chronic Obstructive Pulmonary Disease: A Speckle-Tracking Study. Respiration 2014; 88:223-33. [DOI: 10.1159/000365222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022] Open
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Orde SR, Pulido JN, Masaki M, Gillespie S, Spoon JN, Kane GC, Oh JK. Outcome prediction in sepsis: speckle tracking echocardiography based assessment of myocardial function. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R149. [PMID: 25015102 PMCID: PMC4227017 DOI: 10.1186/cc13987] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/05/2014] [Indexed: 12/26/2022]
Abstract
Introduction Speckle tracking echocardiography (STE) is a relatively novel and sensitive method for assessing ventricular function and may unmask myocardial dysfunction not appreciated with conventional echocardiography. The association of ventricular dysfunction and prognosis in sepsis is unclear. We sought to evaluate frequency and prognostic value of biventricular function, assessed by STE in patients with severe sepsis or septic shock. Methods Over an eighteen-month period, sixty patients were prospectively imaged by transthoracic echocardiography within 24 hours of meeting severe sepsis criteria. Myocardial function assessment included conventional measures and STE. Association with mortality was assessed over 12 months. Results Mortality was 33% at 30 days (n = 20) and 48% at 6 months (n = 29). 32% of patients had right ventricle (RV) dysfunction based on conventional assessment compared to 72% assessed with STE. 33% of patients had left ventricle (LV) dysfunction based on ejection fraction compared to 69% assessed with STE. RV free wall longitudinal strain was moderately associated with six-month mortality (OR 1.1, 95% confidence interval, CI, 1.02-1.26, p = 0.02, area under the curve, AUC, 0.68). No other conventional echocardiography or STE method was associated with survival. After adjustment (for example, for mechanical ventilation) severe RV free wall longitudinal strain impairment remained associated with six-month mortality. Conclusion STE may unmask systolic dysfunction not seen with conventional echocardiography. RV dysfunction unmasked by STE, especially when severe, was associated with high mortality in patients with severe sepsis or septic shock. LV dysfunction was not associated with survival outcomes.
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108
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van de Veerdonk MC, Marcus JT, Bogaard HJ, Vonk Noordegraaf A. State of the art: advanced imaging of the right ventricle and pulmonary circulation in humans (2013 Grover Conference series). Pulm Circ 2014; 4:158-68. [PMID: 25006434 DOI: 10.1086/675978] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/03/2013] [Indexed: 12/27/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by remodeling and vasoconstriction of the pulmonary vasculature, ultimately leading to right ventricular (RV) failure and death. Recent developments in echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and positron emission tomography allow advanced, noninvasive, in vivo assessment of the RV and have contributed to the identification of risk factors, prognostic factors, and monitoring of therapeutic responses in patients with PAH. Although far from reaching its future potential, these techniques have not only provided global RV assessment but also allowed evaluation of changes in cellular and molecular tissue processes, such as metabolism, oxygen balance and ischemia, angiogenesis, and apoptosis. Integrated application of these techniques could provide full insights into the different pathophysiological aspects of a failing RV in the setting of PAH. Recent advances in hybrid imaging have implemented simultaneous measurements of myocardial and vascular interactions and will be one of the most important potential future developments.
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Affiliation(s)
- Mariëlle C van de Veerdonk
- Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - J Tim Marcus
- Physics and Medical Technology, ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Pulmonary Diseases, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
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109
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Blanchard DG, DeMaria AN. Right Ventricular 3-Dimensional Strain in Pulmonary Hypertension. J Am Coll Cardiol 2014; 64:52-3. [DOI: 10.1016/j.jacc.2014.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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110
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Three-Dimensional Speckle Tracking of the Right Ventricle. J Am Coll Cardiol 2014; 64:41-51. [DOI: 10.1016/j.jacc.2014.01.084] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 01/09/2014] [Accepted: 01/19/2014] [Indexed: 11/22/2022]
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111
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Freed BH, Tsang W, Bhave NM, Patel AR, Weinert L, Yamat M, Vicedo BM, Dill K, Mor-Avi V, Gomberg-Maitland M, Lang RM. Right ventricular strain in pulmonary arterial hypertension: a 2D echocardiography and cardiac magnetic resonance study. Echocardiography 2014; 32:257-63. [PMID: 24975738 DOI: 10.1111/echo.12662] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Right ventricular (RV) strain is a potentially useful prognostic marker in patients with pulmonary arterial hypertension (PAH). However, published reports regarding the accuracy of two-dimensional echocardiography (2DE)-derived RV strain against an independent reference in this patient population are limited. The aims of this study were: (1) to study the relationship between 2DE RV longitudinal strain and cardiovascular magnetic resonance (CMR)-derived RV ejection fraction (RVEF) in patients with PAH; (2) to compare 2DE-derived and CMR-derived RV longitudinal strain in these patients; and (3) to determine the reproducibility of these measurements. METHODS Thirty patients with PAH underwent 2DE and CMR imaging within a 2-hour time period. 2DE RV longitudinal strain was measured from a focused RV apical four-chamber view using speckle tracking software. CMR RV longitudinal strain was measured from short-axis slices acquired using fast-strain-encoded sequence. Global peak systolic RV longitudinal strain was calculated for both 2DE and CMR. RESULTS RV longitudinal strain using 2DE software correlated well with CMR-derived RVEF (R = 0.69, P = 0.0006). There was moderate agreement when comparing 2DE to CMR RV longitudinal strain (R = 0.74, P = 0.0002; bias -1%, limits of agreement -9 to 7%). Inter-observer variability and intra-observer variability for RV longitudinal strain were lower for 2DE than CMR. CONCLUSIONS RV longitudinal strain by 2DE provides a good alternative for CMR-derived RVEF in patients with PAH. The moderate agreement in strain measurements between 2DE and CMR suggests that further software improvements are needed before these measurements can be used interchangeably in clinical practice.
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Affiliation(s)
- Benjamin H Freed
- University of Chicago Medicine, Chicago, Illinois; Northwestern Memorial Hospital, Chicago, Illinois
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112
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Ventetuolo CE, Gabler NB, Fritz JS, Smith KA, Palevsky HI, Klinger JR, Halpern SD, Kawut SM. Are hemodynamics surrogate end points in pulmonary arterial hypertension? Circulation 2014; 130:768-75. [PMID: 24951771 DOI: 10.1161/circulationaha.114.009690] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although frequently assessed in trials and clinical practice, hemodynamic response to therapy has never been validated as a surrogate end point for clinical events in pulmonary arterial hypertension (PAH). METHODS AND RESULTS We performed a patient-level pooled analysis of 4 randomized, placebo-controlled trials to determine whether treatment-induced changes in hemodynamic values at 12 weeks accounted for the relationship between treatment assignment and the probability of early clinical events (death, lung transplantation, atrial septostomy, PAH hospitalization, withdrawal for clinical worsening, or escalation in PAH therapy). We included 1119 subjects with PAH. The median (interquartile range) age was 48 years (37-59 years), and 23% were men. A total of 656 patients (59%) received active therapy (101 [15%] iloprost, 118 [18%] sitaxsentan, 204 [31%] sildenafil, and 233 [36%] subcutaneous treprostinil). Active treatment significantly lowered right atrial pressure, mean pulmonary artery pressure, and pulmonary vascular resistance and increased cardiac output and index (P<0.01 for all). Changes in hemodynamic values (except for right atrial pressure and mean pulmonary artery pressure) were significantly associated with the risk of a clinical event (P<0.02 for all). Although active treatment approximately halved the odds of a clinical event compared with placebo (P<0.001), changes in hemodynamics accounted for only 1.2% to 13.9% of the overall treatment effect. CONCLUSIONS Treatment-induced changes in hemodynamics at 12 weeks only partially explain the impact of therapy on the probability of early clinical events in PAH. These findings suggest that resting hemodynamics are not valid surrogate end points for short-term events in PAH clinical trials.
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Affiliation(s)
- Corey E Ventetuolo
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nicole B Gabler
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason S Fritz
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Akaya Smith
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Harold I Palevsky
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James R Klinger
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Scott D Halpern
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven M Kawut
- From the Division of Pulmonary, Critical Care and Sleep, Department of Medicine (C.E.V., J.R.K.) and Department of Health Services, Policy, and Practice (C.E.V.), Alpert Medical School of Brown University, Providence, RI; Center for Clinical Epidemiology and Biostatistics (N.B.G., S.D.H., S.M.K.), Department of Medicine (J.S.F., K.A.S., H.I.P., S.D.H., S.M.K.), Penn Cardiovascular Institute (S.D.H., S.M.K.), and Leonard Davis Institute of Health Economics (S.D.H.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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113
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Evaluation of right ventricle functions and serotonin levels during headache attacks in migraine patients with aura. Int J Cardiovasc Imaging 2014; 30:1255-63. [DOI: 10.1007/s10554-014-0456-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/16/2014] [Indexed: 11/27/2022]
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114
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Spruijt OA, Bogaard HJ, Vonk-Noordegraaf A. Assessment of right ventricular responses to therapy in pulmonary hypertension. Drug Discov Today 2014; 19:1246-50. [PMID: 24637045 DOI: 10.1016/j.drudis.2014.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
Irrespective of its cause, pulmonary hypertension (PH) leads to an increase in pulmonary vascular resistance (PVR). Failing adaption of the right ventricle (RV) to the increased afterload is the main cause of death in PH patients and therefore monitoring RV function during treatment is essential. However, consensus on the optimal method for serial assessment of RV function is lacking and therefore the major clinical trials on PH-specific therapies have not provided clear answers with respect to the response of the RV to treatment. This short review will give an overview of the most important load-dependent and load-independent parameters for assessing RV response to therapy in PH patients.
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Affiliation(s)
- Onno A Spruijt
- Department of Pulmonary Diseases, VU University Medical Center, ZH-4A-48, 1000 SN Amsterdam, The Netherlands
| | - Harm-Jan Bogaard
- Department of Pulmonary Diseases, VU University Medical Center, ZH-4A-48, 1000 SN Amsterdam, The Netherlands.
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, ZH-4A-48, 1000 SN Amsterdam, The Netherlands
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115
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Fenster BE, Lasalvia L, Schroeder JD, Smyser J, Silveira LJ, Buckner JK, Brown KK. Cystatin C: a potential biomarker for pulmonary arterial hypertension. Respirology 2014; 19:583-9. [PMID: 24628703 DOI: 10.1111/resp.12259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/30/2013] [Accepted: 01/14/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Cystatin C (CysC), a novel marker of renal function, predicts left heart failure and cardiovascular mortality. The hypothesis that serum CysC levels correlate with right ventricular (RV) morphology, function and pressure in pulmonary arterial hypertension (PAH) was tested. METHODS As part of a prospective study, 14 PAH subjects and 10 matched controls underwent same-day echocardiography, cardiac magnetic resonance imaging (CMR), and phlebotomy for CysC, brain natriuretic peptide (BNP), and N-terminal BNP (NT-ProBNP). RV ejection fraction (RVEF), end-diastolic volume, end-systolic volume and mass were calculated using CMR. RV systolic pressure (RVSP), strain and diastolic function (including tricuspid valve (TV) E velocity, A velocity, e' velocity, E/A ratio and E/e' ratio) were assessed using echocardiography. RESULTS RVSP was significantly elevated in PAH subjects versus controls (57 ± 17 vs. 28 ± 8 mm Hg, P < 0.0001). CysC was abnormally elevated in the PAH cohort when compared with controls (1.00 ± 0.23 vs 0.78 ± 0.05 mg/L, P = 0.001). CysC positively correlated with RVSP (rho 0.61, P = 0.002), RV end-diastolic volume (rho 0.50, P = 0.01), RV end-systolic volume (rho 0.58, P = 0.003), mass index (rho 0.66, P = 0.0004), strain (rho 0.51, P = 0.01) and strain rate (rho 0.51, P = 0.01) and negatively correlated with RVEF (rho -0.58, P = 0.003) and TV e' (rho -0.75, P < 0.0001). The same correlations with BNP and NT-ProBNP were comparable with CysC. CONCLUSIONS In a small cohort, CysC accurately correlates with RV pressure, function and morphology. CysC may represent a novel PAH biomarker.
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Affiliation(s)
- Brett E Fenster
- Division of Cardiology, National Jewish Health, Denver, Colorado, USA
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116
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Kim SJ. Geometric and Functional Change of Both Ventricles after Atrial Ventricular Septal Defect Closure. J Cardiovasc Ultrasound 2014; 22:180-1. [PMID: 25580191 PMCID: PMC4286638 DOI: 10.4250/jcu.2014.22.4.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Soo-Jin Kim
- Department of Pediatrics, Cardiovascular Center, Konkuk University School of Medicine, Seoul, Korea
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Porres-Aguilar M, Duarte-Rojo A, Krowka MJ. Transthoracic echocardiography screening for the detection of portopulmonary hypertension: a work in progress. Liver Transpl 2013; 19:573-4. [PMID: 23716426 DOI: 10.1002/lt.23663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 04/16/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Mateo Porres-Aguilar
- Division of Hospital Medicine, Department of Internal Medicine; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center; El Paso TX
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology; University of Arkansas for Medical Sciences; Little Rock AR
| | - Michael J. Krowka
- Division of Pulmonary and Critical Care Medicine; von Liebig Transplant Center; Mayo Clinic Rochester MN
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