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Addetia K, Bhave NM, Tabit CE, Gomberg-Maitland M, Freed BH, Dill KE, Lang RM, Mor-Avi V, Patel AR. Sample size and cost analysis for pulmonary arterial hypertension drug trials using various imaging modalities to assess right ventricular size and function end points. Circ Cardiovasc Imaging 2013; 7:115-24. [PMID: 24192452 DOI: 10.1161/circimaging.113.000932] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Placebo-controlled trials for pulmonary arterial hypertension are no longer acceptable because new therapies must show clinically significant effects on top of standard treatment. The purpose of this study was to estimate sample sizes and imaging costs for the planning of a hypothetical pulmonary arterial hypertension drug trial using imaging to detect changes in right ventricular size and function in response to combined therapy. METHODS AND RESULTS Same-day cardiovascular MR (CMR) and 2-dimensional (2D) and 3D transthoracic echocardiography (2DTTE and 3DTTE) were performed in 22 patients with pulmonary arterial hypertension (54±13 years of age) twice, 6 months apart. Short-axis CMR cines and full-volume 3DTTE data sets of the right ventricle were used to measure end-diastolic volume and ejection fraction. Fractional area change was obtained from 2DTTE. Sample size calculations used a 2-sample t test model incorporating differences between baseline and 6-month measurements. Cost estimates were made using the Medicare fee schedule. No significant differences were noted between baseline and follow-up measurements. Large SDs reflected variable progression of disease in individual patients on standard therapy and measurement variability. These sources of variability resulted in intertechnique differences in sample sizes: to detect a change of 5% to 15% in 3DTTE-derived right ventricular ejection fraction and fractional area change or change of 15 to 30 mL in 3DTTE right ventricular end-diastolic volume; sample sizes were 2× to 2.5× those required by CMR. As a result, the total cost of a trial using complete TTE was greater than CMR, which was greater than limited TTE. CONCLUSIONS Because of lower measurement variability, CMR is more cost saving in pulmonary arterial hypertension drug trials than echocardiography, unless limited TTE is used.
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Affiliation(s)
- Karima Addetia
- Section of Cardiology, Department of Medicine, and Department of Radiology, University of Chicago, IL
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102
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Li J, Lee A, Cheng Y. A GPS Map for Pulmonary Hypertension: A Review of Imaging Modalities. Curr Hypertens Rep 2013; 15:650-8. [DOI: 10.1007/s11906-013-0392-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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103
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Right ventricular myocardial performance index is decreased with severe pressure-overload cardiac hypertrophy in young rats. Pediatr Cardiol 2013; 34:1556-66. [PMID: 23467728 DOI: 10.1007/s00246-013-0678-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 02/13/2013] [Indexed: 02/01/2023]
Abstract
Although the right ventricular (RV) myocardial performance index (MPI) usually is increased in the presence of RV dysfunction and pressure overload, debate continues over the correlation between the RV MPI and functional derangement in patients with RV pressure-overload congenital heart disease (CHD). To address this controversy, this study took serial measurements of the RV MPI in addition to invasive RV hemodynamic measurements during the acute stage of mild to severe pressure overload. Right ventricle pressure overload was induced by partial pulmonary arterial banding (PAB) in 3-week-old rats. The rats were divided into two groups: mild pulmonary stenosis (PS) group (20-40 % stenosis; n = 20) and severe PS group (40-70 % stenosis; n = 28). Sham-treated animals (sham group; n = 30) underwent the same surgical procedure without PAB. Pressure-overload RV hypertrophy was documented by weighing the heart, by evaluating echocardiograms, and by evaluating cardiac hypertrophy-associated gene expression. The RV MPI was checked 1, 2, 3, 5, and 8 weeks after PAB. The MPI was calculated as the sum of the isovolumic contraction time and the isovolumic relaxation time (IRT) divided by the ejection time. The RV MPI of the mild PS group did not differ significantly from that of the sham group. The RV MPI of the severe PS group, however, was lower than that of the sham group (0.27 ± 0.01 vs 0.29 ± 0.01) 2 to 8 weeks after PAB: 0.19 ± 0.01 at 2 weeks (P < 0.001), 0.16 ± 0.01 at 3 weeks (P < 0.001), 0.20 ± 0.01 at 5 weeks (P = 0.021), and 0.18 ± 0.01 at 8 weeks (P < 0.001) after PAB. The decreased RV MPI was associated with decreased IRT and increased ejection time. RV hypertrophy contributes to the decrease in the RV MPI in the severe pressure-overload condition.
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104
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Ciurzyński M, Bienias P, Irzyk K, Kostrubiec M, Bartoszewicz Z, Siwicka M, Stelmaszczyk-Emmel A, Górska E, Demkow U, Pruszczyk P. Serum endothelin-1 and NT-proBNP, but not ADMA, endoglin and TIMP-1 levels, reflect impaired right ventricular function in patients with systemic sclerosis. Clin Rheumatol 2013; 33:83-9. [PMID: 23942766 PMCID: PMC3890053 DOI: 10.1007/s10067-013-2354-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/06/2013] [Accepted: 07/26/2013] [Indexed: 11/12/2022]
Abstract
Background Heart and pulmonary involvement is a leading cause of systemic sclerosis (SSc)-related deaths. Objectives The aim of our study was to assess if biochemical markers of right ventricular (RV) overload, endothelial function and collagen metabolism can predict RV dysfunction assessed by Doppler echocardiography in SSc patients. Methods We prospectively studied 111 consecutive patients (101 F, 10 M, age 54.2 ± 13.8 years) with diagnosed SSc (mean disease duration 9.4 ± 11.4 years) and a group of 21 age-matched subjects (18 F, 3 M, age 49.3 + 10.5 years). We performed transthoracic echocardiography (Phillips iE 33) and measured serum endothelin-1 (ET-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), asymmetric dimethylarginine (ADMA), endoglin and human tissue inhibitor of matrix metalloproteinase (TIMP-1) concentration. Results Median serum NT-proBNP level in SSc patients was 133.5 (range 21.86–17,670 pg/ml) and was significantly higher than in controls (p = 0.0002). Moreover, the median serum ET-1 level of 1.49 (range 0.26–8.75 pg/ml) was higher in SSc patients (p = 0.002). However, no significant differences in ADMA, TIMP-1 and endoglin serum concentration between SSc patients and controls were observed. Serum NT-proBNP concentration correlated positively with echocardiographic signs of RV overload: tricuspid regurgitation pressure gradient (r = 0.38, p = 0.0004) and RV Tei index (r = 0.25, p = 0.01). ET-1 serum level correlated negatively with tricuspid annular plane systolic excursion (r = −0.4, p = 0.01) and positively with inferior vena cava diameter measured at expiration (r = 0.38, p = 0.0002). The echocardiographic signs of RV overload were significantly more pronounced in the highest NT-proBNP tertile (>195 pg/ml) group than in the lowest one (<88 pg/ml). Conclusions Serum ET-1 and NT-proBNP, but not endoglin, ADMA and TIMP-1 levels correlating with the echocardiographic parameters of RV overload, can be considered as noninvasive indicators of RV dysfunction in SSc patients.
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Affiliation(s)
- Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland,
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105
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The Tei index and asymptomatic myocarditis in children with severe dengue. Pediatr Cardiol 2013; 34:1307-13. [PMID: 23397334 DOI: 10.1007/s00246-013-0639-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/08/2013] [Indexed: 12/28/2022]
Abstract
This study aimed to assess myocardial involvement in infants and children with severe dengue (as per the new World Health Organization [WHO] classification 2009) using the Tei index. This prospective observational study was conducted in the Department of Pediatrics, PGIMER and the associated Dr. RML Hospital, New Delhi from August to December 2010. The study included 67 children (ages 3 months-14 years) who satisfied the WHO criteria for the diagnosis of probable dengue fever with warning signs or severe dengue and tested positive for dengue via immunoglobulin-M (IgM) capture enzyme-linked immunoassay (MAC-ELISA). The patients were subjected to a complete blood count, liver function tests, renal profile, electrocardiography, myocardial band enzymes of creatine phosphokinase (CPK-MB), chest x-ray, abdomen ultrasonography, and two-dimensional echocardiography with color-flow Doppler mapping. Ejection fraction and Tei index measurements were performed. Significantly fewer patients with severe dengue were found to have myocardial involvement at admission by ejection fraction (48 %) and E/E' (37 %), than by the Tei index (70 %). Of the 67 patients with severe dengue, one died, giving a case fatality rate of 1.5 %. At discharge, the Tei index persisted on the high side for patients with myocardial involvement, whereas the ejection fraction improved for the majority of them. Most of the patients with severe dengue had asymptomatic myocarditis, as evident by a deranged Tei index, which improved but did not normalize by the time of discharge, necessitating a longer follow-up period. For the majority of the patients, inotropic support was not required to maintain hemodynamic stability.
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106
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Bianco JC, Qizilbash B, Carrier M, Couture P, Fortier A, Tardif JC, Lambert J, Denault AY. Is Patient-Prosthesis Mismatch a Perioperative Predictor of Long-Term Mortality After Aortic Valve Replacement? J Cardiothorac Vasc Anesth 2013; 27:647-53. [DOI: 10.1053/j.jvca.2013.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Indexed: 11/11/2022]
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107
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Konishi K, Dohi K, Tanimura M, Sato Y, Watanabe K, Sugiura E, Kumagai N, Nakamori S, Nakajima H, Yamada T, Onishi K, Nakamura M, Nobori T, Ito M. Quantifying longitudinal right ventricular dysfunction in patients with old myocardial infarction by using speckle-tracking strain echocardiography. Cardiovasc Ultrasound 2013; 11:23. [PMID: 23802850 PMCID: PMC3700756 DOI: 10.1186/1476-7120-11-23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated longitudinal right ventricular (RV) function assessed using speckle-tracking strain echocardiography in patient with myocardial infarction (MI), and identified the contributing factors for RV dysfunction. METHODS We retrospectively studied 71 patients with old MI (the OMI group) and 45 normal subjects (the Control group) who underwent a transthoracic echocardiography. Global and free wall RV peak systolic strains (PSSs) in the longitudinal direction were measured by using speckle-tracking strain echocardiography. Left ventricular (LV) PSSs were measured in the longitudinal, radial and circumferential directions. Cardiac hemodynamics including peak systolic pulmonary artery pressure was also assessed non-invasively. Plasma brain natriuretic peptide (BNP) levels were measured in all patients. RESULTS In the OMI group, 73% of the patients had a normal estimated peak systolic pulmonary artery pressure of less than 35 mmHg. Global and free wall RV PSS were impaired in the OMI group compared with the Control group, and these RV systolic indices were significantly associated with heart rate, logarithmic transformed plasma BNP, greater than 1 year after onset of MI, Doppler-derived estimated pulmonary vascular resistance, LV systolic indices, LV mass index, infarcted segments within a territory of the left circumflex artery and residual total occlusion in the culprit right coronary artery. Multivariable linear regression analysis indicated that reduced longitudinal LV PSS in the 4-chamber view and BNP levels ≥500 pg/ml were independently associated with reduced global and free wall RV PSS. Moreover, when patients were divided into 3 groups according to plasma BNP levels (BNP <100 pg/ml; n = 31, 100 ≤BNP <500 pg/ml; n = 24, and BNP ≥500 pg/ml; n = 16), only patients with BNP ≥500 pg/ml had a strong correlation between RV PSS and longitudinal LV PSS in the 4-chamber view (r = 0.78 for global RV PSS and r = 0.71 for free wall RV PSS, p <0.05). CONCLUSION Longitudinal RV systolic strain depends significantly on longitudinal LV systolic strain especially in patients with high plasma BNP levels, but not on estimated peak systolic pulmonary artery pressure. These results indicate that process of RV myocardial dysfunction following MI may be governed by neurohormonal activation which causing ventricular remodeling rather than increased RV afterload.
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Affiliation(s)
- Katsuhisa Konishi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan
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108
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Abstract
PURPOSE OF REVIEW To evaluate new information on the importance of right ventricular function, diagnosis and management in cardiac surgical patients. RECENT FINDINGS There is growing evidence that right ventricular function is a key determinant in survival in cardiac surgery, particularly in patients with pulmonary hypertension. The diagnosis of this condition is helped by the use of specific hemodynamic parameters and echocardiography. In that regard, international consensus guidelines on the echocardiographic assessment of right ventricular function have been recently published. New monitoring modalities in cardiac surgery such as regional near-infrared spectroscopy can also assist management. Management of right ventricular failure will be influenced by the presence or absence of myocardial ischemia and left ventricular dysfunction. The differential diagnosis and management will be facilitated using a systematic approach. SUMMARY The use of right ventricular pressure monitoring and the publications of guidelines for the echocardiographic assessment of right ventricular anatomy and function allow the early identification of right ventricular failure. The treatment success will be associated by optimization of the hemodynamic, echocardiographic and near-infrared spectroscopy parameters.
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109
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Thunberg CA, Gaitan BD, Grewal A, Ramakrishna H, Stansbury LG, Grigore AM. Pulmonary Hypertension in Patients Undergoing Cardiac Surgery: Pathophysiology, Perioperative Management, and Outcomes. J Cardiothorac Vasc Anesth 2013; 27:551-72. [DOI: 10.1053/j.jvca.2012.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Indexed: 11/11/2022]
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110
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Guihaire J, Haddad F, Boulate D, Decante B, Denault AY, Wu J, Herve P, Humbert M, Dartevelle P, Verhoye JP, Mercier O, Fadel E. Non-invasive indices of right ventricular function are markers of ventricular-arterial coupling rather than ventricular contractility: insights from a porcine model of chronic pressure overload. Eur Heart J Cardiovasc Imaging 2013; 14:1140-9. [DOI: 10.1093/ehjci/jet092] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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111
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Ernande L, Cottin V, Leroux PY, Girerd N, Huez S, Mulliez A, Bergerot C, Ovize M, Mornex JF, Cordier JF, Naeije R, Derumeaux G. Right isovolumic contraction velocity predicts survival in pulmonary hypertension. J Am Soc Echocardiogr 2012; 26:297-306. [PMID: 23265440 DOI: 10.1016/j.echo.2012.11.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular function is a strong determinant of prognosis in severe pulmonary hypertension. METHODS The aim of this study was to evaluate the prognostic value of estimates of right ventricular function obtained by echocardiography and Doppler tissue imaging and of functional class and 6-min walk distance (6MWD) in 142 patients with either pulmonary arterial hypertension (n = 104) or chronic thromboembolic pulmonary hypertension (n = 38). Echocardiography was prospectively performed, and demographics, medications, associated medical conditions, New York Heart Association class, and 6MWD at inclusion in addition to vital status, transplantation, and hospital admission related to pulmonary hypertension at follow-up were then collected by review of the medical records. RESULTS Variables associated with overall survival by univariate analysis were 6MWD (P = .009), functional class (P = .024), tricuspid annular plane systolic excursion (P = .03) and isovolumic peak velocity at the tricuspid annulus (IVCv) (P = .003). On multivariate analysis, IVCv (P = .015) and 6MWD (P = .016) were the only independent predictors of survival. Kaplan-Meier estimates of survival at 1 year were 95% in patients with IVCv > 9 cm/sec and 80% in those with IVCv ≤ 9 cm/sec (P = .002). Intraobserver and interobserver variability of IVCv measurement were 5% and 9%, respectively. CONCLUSIONS Measurement of right ventricular function by Doppler tissue imaging, an easy, noninvasive, and reproducible method, is an independent predictor of clinical outcomes in patients with severe pulmonary hypertension.
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Affiliation(s)
- Laura Ernande
- Explorations Fonctionnelles Cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
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112
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Abstract
Right ventricular (RV) function is a strong independent predictor of outcome in a number of distinct cardiopulmonary diseases. The RV has a remarkable ability to sustain damage and recover function which may be related to unique anatomic, physiologic, and genetic factors that differentiate it from the left ventricle. This capacity has been described in patients with RV myocardial infarction, pulmonary arterial hypertension, and chronic thromboembolic disease as well as post-lung transplant and post-left ventricular assist device implantation. Various echocardiographic and magnetic resonance imaging parameters of RV function contribute to the clinical assessment and predict outcomes in these patients; however, limitations remain with these techniques. Early diagnosis of RV function and better insight into the mechanisms of RV recovery could improve patient outcomes. Further refinement of established and emerging imaging techniques is necessary to aid subclinical diagnosis and inform treatment decisions.
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Affiliation(s)
- Evan L Brittain
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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113
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Spectrum of physiological and pathological cardiac and pericardial uptake of FDG in oncology PET-CT. Clin Radiol 2012. [PMID: 23177651 DOI: 10.1016/j.crad.2012.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiac uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) is frequently observed on FDG positron-emission tomography combined with computed tomography (PET-CT) performed for diagnosis, staging, and assessment of therapeutic response of lymphoma and solid cancers, despite careful patient preparation to limit myocardial glucose substrate utilisation. We illustrate the varied physiological patterns of cardiac FDG uptake, and show a spectrum of pathological conditions causing FDG uptake within myocardial and pericardial structures, due to clinically important benign and malignant diseases. Recognition and awareness of these various causes of FDG uptake in the heart, along with the appropriate use of correlative contrast-enhanced CT and magnetic resonance imaging (MRI) will facilitate correct interpretation.
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114
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Abstract
The right ventricle (RV) is in charge of pumping blood to the lungs for oxygenation. Pulmonary arterial hypertension (PAH) is characterized by high pulmonary vascular resistance and vascular remodeling, which results in a striking increase in RV afterload and subsequent failure. There is still unexploited potential for therapies that directly target the RV with the aim of supporting and protecting the right side of the heart, striving to prolong survival in patients with PAH.
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Affiliation(s)
- Veronica Franco
- Department of Cardiovascular Disease, Pulmonary Hypertension and Adult Congential Heart Disease Program, Advanced Heart Failure and Transplantation Program, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA.
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115
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Bossone E, D'Andrea A, D'Alto M, Citro R, Argiento P, Ferrara F, Cittadini A, Rubenfire M, Naeije R. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr 2012; 26:1-14. [PMID: 23140849 DOI: 10.1016/j.echo.2012.10.009] [Citation(s) in RCA: 332] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Indexed: 12/27/2022]
Abstract
Pulmonary arterial hypertension is most often diagnosed in its advanced stages because of the nonspecific nature of early symptoms and signs. Although clinical assessment is essential when evaluating patients with suspected pulmonary arterial hypertension, echocardiography is a key screening tool in the diagnostic algorithm. It provides an estimate of pulmonary artery pressure, either at rest or during exercise, and is useful in ruling out secondary causes of pulmonary hypertension. In addition, echocardiography is valuable in assessing prognosis and treatment options, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stages of disease.
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Affiliation(s)
- Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
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116
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Moceri P, Dimopoulos K, Liodakis E, Germanakis I, Kempny A, Diller GP, Swan L, Wort SJ, Marino PS, Gatzoulis MA, Li W. Echocardiographic Predictors of Outcome in Eisenmenger Syndrome. Circulation 2012; 126:1461-8. [DOI: 10.1161/circulationaha.112.091421] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Eisenmenger syndrome differs significantly from other types of pulmonary arterial hypertension in its physiology and prognosis. We sought to assess the relationship between the echocardiographic characteristics of patients with Eisenmenger syndrome and mortality.
Methods and Results—
Clinical and echocardiographic variables were assessed in 181 consecutive patients with Eisenmenger syndrome, excluding those with complex congenital heart disease. Patients' mean age was 39.1±12.8 years, 59 (32.6%) were male, 122 (67.4%) were in functional class III or higher, and 74 (40.9%) were on advanced therapies. Mean oxygen saturation at rest was 85.1±7.8%, and median B-type natriuretic peptide was 55.4 ng/L. Over a median follow-up of 16.4 months, 19 patients died; the strongest predictors of mortality were tricuspid annular plane systolic excursion and peak systolic velocity, myocardial performance (expressed as total isovolumic time and ratio of systolic to diastolic duration), and elevated central venous pressure (expressed as right atrial [RA] area, RA pressure, and ratio of RA to left atrial area), even after we accounted for advanced therapies. A composite score based on the strongest echocardiographic predictors of outcome, including 1 point for each of the following: tricuspid annular plane systolic excursion <15 mm, ratio of right ventricular effective systolic to diastolic duration ≥1.5, RA area ≥25 cm
2
, ratio of RA to left atrial area ≥1.5, was highly predictive of clinical outcome (area under the curve 0.90±0.01), with no improvement when B-type natriuretic peptide and resting saturations were added into the model.
Conclusions—
Echocardiographic parameters of right ventricular function and RA area predict mortality in Eisenmenger patients. A new composite echocardiographic score, described herewith, may be incorporated into the noninvasive, periodic assessment of these patients.
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Affiliation(s)
- Pamela Moceri
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Konstantinos Dimopoulos
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Emmanouil Liodakis
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Ioannis Germanakis
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Aleksander Kempny
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Gerhard-Paul Diller
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Lorna Swan
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Stephen J. Wort
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Philip S. Marino
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Michael A. Gatzoulis
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
| | - Wei Li
- From the Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom (P.M., K.D., E.L., I.G., A.K., G.D., L.S., S.J.W., P.S.M., M.A.G., W.L.); Pasteur University Hospital, Nice, France (P.M.); and National Institute for Health Research Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom (K.D., G.D., M.A.G.)
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Singh GK, Levy PT, Holland MR, Hamvas A. Novel methods for assessment of right heart structure and function in pulmonary hypertension. Clin Perinatol 2012; 39:685-701. [PMID: 22954276 DOI: 10.1016/j.clp.2012.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Long-term increases in pulmonary vascular resistance and pulmonary arterial pressure resulting from structural alterations and abnormal vasoreactivity of the pulmonary vasculature may lead to right ventricular (RV) remodeling. Conventional methods of assessment of RV structure and function do not provide sensitive markers of RV remodeling for prognostic information. Advances in cardiac imaging have provided the capability to obtain quantitative information on the RV structure and function. This article reviews the clinical conditions that result in PH and discusses the novel and emerging methods for the assessment of right heart structure and function in PH in infants and children.
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Affiliation(s)
- Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
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Kiani A, Shabanian R, Seifirad S, Heidari-Bateni G, Rekabi M, Shahbaznejad L, Dastmalchi R, Kocharian A. The Impact of Preload Alteration on the Myocardial Performance Index through Implementing Positive End Expiratory Pressure. Echocardiography 2012; 29:900-5. [DOI: 10.1111/j.1540-8175.2012.01742.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Czernik C, Rhode S, Metze B, Schmalisch G, Bührer C. Persistently elevated right ventricular index of myocardial performance in preterm infants with incipient bronchopulmonary dysplasia. PLoS One 2012; 7:e38352. [PMID: 22675548 PMCID: PMC3365901 DOI: 10.1371/journal.pone.0038352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/08/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Elevated pulmonary vascular resistance occurs during the first days after birth in all newborn infants and persists in infants at risk for bronchopulmonary dysplasia (BPD). It is difficult to measure in a non-invasive fashion. We assessed the usefulness of the right ventricular index of myocardial performance (RIMP) to estimate pulmonary vascular resistance in very low birth weight infants. STUDY DESIGN Prospective echocardiography on day of life (DOL) 2, 7, 14, and 28 in 121 preterm infants (median [quartiles] gestational age 28 [26]-[29] weeks, birth weight 998 [743-1225] g) of whom 36 developed BPD (oxygen supplementation at 36 postmenstrual weeks). RESULTS RIMP derived by conventional pulsed Doppler technique was unrelated to heart rate or mean blood pressure. RIMP on DOL 2 was similar in infants who subsequently did (0.39 [0.33-0.55]) and did not develop BPD (0.39 [0.28-0.51], p = 0.467). RIMP declined steadily in non-BPD infants but not in BPD infants (DOL 7: 0.31[0.22-0.39] vs. 0.35[0.29-0.48], p = 0.014; DOL 14: 0.23[0.17-0.30] vs. 0.35[0.25-0.43], p<0.001; DOL 28: 0.21[0.15-0.28] vs. 0.31 [0.21-0.35], p = 0.015). CONCLUSIONS In preterm infants, a decline in RIMP after birth was not observed in those with incipient BPD. The pattern of RIMP measured in preterm infants is commensurate with that of pulmonary vascular resistance.
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Affiliation(s)
- Christoph Czernik
- Department of Neonatology, Charité University Medical Center, Berlin, Germany.
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121
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Batal O, Khatib OF, Dweik RA, Hammel JP, McCarthy K, Minai OA. Comparison of baseline predictors of prognosis in pulmonary arterial hypertension in patients surviving ≤2 years and those surviving ≥5 years after baseline right-sided cardiac catheterization. Am J Cardiol 2012; 109:1514-20. [PMID: 22360818 DOI: 10.1016/j.amjcard.2012.01.366] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 01/08/2023]
Abstract
Idiopathic pulmonary arterial hypertension (PAH) is usually associated with a poor outcome but the prognosis with other forms of PAH is not well-described. Advances in therapy have furthered clouded the disease course. We sought to determine the baseline indicators of prognosis in patients with PAH. We reviewed the records of patients with PAH followed up at our institution to identify those who died within 2 years (reduced survival group; n = 21) and those who survived >5 years (long survival group; n = 60). The groups were compared for prognostic significance of the baseline clinical parameters. The reduced survival group were older (p = 0.001) and more likely to have scleroderma-associated PAH (p = 0.01), have pericardial effusion (p = 0.01), have a shorter 6-minute walk test (6MWT) distance (p = 0.001), to require oxygen during 6MWT (p = 0.02), have a worse World Health Organization functional class (p <0.001), and have greater serum brain natriuretic peptide levels (p = 0.01). Regression analysis showed age, World Health Organization functional class, 6MWT distance, the need for oxygen during the 6MWT, and renal disease to be independently associated with a poor prognosis. In conclusion, age, PAH etiology, World Health Organization functional class, pericardial effusion, 6MWT distance, the need for oxygen during the 6MWT, and brain natriuretic peptide are predictors of prognosis in patients PAH receiving specific therapy and might help identify a group that could benefit from aggressive upfront therapy.
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Vizzardi E, D’Aloia A, Bordonali T, Bugatti S, Piovanelli B, Bonadei I, Quinzani F, Rovetta R, Vaccari A, Curnis A, Dei Cas L. Long-Term Prognostic Value of the Right Ventricular Myocardial Performance Index Compared to Other Indexes of Right Ventricular Function in Patients with Moderate Chronic Heart Failure. Echocardiography 2012; 29:773-8. [DOI: 10.1111/j.1540-8175.2012.01703.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cevik A, Kula S, Olgunturk R, Tunaoglu FS, Oguz AD, Pektas A, Saylan B. Quantitative evaluation of right ventricle function by transthoracic echocardiography in childhood congenital heart disease patients with pulmonary hypertension. Echocardiography 2012; 29:840-8. [PMID: 22494051 DOI: 10.1111/j.1540-8175.2012.01697.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The present study aims to quantitatively evaluate the right ventricle (RV) function by means of transthoracic echocardiography in normal children and childhood congenital heart disease patients with pulmonary hypertension. PATIENTS AND METHODS This study was conducted in a cohort including 40 healthy children and 30 pediatric patients with pulmonary hypertension who were diagnosed under close surveillance at the study center between October 2009 and November 2010. RESULTS Statistically significant differences were found between the patient and control groups for the right ventricle myocardial performance index (RVMPI), the left ventricle myocardial performance index (LVMPI), the tricuspid valve systolic flow velocity (Ts), the ratio of systolic pulmonary artery pressure to the right ventricle outflow tract systolic flow velocity time integral (sPAP/RVOT VTI), and the ratio of systolic pulmonary artery pressure to right ventricle outflow tract systolic flow velocity time integral × heart rate (sPAP/[RVOT VTI×HR]). When the children were divided into three groups based on their pulmonary vascular resistance significant differences emerged that predicted an increasing severity of RV dysfunction. Significant differences were also observed for the RVMPI, the LVMPI, and the Ts as well as for echocardiographic pulmonary flow (Qp) and systemic flow (Qs). DISCUSSION The present study demonstrates that echocardiographic parameters can be used for the quantitative detection of RV dysfunction in childhood congenital heart disease patients with high pulmonary artery pressure (systolic, diastolic, and mean) or pulmonary vascular resistance.
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Affiliation(s)
- Ayhan Cevik
- Department of Pediatric Cardiology, Gazi University Medical Faculty Hospital, Ankara, Turkey.
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Valsangiacomo Buechel ER, Mertens LL. Imaging the right heart: the use of integrated multimodality imaging. Eur Heart J 2012; 33:949-60. [PMID: 22408035 DOI: 10.1093/eurheartj/ehr490] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
During recent years, right ventricular (RV) structure and function have been found to be an important determinant of outcome in different cardiovascular and also pulmonary diseases. Currently, echocardiography and cardiac magnetic resonance (CMR) imaging are the two imaging modalities most commonly used to visualize the RV. Most structural abnormalities of the RV can be reliably described by echocardiography but due its complex geometrical shape, echocardiographic assessment of RV function is more challenging. Newer promising echocardiographic techniques are emerging but lack of validation and limited normal reference data influence their routine clinical application. Cardiac magnetic resonance is generally considered the clinical reference technique due to its unlimited imaging planes, superior image resolution, and three-dimensional volumetric rendering. The accuracy and reliability of CMR measurements make it the ideal tool for serial examinations of RV function. Multidetector computed tomography (MDCT) plays an important role in the diagnosis of pulmonary emboli but can also be used for assessing RV ischaemic disease or as an alternative for CMR if contra-indicated. Radionuclide techniques have become more obsolete in the current era. The different imaging modalities should be considered complimentary and each plays a role for different indications.
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Affiliation(s)
- Emanuela R Valsangiacomo Buechel
- Division of Paediatric Cardiology and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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Kellihan HB, Stepien RL. Pulmonary hypertension in canine degenerative mitral valve disease. J Vet Cardiol 2012; 14:149-64. [PMID: 22364721 DOI: 10.1016/j.jvc.2012.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/10/2012] [Accepted: 01/11/2012] [Indexed: 11/27/2022]
Abstract
Pulmonary hypertension secondary to degenerative mitral valve disease has been recognized clinically for many years in veterinary medicine, and clinical diagnosis of this syndrome in dogs has been enhanced greatly by widespread use of echocardiography and Doppler echocardiography. Medical therapy is now available to treat this clinical complication of mitral valve disease, making timely diagnosis even more important to patient longevity and quality of life.
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Affiliation(s)
- Heidi B Kellihan
- Section of Cardiology, Department of Medicine, School of Veterinary Medicine, University of Wisconsin, 2015 Linden Dr., Madison, WI 53706, USA.
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129
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Abstract
Pulmonary hypertension is a complex and multidisciplinary disorder. The classification of pulmonary hypertension includes 5 groups. Pulmonary arterial hypertension is a rare disorder that can be idiopathic or heritable in nature, or associated with other conditions, such as scleroderma or congenital heart disease. The recent decades have realized advances in the treatment of this once devastating disease. More commonly, pulmonary hypertension is associated with other disorders, such as those that elevate left heart filling pressures and hypoxemic lung disease. Chronic thromboembolic disease can result in pulmonary hypertension. To determine the etiology, a thorough and methodical evaluation must be completed. Often, an echocardiogram is the first test to suggest the diagnosis of pulmonary hypertension. Studies to identify potential associated causes are important. The diagnostic evaluation culminates in right heart catheterization. Over recent years, advances in therapies, including the prostacyclins, the endothelin receptor antagonists, and the phosphodiesterase type 5 inhibitors, have resulted in an improved quality of life and outlook for patients with what is often a progressive disease.
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130
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Freed BH, Patel AR, Lang RM. Redefining the Role of Cardiovascular Imaging in Patients with Pulmonary Arterial Hypertension. Curr Cardiol Rep 2012; 14:366-73. [DOI: 10.1007/s11886-012-0253-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure. Int J Cardiovasc Imaging 2012; 28:1905-16. [PMID: 22310981 DOI: 10.1007/s10554-012-0022-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022]
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Akintunde AA. The clinical value of the Tei index among Nigerians with hypertensive heart failure: correlation with other conventional indices. Cardiovasc J Afr 2012; 23:40-3. [PMID: 22331251 PMCID: PMC3721940 DOI: 10.5830/cvja-2011-032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 06/06/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Various conventional methods are used for functional evaluation and risk stratification in heart failure. A combined index of global myocardial performance called the Tei index has been described. The aim of this study was to evaluate the correlation of the Tei index with other conventional indices of systolic and diastolic function among Nigerians with hypertensive heart failure. METHODS Fifty-five subjects with hypertensive heart failure and 30 controls were examined, a clinical history was taken, and echocardiography was performed on them. The subjects were categorised into four groups based on their ejection fraction (normal ejection fraction, mild, moderate and severe heart failure). The Tei index was calculated as the sum of the isovolumic relaxation and contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0. RESULTS The Tei index was significantly higher among subjects with hypertensive heart failure compared with the controls (0.91 ± 0.33 vs 0.28 ± 0.16, p < 0.005). The Tei index also increased with the severity of the heart failure and was inversely correlated with ejection fraction (r = -0.697, p < 0.001) and fractional shortening (r = -0.580, p = 0.001). It was directly correlated with mitral E/A ratio (r = 0.246, p = 0.030), left ventricular internal diastolic dimension (r = 0.414, p = 0.002), left ventricular internal systolic dimension (r = 0.596, p < 0.001) and deceleration time (r = 0.219, p = 0.032). CONCLUSION The Tei index correlated significantly with other conventional indices of systolic and diastolic function among Nigerians with hypertensive heart failure. It can be used as a risk-stratification index similar to other traditional indices of systolic and diastolic function.
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Affiliation(s)
- A A Akintunde
- Division of Cardiology, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria.
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133
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Nagai T, Kohsaka S, Murata M, Okuda S, Anzai T, Fukuda K, Satoh T. Significance of electrocardiographic right ventricular hypertrophy in patients with pulmonary hypertension with or without right ventricular systolic dysfunction. Intern Med 2012; 51:2277-83. [PMID: 22975535 DOI: 10.2169/internalmedicine.51.7731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We sought to determine the value of electrocardiographic right ventricular hypertrophy (ECG-RVH) in pulmonary hypertension (PH) patients with right ventricular systolic dysfunction defined by cardiac magnetic resonance (CMR-RVSD). PATIENTS A total of 31 consecutive patients with PH with a mean pulmonary arterial pressure of >25 mmHg underwent both ECG and CMR studies. Patients were divided into 2 groups according to the presence of RVSD, defined as a RV ejection fraction <35%. Logistic regression modeling was performed to define the association between ECG-RVH and CMR-RVSD. RESULTS About half of the patients had RVSD (n=15 ; 48%). The R to S wave ratio (p=0.01) or incidence of qR pattern (p=0.002) in lead V(1) was significantly greater in patients with PH complicated by RVSD than in those without RVSD. These 2 patterns were significant predictors of RVSD [odds ratio (OR), 19.3 for qR; OR, 14.0 for R/S>1] and when each of these ECG findings was assigned with a point proportional to OR (score of 2 for qR in lead V(1) and score of 1 for R/S>1 in lead V(1)), the incidence of RVSD increased by the total ECG score. CONCLUSION The combination of ECG-RVH findings, especially in lead V(1), predicts the presence of RVSD defined by CMR. ECG might be a useful tool for estimating the presence of RVSD in patients with PH.
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Affiliation(s)
- Toshiyuki Nagai
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Japan.
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134
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Grünig E, Barner A, Bell M, Claussen M, Dandel M, Dumitrescu D, Gorenflo M, Holt S, Kovacs G, Ley S, Meyer JF, Pabst S, Riemekasten G, Saur J, Schwaiblmair M, Seck C, Sinn L, Sorichter S, Winkler J, Leuchte HH. Non-invasive diagnosis of pulmonary hypertension: ESC/ERS Guidelines with Updated Commentary of the Cologne Consensus Conference 2011. Int J Cardiol 2011; 154 Suppl 1:S3-12. [DOI: 10.1016/s0167-5273(11)70488-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Pulmonary hypertension (PH) is a relatively misunderstood disease, partly related to the fact that many perceive PH to be a singular diagnosis. An unintended consequence of this is the misapplication of the role of the Doppler-Echocardiographic (DE) examination, as well as an underappreciation for its ability to help discern PH pathophysiology prior to right heart catheterization. Since DE often serves as the "gatekeeper" to invasive right heart catheterization, misinterpretation of the DE can lead to missed or delayed diagnosis with devastating consequences. Too often, the primary or nearly exclusive focus of the DE examination is placed on the pulmonary artery pressure estimation. Two main issues with this approach are that Doppler pressure estimations can be inaccurate and even when accurate, without integration of additional 2-D and Doppler information, the clinician will often still not appreciate the pathophysiology of the PH nor its clinical significance. This review will focus on the 2-D and Doppler features necessary to assess pulmonary vascular disease (PVD), discern the salient differences between PVD and pulmonary venous hypertension (PVH), and how to integrate these key DE parameters such that PH pathophysiology can be determined noninvasively and early in the patient workup. Overreliance on any single DE metric, and especially PA pressure estimation, detracts from the overall diagnostic potential of the DE examination. Integrating the relative balance of right and left heart findings, along with proper Doppler interpretation provides a wealth of clinical and pathophysiologic insight prior to invasive hemodynamic assessment. The end results are heightened awareness and improved identification of which patients should be referred for further invasive testing, as well the use of the DE information to compliment the findings from invasive testing.
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Affiliation(s)
- Justin D Roberts
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Haddad F, Peterson T, Fuh E, Kudelko KT, de Jesus Perez V, Skhiri M, Vagelos R, Schnittger I, Denault AY, Rosenthal DN, Doyle RL, Zamanian RT. Characteristics and Outcome After Hospitalization for Acute Right Heart Failure in Patients With Pulmonary Arterial Hypertension. Circ Heart Fail 2011; 4:692-9. [DOI: 10.1161/circheartfailure.110.949933] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- François Haddad
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Tyler Peterson
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Eric Fuh
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Kristina T. Kudelko
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Vinicio de Jesus Perez
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Mehdi Skhiri
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Randall Vagelos
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Ingela Schnittger
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Andre Y. Denault
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - David N. Rosenthal
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Ramona L. Doyle
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
| | - Roham T. Zamanian
- From the Division of Cardiovascular Medicine (F.H., M.S., R.V., I.S.), Department of Medicine (T.P., E.F.), Division of Pulmonary and Critical Care Medicine (K.T.K., V.d.J.P., R.L.D., R.T.Z.), and Division of Cardiology, Department of Pediatrics (D.N.R.), Stanford University, Stanford, CA; and Department of Anesthesia, Montreal University, Montreal, Quebec, Canada (A.Y.D.)
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Correale M, Totaro A, Ieva R, Brunetti ND, Di Biase M. Time intervals and myocardial performance index by tissue Doppler imaging. Intern Emerg Med 2011; 6:393-402. [PMID: 20949333 DOI: 10.1007/s11739-010-0469-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/23/2010] [Indexed: 10/19/2022]
Abstract
The application of tissue Doppler imaging (TDI) has shown remarkable growth in clinical practice during the past few years, especially, in risk stratification of patients with coronary heart disease or heart failure (systolic and diastolic). Myocardial performance index (MPI) is a Doppler echocardiographic parameter defined as the sum of the isovolemic contraction and relaxation times divided by the ejection time. It is considered as a reliable parameter to assess global left ventricular function. Cardiac time intervals and MPI have also been found as new applications in diagnosing cardiotoxicity from chemotherapy, COPD, valvular heart disease, pulmonary hypertension and endocrinopathies.
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Affiliation(s)
- Michele Correale
- Department of Cardiology, Ospedali Riuniti OO.RR, University of Foggia, viale L Pinto, 1, 71100 Foggia, Italy.
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138
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Fukuda Y, Tanaka H, Sugiyama D, Ryo K, Onishi T, Fukuya H, Nogami M, Ohno Y, Emoto N, Kawai H, Hirata KI. Utility of Right Ventricular Free Wall Speckle-Tracking Strain for Evaluation of Right Ventricular Performance in Patients with Pulmonary Hypertension. J Am Soc Echocardiogr 2011; 24:1101-8. [DOI: 10.1016/j.echo.2011.06.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Indexed: 12/14/2022]
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Grapsa J, Dawson D, Nihoyannopoulos P. Assessment of right ventricular structure and function in pulmonary hypertension. J Cardiovasc Ultrasound 2011; 19:115-25. [PMID: 22073320 PMCID: PMC3209589 DOI: 10.4250/jcu.2011.19.3.115] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 08/12/2011] [Accepted: 08/17/2011] [Indexed: 12/02/2022] Open
Abstract
Right ventricular function plays an important role in determining cardiac symptoms and exercise capacity in chronic heart failure. It is known that right ventricle has complex anatomy and physiology. The purpose of this review paper is to demonstrate the best assessment of the right ventricle with current echocardiography. Echocardiography can assess sufficiently right ventricular structure and function and also suggest prognosis in pulmonary hypertension patients, especially with the use of modern imaging techniques. Finally, the new imaging modality of real time three dimensional echocardiography is interchangeable to cardiac magnetic resonance in reproducibility and accuracy.
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Affiliation(s)
- Julia Grapsa
- Department of Cardiovascular Sciences, Imperial College of London, National Heart and Lung Institute, Hammersmith Hospital, London, UK
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140
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Farrag A, El-Aroussy W, Zaghloul S, El-Guindy M, Yacoub M. Prevalence and severity of pulmonary hypertension in asymptomatic rural residents with schistosomal infection in the Nile Delta. Trop Med Int Health 2011; 17:112-8. [DOI: 10.1111/j.1365-3156.2011.02891.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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141
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Abdelaziz AA, Daoud EM. Assessment of right ventricular function by myocardial performance index in diabetic patients. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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142
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Aggarwal S, Stockmann P, Klein MD, Natarajan G. Echocardiographic measures of ventricular function and pulmonary artery size: prognostic markers of congenital diaphragmatic hernia? J Perinatol 2011; 31:561-6. [PMID: 21311494 DOI: 10.1038/jp.2011.3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare echocardiographic measures of biventricular function and pulmonary artery size in infants with congenital diaphragmatic hernia (CDH) and normal controls, and examine their correlation, if any, with outcomes in CDH. STUDY DESIGN We included consecutive neonates (<1 month old) with CDH and term controls without structural heart defects. Clinical and outcomes data were recorded and echocardiograms evaluated for right ventricular (RV) and left ventricular (LV) myocardial performance index (MPI), cardiac output index (CI) and McGoon index, among others. Statistical analyses (SPSS version 17, SPSS, Chicago, IL, USA) included between-group comparisons, using analysis of variance and χ(2)-test and binary regression, with significance set at P<0.05. RESULT Infants with CDH (n=34) were comparable with controls (n=35) in their age, weight, gestational age and gender. CDH was left sided in 24 (70%) neonates. Extracorporeal membrane oxygenation (ECMO) was required in 15 (45%) neonates; 18 (53%) infants survived. MPIs, CI and eccentricity index in systole were significantly worse in the CDH group, compared with controls and among CDH infants who died, compared with survivors. Infants with CDH who died or needed ECMO had significantly impaired MPIs and CI than survivors. On regression analyses, LV CI and MPIs were independently associated with mortality. CONCLUSION Infants with CDH had significantly impaired ventricular function and pulmonary hypertension, compared with controls. In the CDH group, LV dysfunction was associated with death and adverse outcomes. Further studies incorporating echocardiographic indices as prognostic markers of CDH are warranted.
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Affiliation(s)
- S Aggarwal
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, MI 48201, USA.
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143
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Denault A, Deschamps A, Tardif JC, Lambert J, Perrault L. Pulmonary hypertension in cardiac surgery. Curr Cardiol Rev 2011; 6:1-14. [PMID: 21286273 PMCID: PMC2845789 DOI: 10.2174/157340310790231671] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Revised: 03/20/2009] [Accepted: 03/31/2009] [Indexed: 12/14/2022] Open
Abstract
Pulmonary hypertension is an important prognostic factor in cardiac surgery associated with increased morbidity and mortality. With the aging population and the associated increase severity of illness, the prevalence of pulmonary hypertension in cardiac surgical patients will increase. In this review, the definition of pulmonary hypertension, the mechanisms and its relationship to right ventricular dysfunction will be presented. Finally, pharmacological and non-pharmacological therapeutic and preventive approaches will be presented.
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Affiliation(s)
- André Denault
- Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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144
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Kiatchoosakun S, Wongvipaporn C, Nanagara R, Hoit BD. Right ventricular systolic pressure assessed by echocardiography: a predictive factor of mortality in patients with scleroderma. Clin Cardiol 2011; 34:488-93. [PMID: 21717471 DOI: 10.1002/clc.20920] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 03/29/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a well-known complication of systemic sclerosis (SSc). Doppler echocardiographic screening for the detection of PAH (by measuring right ventricular systolic pressure [RVSP]) is therefore recommended for all patients with SSc. However, the validity of RVSP as a predictor of mortality in patients with SSc is not well established. HYPOTHESIS Doppler-determined PAH identifies a high-risk subset of patients with SSc with decreased survival. METHODS We performed echocardiography in 155 consecutive patients with SSc between May 2005 and July 2006 and tested the value of an RVSP level of ≥36 mm Hg to predict mortality. Cox proportional hazards model was used to examine the individual relationship between each variable and the mortality rate. RESULTS Tricuspid regurgitant jets for RVSP determination were quantified in 129 patients (82.6%), of which 47 (36.4%) had RVSP ≥36 mm Hg. The median follow-up time was 34 months. The 1-, 2-, and 3-year survival rates were significantly lower among SSc patients with RVSP ≥36 vs ≤36 mm Hg (82%, 78%, and 67% vs 98%, 90%, and 86%, respectively, P < 0.01 by Wilcoxon test). In a multivariate analysis including echocardiographic and clinical variables, only an RVSP ≥36 mm Hg and a New York Heart Association III/IV class were associated with increased mortality; the respective Cox hazard ratios were 2.22 (95% confidence interval [CI]: 1.01-4.89, P = 0.048) and 4.77 (95% CI: 2.09-10.90, P = 0.000). CONCLUSIONS Our results indicate that Doppler RVSP identifies a high-risk subset and supports the use of Doppler RVSP as a screening test in patients with SSc who may warrant early treatment of their PAH.
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Affiliation(s)
- Songsak Kiatchoosakun
- Division of Cardiology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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145
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Alternatives to Lung Transplantation: Treatment of Pulmonary Arterial Hypertension. Clin Chest Med 2011; 32:399-410. [DOI: 10.1016/j.ccm.2011.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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146
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Vitarelli A, Franciosa P, Nguyen BL, Capotosto L, Ciccaglioni A, Conde Y, Iorio G, De Curtis G, Caranci F, Vitarelli M, Lucchetti P, Dettori O, De Cicco V. Additive Value of Right Ventricular Dyssynchrony Indexes in Predicting the Success of Cardiac Resynchronization Therapy: A Speckle-Tracking Imaging Study. J Card Fail 2011; 17:392-402. [DOI: 10.1016/j.cardfail.2010.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 11/24/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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147
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Échographie : intérêt et limite pour le dépistage et le suivi de l’hypertension artérielle pulmonaire. Presse Med 2011; 40 Suppl 1:1S14-20. [DOI: 10.1016/s0755-4982(11)70003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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148
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Conventional and segmental myocardial Tei indices measurement in patients with acute ST-segment elevation myocardial infarction: Is there a relation? Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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149
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Carvalho VT, Barbosa MM, Nunes MCP, Cardoso YS, de Sá Filho IM, Oliveira FR, Antunes CMF, Lambertucci JR. Early Right Cardiac Dysfunction in Patients with Schistosomiasis Mansoni. Echocardiography 2011; 28:261-7. [DOI: 10.1111/j.1540-8175.2010.01330.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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150
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Utsunomiya H, Nakatani S, Okada T, Kanzaki H, Kyotani S, Nakanishi N, Kihara Y, Kitakaze M. A simple method to predict impaired right ventricular performance and disease severity in chronic pulmonary hypertension using strain rate imaging. Int J Cardiol 2011; 147:88-94. [DOI: 10.1016/j.ijcard.2009.08.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/14/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
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