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Echocardiography in Pulmonary Arterial Hypertension: Is It Time to Reconsider Its Prognostic Utility? J Clin Med 2021; 10:jcm10132826. [PMID: 34206876 PMCID: PMC8268493 DOI: 10.3390/jcm10132826] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/26/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is characterized by an insult in the pulmonary vasculature, with subsequent right ventricular (RV) adaptation to the increased afterload that ultimately leads to RV failure. The awareness of the importance of RV function in PAH has increased considerably because right heart failure is the predominant cause of death in PAH patients. Given its wide availability and reduced cost, echocardiography is of paramount importance in the evaluation of the right heart in PAH. Several echocardiographic parameters have been shown to have prognostic implications in PAH; however, the role of echocardiography in the risk assessment of the PAH patient is limited under the current guidelines. This review discusses the echocardiographic evaluation of the RV in PAH and during therapy, and its prognostic implications, as well as the potential significant role of repeated echocardiographic assessment in the follow-up of patients with PAH.
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Afzal S, Piayda K, Maier O, Goh S, Hellhammer K, Cramer M, Bönner F, Polzin A, Nijhof N, Kelm M, Zeus T, Veulemans V. Current and Future Aspects of Multimodal Imaging, Diagnostic, and Treatment Strategies in Bicuspid Aortic Valve and Associated Aortopathies. J Clin Med 2020; 9:jcm9030662. [PMID: 32121483 PMCID: PMC7141257 DOI: 10.3390/jcm9030662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Bicuspid aortic valve (BAV) is the most frequent congenital cardiac abnormality leading to premature aortic valve apparatus dysfunction and is often associated with aortopathy. Therefore, current guidelines recommend a surgical aortic valve replacement (SAVR), even if many patients are deemed inoperable owing to their comorbidities and require alternatives such as transcatheter aortic valve replacement (TAVR). However, BAV variations remain challenging for procedural success. Therefore, the latest development in different imaging modalities (echocardiography, multislice-computertomographie, cardiovascular magnetic resonance) allows in-depth analysis for preprocedural risk stratification, follow up, and patient selection. Furthermore, we shed light on the latest developments in pre- and periprocedural fusion imaging as well as on current and future treatment options.
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Affiliation(s)
- Shazia Afzal
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Shouheng Goh
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Katharina Hellhammer
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Mareike Cramer
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Florian Bönner
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | | | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
- CARID (Cardiovascular Research Institute Düsseldorf), Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; (S.A.); (K.P.); (O.M.); (S.G.); (K.H.); (M.C.); (F.B.); (A.P.); (M.K.); (T.Z.)
- Correspondence:
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