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Shi S, Zhu X, Cheang I, Liao S, Yin T, Lu X, Yao W, Zhang H, Li X, Zhou Y. Development and validation of a diagnostic nomogram in pulmonary hypertension due to left heart disease. Heart Lung 2024; 65:11-18. [PMID: 38364358 DOI: 10.1016/j.hrtlng.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Pulmonary hypertension (pH) due to left heart disease (pH-LHD) is the most common form of pH in clinical practice. OBJECTIVES The purpose of the study is to develop a diagnostic nomogram predictive model combining conventional noninvasive examination and detection indicators. METHODS Our study retrospectively included 361 patients with left heart disease (LHD) who underwent right heart catheterization between 2013 and 2020. All patients were randomly divided into a training cohort (253, 70 %) and a validation cohort (108, 30 %). pH was defined as resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg measured by RHC examination. Data dimension reduction and feature selection were used by Lasso regression model. The nomogram was constructed based on multivariable logistic regression. RESULTS A total of 175 patients with LHD were diagnosed with pH during their hospitalization, representing 48.5 % of the cohort. The mean age of the overall group was 55.6 years, with 76.7 % being male patients. Excessive resting heart rate, elevated New York Heart Association functional class, increased red blood cell distribution width, right ventricular end-diastolic diameter, and pulmonary artery systolic pressure measured by echocardiography were independently associated with the prevalence of pH-LHD. The inclusion of these 5 variables in the nomogram showed good discrimination (AUC = 0.866 [95 % CI, 0.820-0.911]) and optimal calibration (Hosmer-Lemeshow test, P = 0.791) for the validation cohort. CONCLUSIONS The noninvasive nomogram of pH-LHD developed in this study has excellent diagnostic value and clinical applicability, and can more accurately evaluate the presence risk of pH in patients with LHD.
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Affiliation(s)
- Shi Shi
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Department of Cardiology, Hai'an People's Hospital, Nantong 226600, China
| | - Xu Zhu
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Iokfai Cheang
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Shengen Liao
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Ting Yin
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Xinyi Lu
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Wenming Yao
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Haifeng Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou 215002, China
| | - Xinli Li
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Yanli Zhou
- National Key Laboratory for Innovation and Transformation of Luobing Theory. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.
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Kadoglou NPE, Khattab E, Velidakis N, Gkougkoudi E, Myrianthefs MM. The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension. J Pers Med 2024; 14:474. [PMID: 38793056 PMCID: PMC11122427 DOI: 10.3390/jpm14050474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s'), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.
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Affiliation(s)
- Nikolaos P. E. Kadoglou
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Elina Khattab
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Nikolaos Velidakis
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Evaggelia Gkougkoudi
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Michael M. Myrianthefs
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
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Wu T, Li X, Zhang D, Gong LG. Early impairment of right ventricular systolic function in patients with prediabetes and type 2 diabetes mellitus: An analysis of two-dimensional speckle tracking echocardiography. Echocardiography 2023; 40:831-840. [PMID: 37449864 DOI: 10.1111/echo.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 06/17/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is a metabolic disease that affects multiple target organs. Current data on right ventricular damage in type 2 diabetes, especially in prediabetes, are limited. Due to the anatomical characteristics of the right ventricle, the assessment of the right ventricle by conventional echocardiography is difficult, whereas the ultrasound two-dimensional speckle tracking echocardiography can provide information on myocardial systolic function by tracking the motion information of myocardial speckles, which can sensitively reflect myocardial mechanical changes. AIMS To assess the effect of prediabetes and diabetes with preserved left ventricular ejection fraction on right ventricular myocardial systolic function and to identify independent risk factors affecting right ventricular systolic function. METHODS A total of 49 normoglycaemic (NG) healthy individuals, 43 prediabetics (PDM), and 52 type 2 diabetics (T2DM) were recruited. All study subjects underwent conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). RESULTS The right ventricular global longitudinal strain (RVGLS) (20.80 ± 1.96% vs. 18.99 ± 3.20% vs. 16.85 ± 4.01%), left ventricular global longitudinal strain (LVGLS), and interventricular septal longitudinal strain (IVS-LS) (17.28 ± 2. 35% vs. 16.14 ± 3.22% vs. 15.53 ± 3.33%) gradually decreased from the controls, through patients with prediabetes, to those with diabetes (p < .001). Right ventricular free wall strain (RVFW-LS) was higher in the control group (25.63 ± 4.58% vs. 22.83 ± 4.83% vs. 20.79 ± 4.92%) than in the other two groups with a statistically significant difference (p < .001), while RVFW-LS was not statistically different between the prediabetic and diabetic groups. Multivariate regression analysis showed that HbA1c (β = -.626, p < .001), IVS-LS (β = .417, p < .001), and left ventricular end-diastolic diameter (LVEDd) (β = .191, p = .011) were independently correlated with RVGLS. CONCLUSIONS Two-dimensional speckle tracking echocardiography can sensitively detect subtle changes in the early impairment of right ventricular systolic function in patients with abnormal glucose metabolism. Type 2 diabetes is the common mechanism causing impaired myocardial mechanics in the right and left ventricles. The reduced global systolic longitudinal strain of the right ventricle was associated with reduced global septal longitudinal strain and left ventricular remodeling. HbA1c is an independent predictor of the global longitudinal strain of the right ventricle, and controlling blood glucose levels may be expected to improve the extent of myocardial damage.
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Affiliation(s)
- Ting Wu
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Xia Li
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Dan Zhang
- Department of Ultrasound, Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Liang-Geng Gong
- Department of Medical Imaging Center, Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
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Prathiksha Prabhu K, Nayak K, Nayak V, Prabhu S, Rekha V, Ashwal AJ, Sudhakar Rao M. Ventricular strain patterns in multivalvular heart disease: a cross-sectional study. Int J Cardiovasc Imaging 2023; 39:331-338. [PMID: 36306043 PMCID: PMC9870819 DOI: 10.1007/s10554-022-02737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
Multivalvular heart disease (MVD) is an aggregate of regurgitant and/or stenotic lesions of at least two cardiac valves. Ventricular tissue deformation imaging is a powerful predictor of subclinical myocardial dysfunction in patients with MVD.The aim of this study was to examine the left and right ventricular strain patterns in MVD as well as observe any association between right-sided valvular involvement (tricuspid or pulmonary valve lesion) with that of aortic and/or mitral valve lesion. Patients with at least moderate forms of MVD were included in the present study. 72 patients with mean age of 56.69 ± 14.59 years and various presentations of MVD were finally enrolled in this study. The commonest cause for MVD was rheumatic heart disease in these patients. Conventional 2-dimensional parameters as well as tissue deformation imaging parameters were assessed in offline mode for these patients. The Mean ± SD values for various quantitative 2D echocardiographic conventional and tissue deformation imaging were assessed. It was observed that LV strain parameters including the global longitudinal strain (GLS) were preserved whereas the RV strain parameters were mildly reduced (RV GLS total is - 19.49 ± 6.08%). Also, when conventional echocardiographic parameters were assessed to see any association between aortic and/or mitral valve disease with that of right-sided valvular lesions (tricuspid or pulmonary); 2D conventional echocardiographic parameters like left atrial dimension (p = 0.034), TAPSE (tricuspid annular plane systolic excursion) (p < 0.001), RVSP (right ventricular systolic pressure) (p < 0.001) and IVC (inferior vena cava) dimensions (p < 0.001) showed a statistically significant result; whereas, when strain parameters for LV and RV were assessed, they did not show any statistical difference for the same. In this series of patients with significant MVD, our findings suggest that ventricular strain parameters may be reliable markers of myocardial dysfunction, but may alter depending on the underlying combination of MVD, and right ventricular strain should also be an important parameter while assessing different combinations of MVD.
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Affiliation(s)
- K. Prathiksha Prabhu
- Department of Cardiovascular Technology, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education, Manipal, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education, Manipal, India
| | - Vidya Nayak
- Department of Cardiovascular Technology, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education, Manipal, India
| | - Sridevi Prabhu
- Department of Cardiovascular Technology, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education, Manipal, India
| | - V. Rekha
- Department of Cardiovascular Technology, Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education, Manipal, India
| | - A. J. Ashwal
- Department of Cardiology, Kasturba Medical College (KMC), Manipal Academy of Higher Education, Manipal, India
| | - M. Sudhakar Rao
- Department of Cardiology, Kasturba Medical College (KMC), Manipal Academy of Higher Education, Manipal, India
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Sinkala E, Ahmed HY, Sibomana JP, Lee MH, Kassa B, Kumar R, Mazimba S, Binegdie AB, Mpisa S, Wamundila K, Graham BB, Hilton JF. Rationale and design of a screening study to detect schistosomiasis-associated pulmonary hypertension in Ethiopia and Zambia. Pulm Circ 2022; 12:e12072. [PMID: 35514775 PMCID: PMC9063961 DOI: 10.1002/pul2.12072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/28/2022] [Accepted: 03/27/2022] [Indexed: 11/05/2022] Open
Abstract
Schistosomiasis is a major cause of pulmonary arterial hypertension (PAH) worldwide, but the prevalence and risk factors for schistosomiasis-associated PAH (SchPAH) development are not well understood. Schistosomiasis-associated hepatosplenic disease (SchHSD) is thought to be a major risk factor for PAH development. Herein, we describe our plans for prospectively screening SchHSD subjects for clinical evidence of PAH at two major academic medical centers and national referral hospitals in Addis Ababa, Ethiopia and Lusaka, Zambia. The screening study will primarily be conducted by echocardiography, in addition to clinical assessments. Plasma samples will be drawn and banked for subsequent analysis based on preclinical animal model rationale. If successful, this study will demonstrate feasibility of conducting prospective cohort studies of SchPAH screening in schistosomiasis-endemic regions of Africa, and provide initial data on clinic-based disease prevalence and potential mechanistic biomarkers underlying disease pathogenesis.
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Affiliation(s)
- Edford Sinkala
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Hanan Yusuf Ahmed
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
| | - Jean Pierre Sibomana
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
- Department of Medicine, Butare University Teaching HospitalUniversity of RwandaButareRwanda
| | - Michael H. Lee
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Biruk Kassa
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Rahul Kumar
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sula Mazimba
- Department of Medicine, Division of CardiologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Amsalu B. Binegdie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Tikur Anbessa Specialized Hospital, College of Health SciencesUniversity of Addis AbabaAddis AbabaEthiopia
| | - Sydney Mpisa
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Kawana Wamundila
- Hepatology Clinic, Department of MedicineUniversity of Zambia Teaching HospitalLusakaZambia
| | - Brian B. Graham
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joan F. Hilton
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Yamagata Y, Ikeda S, Kojima S, Ueno Y, Nakata T, Koga S, Ohno C, Yonekura T, Yoshimuta T, Minami T, Kawano H, Maemura K. Right Ventricular Dyssynchrony in Patients With Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension. Circ J 2022; 86:936-944. [DOI: 10.1253/circj.cj-21-0849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yuki Yamagata
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Sanae Kojima
- Ultrasound Diagnostic Center, Nagasaki University Hospital
| | - Yuki Ueno
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomoo Nakata
- Department of Cardiology, Saiseikai Nagasaki Hospital
| | - Seiji Koga
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Chikara Ohno
- Ultrasound Diagnostic Center, Nagasaki University Hospital
| | - Tsuyoshi Yonekura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Tsuyoshi Yoshimuta
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Takako Minami
- Ultrasound Diagnostic Center, Nagasaki University Hospital
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
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Liu BY, Wu WC, Zeng QX, Liu ZH, Niu LL, Tian Y, Luo Q, Zhao ZH, Quan RL, Lin JR, Wang H, He JG, Xiong CM. Comparison of the capability of risk stratification evaluation between two- and three-dimensional speckle-tracking strain in pre-capillary pulmonary hypertension. Pulm Circ 2019; 9:2045894019894525. [PMID: 31908764 PMCID: PMC6935885 DOI: 10.1177/2045894019894525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023] Open
Abstract
To investigate and compare the value of right ventricular longitudinal strain detected by two-dimensional and three-dimensional speckle-tracking echocardiography in risk stratification evaluation in pre-capillary pulmonary hypertension. We consecutively screened 66 patients diagnosed with pre-capillary pulmonary hypertension in our center. According to the risk assessment recommended by 2015 European Society of Cardiology Guidelines, all participants were classified into low- and intermediate-high-risk group. Two-dimensional and three-dimensional strains were measured using off-line softwares (GE EchoPAC version 201 and TomTec, 4D RV Function 2.0). Fifty-seven pre-capillary pulmonary hypertension patients (average 35 years old, 18 males and 39 females) were finally enrolled in our study, 32 (56.1%) were classified in low-risk group, while 25 (43.9%) were in the intermediate-high-risk group. Clinical data associated with disease severity, such as N-terminal pro-brain natriuretic peptide (r = 0.574, P < 0.001), peak oxygen consumption (r = -0.484, P < 0.001), and 6-min walking distance (r = -0.356, P = 0.008) were significantly correlated with two-dimensional right ventricular longitudinal strain; while the correlations with three-dimensional right ventricular longitudinal strain were weaker. Receiver operating characteristic curves for the detection of intermediate-high risk stratification showed two-dimensional right ventricular longitudinal strain had the best predictive capacity (area under curve, 0.82, 95% CI: 0.71-0.93, P < 0.001). Univariate and Multivariate Logistic regression analyses identified two-dimensional right ventricular longitudinal strain as an independent predictor (OR: 1.42, 95% CI: 1.18-1.71, P < 0.001) of intermediate-high risk stratification in this cohort of pre-capillary pulmonary hypertension patients, the predictive capacity retained (OR: 1.45, 95% CI: 1.18-1.78, P < 0.001) after adjusted by age, gender, and body mass index, while three-dimensional speckle-tracking echocardiography parameters were not. In conclusion, when used for the detection of intermediate-high risk stratification in pre-capillary pulmonary hypertension, two-dimensional right ventricular longitudinal strain was better than three-dimensional right ventricular longitudinal strain.
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Affiliation(s)
- Bing-Yang Liu
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Qi-Xian Zeng
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Zhi-Hong Liu
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Li-Li Niu
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Yue Tian
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Qin Luo
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Zhi-Hui Zhao
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Rui-Lin Quan
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Jing-Ru Lin
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Jian-Guo He
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Chang-Ming Xiong
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
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Park JH. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circ J 2019; 49:908-931. [PMID: 31456367 PMCID: PMC6753023 DOI: 10.4070/kcj.2019.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 01/14/2023] Open
Abstract
Echocardiography is the first and is the most-available imaging modality for many cardiovascular diseases, and echocardiographic parameters can give much important information for diagnosis, treatment, and prognostic evaluations. Left ventricular ejection fraction (LVEF) is the most commonly used echocardiographic parameter for left ventricular (LV) systolic function. Although LVEF is used routinely in daily practice, it is calculated from volumetric change without representing true myocardial properties. Recently, strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Although strain echocardiography has been applied to measure the right ventricle and left atrium, in addition to analyzing the LV, many cardiologists who are not imaging specialists are unaware of its clinical use and importance. Therefore, this review describes the measurement and clinical utility of 2-dimensional strain analysis in various cardiovascular diseases.
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Affiliation(s)
- Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
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Meng H, Chandrasekaran K, Villarraga HR, Shah AA, Kittipovanonth M, Cha SS, Pellikka PA, Seward JB. Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging. Echocardiography 2019; 36:877-887. [DOI: 10.1111/echo.14328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/12/2019] [Indexed: 01/24/2023] Open
Affiliation(s)
| | | | | | - Aijaz A. Shah
- Department of CardiologyPrince Sultan Cardiac Center Riyadh Saudi Arabia
| | | | - Stephen S. Cha
- Division of BiostatisticsMayo Clinic Rochester Minnesota
| | | | - James B. Seward
- Division of Cardiovascular DiseasesMayo Clinic Rochester Minnesota
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Lee JH, Park JH. Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography. J Cardiovasc Imaging 2018; 26:111-124. [PMID: 30310878 PMCID: PMC6160817 DOI: 10.4250/jcvi.2018.26.e11] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 01/12/2023] Open
Abstract
Right ventricular (RV) systolic dysfunction has been identified as an independent prognostic marker of many cardiovascular diseases. However, there are problems in measuring RV systolic function objectively and identification of RV dysfunction using conventional echocardiography. Strain echocardiography is a new imaging modality to measure myocardial deformation. It can measure intrinsic myocardial function and has been used to measure regional and global left ventricular (LV) function. Although the RV has different morphologic characteristics than the LV, strain analysis of the RV is feasible. After strain echocardiography was introduced to measure RV systolic function, it became more popular and was incorporated into recent echocardiographic guidelines. Recent studies showed that RV global longitudinal strain (RVGLS) can be used as an objective index of RV systolic function with prognostic significance. In this review, we discuss RVGLS measurement, normal reference values, and the clinical importance of RVGLS.
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Affiliation(s)
- Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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11
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Torrealba N, Navarro-Marquez M, Garrido V, Pedrozo Z, Romero D, Eura Y, Villalobos E, Roa JC, Chiong M, Kokame K, Lavandero S. Herpud1 negatively regulates pathological cardiac hypertrophy by inducing IP3 receptor degradation. Sci Rep 2017; 7:13402. [PMID: 29042597 PMCID: PMC5645377 DOI: 10.1038/s41598-017-13797-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/02/2017] [Indexed: 01/19/2023] Open
Abstract
Cardiac hypertrophy is an adaptive response triggered by pathological stimuli. Regulation of the synthesis and the degradation of the Ca2+ channel inositol 1,4,5-trisphosphate receptor (IP3R) affects progression to cardiac hypertrophy. Herpud1, a component of the endoplasmic reticulum-associated degradation (ERAD) complex, participates in IP3R1 degradation and Ca2+ signaling, but the cardiac function of Herpud1 remains unknown. We hypothesize that Herpud1 acts as a negative regulator of cardiac hypertrophy by regulating IP3R protein levels. Our results show that Herpud1-knockout mice exhibit cardiac hypertrophy and dysfunction and that decreased Herpud1 protein levels lead to elevated levels of hypertrophic markers in cultured rat cardiomyocytes. In addition, IP3R levels were elevated both in Herpud1-knockout mice and Herpud1 siRNA-treated rat cardiomyocytes. The latter treatment also led to elevated cytosolic and nuclear Ca2+ levels. In summary, the absence of Herpud1 generates a pathological hypertrophic phenotype by regulating IP3R protein levels. Herpud1 is a novel negative regulator of pathological cardiac hypertrophy.
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Affiliation(s)
- Natalia Torrealba
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile
| | - Mario Navarro-Marquez
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile
| | - Valeria Garrido
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile
| | - Zully Pedrozo
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile.,Instituto de Ciencias Biomédicas, Facultad de Medicina Universidad de Chile, Santiago, Chile
| | - Diego Romero
- Department of Pathology, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Yuka Eura
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Elisa Villalobos
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile.,Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan Carlos Roa
- Department of Pathology, Advanced Center for Chronic Diseases (ACCDiS), Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Mario Chiong
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile
| | - Koichi Kokame
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Sergio Lavandero
- Advanced Center for Chronic Disease (ACCDiS) & Center for Molecular Studies of the Cell (CEMC), Facultad de Ciencias Químicas y Farmacéuticas & Facultad de Medicina, Santiago, Chile. .,Instituto de Ciencias Biomédicas, Facultad de Medicina Universidad de Chile, Santiago, Chile. .,Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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12
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Role of Two-Dimensional Speckle-Tracking Echocardiography Strain in the Assessment of Right Ventricular Systolic Function and Comparison with Conventional Parameters. J Am Soc Echocardiogr 2017; 30:937-946.e6. [PMID: 28803684 DOI: 10.1016/j.echo.2017.06.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Despite the already well-known role the right side of the heart plays in many diseases, right ventricular (RV) function has only recently been carefully considered. Echocardiography is the first-line diagnostic technique for the assessment of the right ventricle and right atrium, whereas cardiac magnetic resonance is considered the gold standard but is limited by cost and availability. According to the current guidelines, systolic RV function should be assessed by several conventional measurements, but the efficacy of these parameters as diagnostic and prognostic tools has been questioned by many authors. The development in recent years of myocardial deformation imaging techniques and their application to the right heart chambers has allowed deeper evaluation of the importance of RV function in the pathophysiology of a large number of cardiovascular conditions, but the real value of this new tool has not been completely clarified. The aim of this review is to provide a wide and careful analysis of findings available in the literature about the assessment of RV systolic function by strain measurements, comparing them with conventional parameters and evaluating their role in several clinical settings.
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13
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Li Y, Wang Y, Meng X, Zhu W, Lu X. Assessment of right ventricular longitudinal strain by 2D speckle tracking imaging compared with RV function and hemodynamics in pulmonary hypertension. Int J Cardiovasc Imaging 2017; 33:1737-1748. [PMID: 28553693 DOI: 10.1007/s10554-017-1182-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022]
Abstract
The right ventricular longitudinal strain (RVLS) of pulmonary hypertension (PH) patients and its relationship with RV function parameters measured by echocardiography and hemodynamic parameters measured by right heart catheterization was investigated. According to the WHO functional class (FC), 66 PH patients were divided into FC I/II (group 1) and III/IV (group 2). RV function parameters were measured by echocardiographic examinations. Hemodynamic parameters were obtained by right heart catheterization. Patients in group 2 had higher systolic pulmonary artery pressure (sPAP; P < 0.05) than patients in group (1) significant between-group differences were observed in global RVLS (RVLSglobal), free wall RVLS (RVLSFW; P < 0.01), and RV conventional function parameters (all P < 0.05). Moreover, mPAP and PVR increased remarkably and CI decreased significantly in group (2) RVLSglobal had a positive correlation with 6-min walking distance (6MWD; r = 0.492, P < 0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP; r = 0.632, P < 0.001), while RVLSFW had a positive correlation with 6MWD (r = 0.483, P < 0.001) and NT-proBNP (r = 0.627, P < 0.001). Hemodynamics analysis revealed that RVLSglobal had a positive correlation with mPAP (r = 0.594, P < 0.001), PVR (r = 0.573, P < 0.001) and CI (r = 0.366, P = 0.003), while RVLSFW had a positive correlation with mPAP (r = 0.597, P < 0.001), PVR (r = 0.577, P < 0.001) and CI (r = 0.369, P = 0.002). According to receiver operating characteristic curves, the optimal cut-off values of RVLSglobal (-15.0%) and RVLSFW (-15.3%) for prognosis detection with good sensitivity and specificity. Evidence has shown that RVLS measurement can provide the much-needed and reliable information on RV function and hemodynamics. Therefore, this qualifies as a patient-friendly approach for the clinical management of PH patients.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Yidan Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiangli Meng
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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14
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Li Y, Wang Y, Ye X, Kong L, Zhu W, Lu X. Clinical study of right ventricular longitudinal strain for assessing right ventricular dysfunction and hemodynamics in pulmonary hypertension. Medicine (Baltimore) 2016; 95:e5668. [PMID: 27977616 PMCID: PMC5268062 DOI: 10.1097/md.0000000000005668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
This study aimed to appraise the application of right ventricular longitudinal strain for assessing right ventricular dysfunction and severe hemodynamic changes in pulmonary hypertension. The study included 53 patients clinically diagnosed with PH. Tissue Doppler-derived tricuspid lateral annular systolic velocity (s'), early diastolic peak velocity (e'), late diastolic peak velocity (a'), tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), and right ventricular fractional area change (FAC) were determined. The STI parameter was RV free wall longitudinal peak systolic strain (RV LPSS). The patients were assigned into two groups based on a RV LPSS value of - 19%.RV LPSS, s', TAPSE, RIMP, FAC, a' and e'/a' showed significant differences. PH patients with an RV LPSS≥ -19% exhibited a lower RV function (P < 0.05). RV LPSS was negatively correlated with TAPSE (r = -0.326, P < 0.05) and FAC (r = -0.495, P < 0.001) and positively correlated with RIMP (r = 0.508, P < 0.001). The optimal cut-off value of RV LPSS to reveal an mPAP ≥ 45 mmHg defined based on the receiver operating characteristic curve analysis was - 19.26% with a sensitivity of 83.9% and a specificity of 73.4%.Distinguishing the degree of RV dysfunction by 2D-STI may help physicians to determine the state of cardiac function and degree of PH in patients and offer a basis for subsequent clinical diagnosis and therapy. Our study demonstrates the superiority of RV LPSS for uncovering severe PH over the traditional echocardiographic parameters.
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15
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Rice JL, Stream AR, Fox DL, Geraci MW, Vandivier RW, Dorosz JL, Bull TM. Speckle Tracking Echocardiography to Evaluate for Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease. COPD 2016; 13:595-600. [PMID: 26829151 DOI: 10.3109/15412555.2015.1134468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD), increasing morbidity and mortality. Current echocardiographic measures have poor predictive value for the diagnosis of PH in COPD. Right ventricular (RV) strain obtained by speckle tracking echocardiography (STE) is a measure of myocardial deformation which correlates with RV function and survival in subjects with pulmonary arterial hypertension. We hypothesized that RV strain measurements would be feasible and correlate with invasive hemodynamic measurements in patients with COPD. Retrospective analysis of RV strain values from subjects with severe COPD with echocardiogram within 48 hours of right heart catheterization was performed. First, 54 subjects were included in the analysis. Right ventricular systolic pressure (RVSP) and RV strain could be estimated in 31% and 57%, respectively. Then, 61% had RV-focused apical views, and of those, RV strain could be obtained for 94%. RV free wall strain correlated with PVR (r = 0.41, p = 0.02). Subjects with pulmonary vascular resistance (PVR) > 3 Wood units (WU) had less negative (worse) RV free wall strain values than those with PVR ≤ 3 WU, with a median strain of -20 (-23, -12) versus -23 (-29, -15), p < 0.05. A receiver operating characteristic curve demonstrated an RV free wall strain of > -23 to be 92% sensitive and 44% specific for identifying PVR > 3 WU (AUC 0.71). RV strain estimates are feasible in the majority of subjects with severe COPD. RV strain correlates with PVR and may improve screening for PH in subjects with COPD.
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Affiliation(s)
- Jessica L Rice
- a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA.,b Colorado Pulmonary Vascular Disease Center , University of Colorado , Aurora , Colorado , USA
| | - Amanda R Stream
- a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA.,b Colorado Pulmonary Vascular Disease Center , University of Colorado , Aurora , Colorado , USA
| | - Daniel L Fox
- a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA.,b Colorado Pulmonary Vascular Disease Center , University of Colorado , Aurora , Colorado , USA
| | - Mark W Geraci
- a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA
| | - R William Vandivier
- a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA
| | - Jennifer L Dorosz
- b Colorado Pulmonary Vascular Disease Center , University of Colorado , Aurora , Colorado , USA.,c Division of Cardiovascular Medicine , University of Colorado , Aurora , Colorado , USA
| | - Todd M Bull
- a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA.,b Colorado Pulmonary Vascular Disease Center , University of Colorado , Aurora , Colorado , USA.,c Division of Cardiovascular Medicine , University of Colorado , Aurora , Colorado , USA
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16
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Pristera N, Musarra R, Schilz R, Hoit BD. The Role of Echocardiography in the Evaluation of Pulmonary Arterial Hypertension. Echocardiography 2015; 33:105-16. [PMID: 26522749 DOI: 10.1111/echo.13113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The evaluation of pulmonary arterial hypertension (PAH) requires a multimodality approach that combines invasive and noninvasive imaging studies to ensure accurate diagnosis and classification. Given the complexity of the hemodynamic relationships between the left heart, pulmonary circulation, and right heart, the diagnosis of PAH is often a challenging task. Right heart catheterization is the gold standard for diagnosis, providing the hemodynamic information that defines the disease. Nonetheless, echocardiography continues to be a valuable tool in the approach to the patient with suspected PAH. Echocardiographic assessment generates a wealth of information about the response of the right heart to elevated pulmonary pressures and provides essential diagnostic and prognostic data to the clinician. Numerous measurements can be used to identify alterations in right heart morphology, pressure, and function; although each variable in isolation may have little utility, meaningful information is revealed when multiple parameters are considered together. In this article, we will review the echocardiographic measurements employed in assessment of the right heart and seek to clarify the role of echocardiography in the diagnostic workup of PAH.
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Affiliation(s)
| | - Ray Musarra
- Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Robert Schilz
- Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Brian D Hoit
- Case Western Reserve University, Cleveland, Ohio.,Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, Ohio.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio
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