1
|
Cacioli G, Ciabatti M, Cristiano E, Notari C, Papisca I, Distefano G, Menafra G, Monica PLD, Feccia MA, Pergolini A, Maestrini V, Sbaraglia F, Ranocchi F, Musumeci F. Myocardial Work by Speckle-Tracking Echocardiography in Heart Transplant Recipients: Association Between Global Work Efficiency and Coronary Allograft Vasculopathy. Am J Cardiol 2024; 228:1-9. [PMID: 39053724 DOI: 10.1016/j.amjcard.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Coronary allograft vasculopathy (CAV) is a leading cause of morbidity and mortality after heart transplantation. CAV is often diagnosed in later stages or during routine screening in asymptomatic subjects. Myocardial work (MW), calculated using left ventricular global longitudinal strain (LV-GLS) and systemic blood pressure, may be associated with the presence of CAV and outperform conventional echocardiographic parameters. In this retrospective observational study, heart transplant recipients who underwent regular follow-up at our institution between May 2022 and September 2023 were enrolled. All included patients underwent speckle-tracking echocardiography, including MW indexes. CAV was classified according to invasive coronary angiography or computed tomography performed within 12 months of index echocardiography. We collected all available clinical and echocardiographic parameters and evaluated the potential association with CAV. CAV was detected in 29 of 93 patients (31%) (CAV+). Of the MW indexes, the mean global work efficiency (GWE) was 90 ± 6% and was significantly lower in CAV+ than CAV- subjects (86 ± 7% vs 91 ± 4%, p <0.001). GWE (OR 0.86, CI 0.77 to 0.94, p = 0.002), E/e' ratio (OR 1.27, CI 1.08 to 1.52, p = 0.006), and left ventricular ejection fraction (OR 0.90; CI 0.81 to 0.98, p = 0.017) were independently associated with the presence of CAV. GWE (GWE vs LV-GLS, delta area under the curve 0.154, p = 0.047) and the proposed model (GWE+E/e' vs LV-GLS, delta area under the curve 0.198, p = 0.004) were significantly superior in stratifying the incremental risk for CAV compared with LV-GLS. In conclusion, GWE was observed to be independently associated with the presence of CAV. MW could represent a novel noninvasive screening method for CAV in heart transplant recipients. Larger and prospective studies are needed to confirm this hypothesis.
Collapse
Affiliation(s)
- Giulio Cacioli
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy.
| | | | - Ernesto Cristiano
- Department of Electrophysiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Claudia Notari
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Ilaria Papisca
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Giada Distefano
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Giovanni Menafra
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Paola Lilla Della Monica
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Mariano Antonio Feccia
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Amedeo Pergolini
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Sbaraglia
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Federico Ranocchi
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Francesco Musumeci
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| |
Collapse
|
2
|
Nonaka H, Rätsep I, Obonyo NG, Suen JY, Fraser JF, Chan J. Current trends and latest developments in echocardiographic assessment of right ventricular function: load dependency perspective. Front Cardiovasc Med 2024; 11:1365798. [PMID: 39011493 PMCID: PMC11249019 DOI: 10.3389/fcvm.2024.1365798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
Right ventricle (RV) failure is a common complication of many cardiopulmonary diseases. Since it has a significant adverse impact on prognosis, precise determination of RV function is crucial to guide clinical management. However, accurate assessment of RV function remains challenging owing to the difficulties in acquiring its intricate pathophysiology and imaging its complex anatomical structure. In addition, there is historical attention focused exclusively on the left ventricle assessment, which has led to overshadowing and delayed development of RV evaluation. Echocardiography is the first-line and non-invasive bedside clinical tool for assessing RV function. Tricuspid annular plane systolic excursion (TAPSE), RV systolic tissue Doppler velocity of the tricuspid annulus (RV S'), and RV fractional area change (RV FAC) are conventional standard indices routinely used for RV function assessment, but accuracy has been subject to several limitations, such as load-dependency, angle-dependency, and localized regional assessment. Particularly, load dependency is a vexing issue, as the failing RV is always in a complex loading condition, which alters the values of echocardiographic parameters and confuses clinicians. Recently, novel echocardiographic methods for improved RV assessment have been developed. Specifically, "strain", "RV-pulmonary arterial (PA) coupling", and "RV myocardial work" are newly applied methods for RV function assessment, a few of which are designed to surmount the load dependency by taking into account the afterload on RV. In this narrative review, we summarize the latest data on these novel RV echocardiographic parameters and highlight their strengths and limitations. Since load independency is one of the primary advantages of these, we particularly emphasize this aspect.
Collapse
Affiliation(s)
- Hideaki Nonaka
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Indrek Rätsep
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Nchafatso G Obonyo
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom
- Clinical Research and Training Department, Initiative to Develop African Research Leaders/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Faculty of Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| |
Collapse
|
3
|
Surkova E, Lakatos BK, Fábián A, Kovács A, Senior R, Li W. Myocardial work of the systemic right ventricle and its association with outcomes. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1105-1114. [PMID: 38507153 DOI: 10.1007/s10554-024-03081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
We aimed to evaluate clinical and prognostic significance of myocardial work parameters of the systemic right ventricle (SRV). Thirty-eight patients with the SRV underwent echocardiographic assessment of the SRV systolic function including 3D-echocardiography derived ejection fraction, 2D longitudinal strain and myocardial work analysis. The study endpoint was the combination of all-cause mortality and heart transplantation. Global constructive work (GCW) and global work index (GWI) demonstrated moderate correlation with the 3DE-derived SRV ejection fraction (EF) (Rho 0.64, p < 0.0001 and Rho 0.63, p < 0.0001, respectively). GCW showed the strongest correlation with the BNP level (Rho - 0.77, p < 0.0001), closely followed by GWI, 4-chamber longitudinal strain and 3DE EF (all Rho - 0.73, p < 0.0001). GCW and GWI were significantly lower in patients with moderate or severe tricuspid regurgitation compared with less than moderate regurgitation (1226 ± 439 vs 1509 ± 264 mmHg%, p = 0.02, and 984 ± 348 vs 1259 ± 278 mmHg%, p = 0.01, respectively). During a follow-up of 3.5 (2.8-3.9) years, seven patients (18%) died and one received transplantation (3%). They had significantly lower GCW and GWI compared with patients who did not reach the study endpoint (908 ± 255 vs 1433 ± %, p < 0.001 and 721 ± 210 vs 1173 ± 315 mmHg%, p < 0.001, respectively). In Cox regression analysis, GCW, GWI, 3DE SRV volumes and EF were the best-fit models based on the Akaike Information Criterion, outperforming longitudinal strain parameters. GWI and GCW, novel echocardiographic parameters of myocardial work, provided reliable quantification of the SRV systolic function. GWI, GCW and 3DE-derived SRV parameters were closely associated with all-cause mortality and heart transplantation in patients with the SRV.
Collapse
Affiliation(s)
- Elena Surkova
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK.
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, 68, Varosmajor Str., Budapest, 1122, Hungary
| | - Roxy Senior
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London, SW3 6LY, UK
| | - Wei Li
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse St, Chelsea, London, SW3 6LY, UK
| |
Collapse
|
4
|
Barrett CM, Parag B, Hughes A, Athwal PSS, Guo Y, Alexy T, Shenoy C. Right Ventricular Function on Cardiovascular Magnetic Resonance Imaging and Long-Term Outcomes in Stable Heart Transplant Recipients. Circ Cardiovasc Imaging 2024; 17:e016415. [PMID: 38563143 PMCID: PMC11021158 DOI: 10.1161/circimaging.123.016415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In heart transplant recipients, right ventricular (RV) dysfunction may occur for a variety of reasons. Whether RV dysfunction in the stable phase after heart transplantation is associated with long-term adverse outcomes is unknown. We aimed to determine the long-term prognostic significance of RV dysfunction identified on cardiovascular magnetic resonance imaging (CMR) at least 1 year after heart transplantation. METHODS In consecutive heart transplant recipients who underwent CMR for surveillance, we assessed 2 CMR measures of RV function: RV ejection fraction and RV global longitudinal strain (RVGLS). We investigated associations between RV dysfunction and a composite end point of death or major adverse cardiac events, including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. RESULTS A total of 257 heart transplant recipients (median age, 59 years; 75% men) who had CMR at a median of 4.3 years after heart transplantation were included. Over a median follow-up of 4.4 years after the CMR, 108 recipients experienced death or major adverse cardiac events. In a multivariable Cox regression analysis adjusted for age, time since transplantation, indication for transplantation, cardiac allograft vasculopathy, history of rejection, and CMR covariates, RV ejection fraction was not associated with the composite end point, but RVGLS was independently associated with the composite end point with a hazard ratio of 1.08 per 1% worsening in RVGLS ([95% CI, 1.00-1.17]; P=0.046). RVGLS provided incremental prognostic value over other variables in multivariable analyses. The association was replicated in subgroups of recipients with normal RV ejection fraction and recipients with late gadolinium enhancement imaging. A similar association was seen with a composite end point of cardiovascular death or major adverse cardiac events. CONCLUSIONS CMR feature tracking-derived RVGLS assessed at least 1 year after heart transplantation was independently associated with the long-term risk of death or major adverse cardiac events. Future studies should investigate its role in guiding clinical decision-making in heart transplant recipients.
Collapse
Affiliation(s)
- Collin M. Barrett
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Bawaskar Parag
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Andrew Hughes
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Pal Satyajit Singh Athwal
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Yugene Guo
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tamas Alexy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| |
Collapse
|
5
|
Colak A, Erdemir AG, Hazirolan T, Pirat B, Eroglu S, Aydinalp A, Muderrisoglu H, Sade LE. Multiparametric assessment of right ventricular function in heart transplant recipients by echocardiography and relations with pulmonary hemodynamics. Echocardiography 2023; 40:1350-1355. [PMID: 37955614 DOI: 10.1111/echo.15713] [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: 07/26/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE Right ventricular (RV) dilatation and dysfunction are usually present in heart transplant (HTx) patients and worsened with residual pulmonary hypertension (PH). We aimed to determine the ability of different echocardiographic modalities to evaluate RV function in comparison with cardiac magnetic resonance (CMR) and their relations with pulmonary hemodynamics in HTx patients. METHODS A total of 62 data sets [echocardiographic, hemodynamic, and CMR] were acquired from 35 HTx patients. Comprehensive echocardiography, including two-dimensional (2D) transthoracic echocardiography, speckle tracking echocardiography, and three-dimensional (3D) echocardiography, was performed. Mean pulmonary artery pressure (mPAP) was obtained invasively from right heart catheterization. The correlations between all echocardiographic parameters and CMR imaging data and the differences between patients with and without residual PH were evaluated. RESULTS Diastolic and systolic RV volumes and RV ejection fraction (RVEF) by 3D echocardiography correlated strongly with CMR-derived volumes and RVEF (r = .91, r = .79, r = .64; p < .0001 for each, respectively). Among other parameters, RV fractional area change (r = .439; p < .001) and RV free wall longitudinal strain (RVFW-LS) (r = -.34; p < .05) correlated moderately with CMR-RVEF, whereas tricuspid annulus S' velocity (r = .29; p < .05) and tricuspid annular systolic plane excursion (r = .27; p < .05) correlated weakly with CMR-RVEF. Additionally, 3D-RVEF and RVFW-LS were significantly decreased in studies with mPAP ≥ 20 mm Hg in comparison to those with mPAP < 20 mm Hg (47.7 ± 3.7 vs. 50.9 ± 5.3, p = .04 and -15.5 ± 3.1 vs. -17.5 ± 3, p = .03, respectively). CONCLUSION The best method for the evaluation of RV function in HTx recipients is 3D echocardiography. Besides, the subclinical impact of residual PH on RV function can be best determined by RVFW-LS and 3D-RVEF in these patients.
Collapse
Affiliation(s)
- Ayse Colak
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
- Department of Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Gurkan Erdemir
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tuncay Hazirolan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bahar Pirat
- Department of Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Serpil Eroglu
- Department of Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Alp Aydinalp
- Department of Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Haldun Muderrisoglu
- Department of Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Leyla Elif Sade
- UPMC-Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
6
|
Richter MJ, Douschan P, Fortuni F, Gall H, Ghofrani HA, Keranov S, Kremer N, Kriechbaum SD, Rako ZA, Rieth AJ, da Rocha BB, Seeger W, Zedler D, Yildiz S, Yogeswaran A, Tello K. Echocardiographic pressure-strain loop-derived stroke work of the right ventricle: validation against the gold standard. ESC Heart Fail 2023; 10:3209-3215. [PMID: 37415381 PMCID: PMC10567659 DOI: 10.1002/ehf2.14453] [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: 11/05/2022] [Revised: 05/08/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
AIMS Commercially available integrated software for echocardiographic measurement of stroke work (SW) is increasingly used for the right ventricle, despite a lack of validation. We sought to assess the validity of this method [echo-based myocardial work (MW) module] vs. gold-standard invasive right ventricular (RV) pressure-volume (PV) loops. METHODS AND RESULTS From the prospectively recruiting EXERTION study (NCT04663217), we included 42 patients [34 patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) and 8 patients with absence of cardiopulmonary disease] with RV echocardiography and invasive PV catheterization. Echocardiographic SW was assessed as RV global work index (RVGWI) generated via the integrated pressure-strain MW software. Invasive SW was calculated as the area bounded by the PV loop. An additional parameter derived from the MW module, RV global wasted work (RVGWW), was correlated with PV loop measures. RVGWI significantly correlated with invasive PV loop-derived RV SW in the overall cohort [rho = 0.546 (P < 0.001)] and the PAH/CTEPH subgroup [rho = 0.568 (P < 0.001)]. Overall, RVGWW correlated with invasive measures of arterial elastance (Ea), the ratio of end-systolic elastance (Ees)/Ea, and end-diastolic elastance (Eed) significantly. CONCLUSIONS Integrated echo measurement of pressure-strain loop-derived SW correlates with PV loop-based assessment of RV SW. Wasted work correlates with invasive measures of load-independent RV function. Given the methodological and anatomical challenges of RV work assessment, evolution of this approach by incorporating more elaborated echo analysis data and an RV reference curve might improve its reliability to mirror invasively assessed RV SW.
Collapse
Affiliation(s)
- Manuel J. Richter
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Philipp Douschan
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
- Division of Pulmonology, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Federico Fortuni
- Department of CardiologySan Giovanni Battista HospitalFolignoItaly
- Department of CardiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Henning Gall
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Hossein A. Ghofrani
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
- Department of PneumologyKerckhoff Heart, Rheuma and Thoracic CenterBad NauheimGermany
- Department of MedicineImperial College LondonLondonUK
| | - Stanislav Keranov
- Department of Cardiology and AngiologyUniversity of GiessenGiessenGermany
| | - Nils Kremer
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Steffen D. Kriechbaum
- Department of CardiologyHeart and Thorax Center, Campus Kerckhoff, University of GiessenBad NauheimGermany
| | - Zvonimir A. Rako
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Andreas J. Rieth
- Department of CardiologyHeart and Thorax Center, Campus Kerckhoff, University of GiessenBad NauheimGermany
| | - Bruno Brito da Rocha
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Werner Seeger
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Daniel Zedler
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Selin Yildiz
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Athiththan Yogeswaran
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| | - Khodr Tello
- Department of Internal MedicineJustus‐Liebig‐University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL)Klinikstrasse 3235392GiessenGermany
| |
Collapse
|
7
|
Donal E, Taconne M, Le Rolle V, Galli E. Tips and tricks for the non-invasive assessment of myocardial work: the good, the bad and the ugly. Eur Heart J Cardiovasc Imaging 2023; 24:324-326. [PMID: 36149777 DOI: 10.1093/ehjci/jeac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Erwan Donal
- Service de Cardiologie - Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35033 Rennes, France
| | - Marion Taconne
- Service de Cardiologie - Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35033 Rennes, France
| | - Virginie Le Rolle
- Service de Cardiologie - Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35033 Rennes, France
| | - Elena Galli
- Service de Cardiologie - Hôpital Pontchaillou, Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35033 Rennes, France
| |
Collapse
|
8
|
Rako ZA, Kremer N, Yogeswaran A, Richter MJ, Tello K. Adaptive versus maladaptive right ventricular remodelling. ESC Heart Fail 2022; 10:762-775. [PMID: 36419369 PMCID: PMC10053363 DOI: 10.1002/ehf2.14233] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Right ventricular (RV) function and its adaptation to increased afterload [RV-pulmonary arterial (PA) coupling] are crucial in various types of pulmonary hypertension, determining symptomatology and outcome. In the course of disease progression and increasing afterload, the right ventricle undergoes adaptive remodelling to maintain right-sided cardiac output by increasing contractility. Exhaustion of compensatory RV remodelling (RV-PA uncoupling) finally leads to maladaptation and increase of cardiac volumes, resulting in heart failure. The gold-standard measurement of RV-PA coupling is the ratio of contractility [end-systolic elastance (Ees)] to afterload [arterial elastance (Ea)] derived from RV pressure-volume loops obtained by conductance catheterization. The optimal Ees/Ea ratio is between 1.5 and 2.0. RV-PA coupling in pulmonary hypertension has considerable reserve; the Ees/Ea threshold at which uncoupling occurs is estimated to be ~0.7. As RV conductance catheterization is invasive, complex, and not widely available, multiple non-invasive echocardiographic surrogates for Ees/Ea have been investigated. One of the first described and best validated surrogates is the ratio of tricuspid annular plane systolic excursion to estimated pulmonary arterial systolic pressure (TAPSE/PASP), which has shown prognostic relevance in left-sided heart failure and precapillary pulmonary hypertension. Other RV-PA coupling surrogates have been formed by replacing TAPSE with different echocardiographic measures of RV contractility, such as peak systolic tissue velocity of the lateral tricuspid annulus (S'), RV fractional area change, speckle tracking-based RV free wall longitudinal strain and global longitudinal strain, and three-dimensional RV ejection fraction. PASP-independent surrogates have also been studied, including the ratios S'/RV end-systolic area index, RV area change/RV end-systolic area, and stroke volume/end-systolic volume. Limitations of these non-invasive surrogates include the influence of severe tricuspid regurgitation (which can cause distortion of longitudinal measurements and underestimation of PASP) and the angle dependence of TAPSE and PASP. Detection of early RV remodelling may require isolated analysis of single components of RV shortening along the radial and anteroposterior axes as well as the longitudinal axis. Multiple non-invasive methods may need to be applied depending on the level of RV dysfunction. This review explains the mechanisms of RV (mal)adaptation to its load, describes the invasive assessment of RV-PA coupling, and provides an overview of studies of non-invasive surrogate parameters, highlighting recently published works in this field. Further large-scale prospective studies including gold-standard validation are needed, as most studies to date had a retrospective, single-centre design with a small number of participants, and validation against gold-standard Ees/Ea was rarely performed.
Collapse
Affiliation(s)
- Zvonimir A. Rako
- Department of Internal Medicine Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL) Klinikstrasse 33 35392 Giessen Germany
| | - Nils Kremer
- Department of Internal Medicine Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL) Klinikstrasse 33 35392 Giessen Germany
| | - Athiththan Yogeswaran
- Department of Internal Medicine Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL) Klinikstrasse 33 35392 Giessen Germany
| | - Manuel J. Richter
- Department of Internal Medicine Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL) Klinikstrasse 33 35392 Giessen Germany
| | - Khodr Tello
- Department of Internal Medicine Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL) Klinikstrasse 33 35392 Giessen Germany
| |
Collapse
|
9
|
Leurent G, Auffret V, Donal E. Right Ventricular-Pulmonary Artery Coupling: A Simple Marker to Guide Complex Clinical Decisions? JACC Cardiovasc Interv 2022; 15:1834-1836. [PMID: 36137686 DOI: 10.1016/j.jcin.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Guillaume Leurent
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France.
| | - Vincent Auffret
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Erwan Donal
- Department of Cardiology, University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| |
Collapse
|