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Xu Z, Dou R, Zhou Z, Zhang H, Zhang C, Li Q, Xu L, Gu H. Differential biventricular adaption to pulmonary vascular disease in patients with idiopathic/heritable and congenital heart disease: a prospective cardiac magnetic resonance and invasive study. Eur Heart J Cardiovasc Imaging 2023; 24:1528-1535. [PMID: 37201191 DOI: 10.1093/ehjci/jead106] [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: 02/17/2023] [Revised: 03/21/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023] Open
Abstract
AIMS Despite shared pathophysiological mechanisms, patients with idiopathic/heritable pulmonary arterial hypertension (IPAH/HPAH) have a poorer prognosis than those with PAH after congenital heart defect repair. Ventricular adaption remains unclear and could provide a basis for explaining differences in clinical outcomes. The aim of this prospective study was to assess clinical status, haemodynamic profile, and biventricular adaptation to PAH in children with various forms of PAH. METHODS AND RESULTS Consecutive patients with IPAH/HPAH or post-operative PAH were prospectively recruited (n = 64). All patients underwent a comprehensive, protocolized assessment including functional assessment, measurement of brain natriuretic peptide (BNP) levels, invasive measurements, and a cardiac magnetic resonance (CMR) assessment. A cohort of age- and sex-matched healthy subjects served as controls. Patients with post-operative PAH had a better functional class (61.5 vs. 26.3% in Class I/II, P = 0.02) and a longer 6-min walk distance (320 ± 193 vs. 239 ± 156 m, P = 0.008) than IPAH/HPAH. While haemodynamic parameters were not significantly different between IPAH/HPAH and post-operative patients, post-operative patients with PAH presented with higher left ventricular volumes and better right ventricular function compared with patients with IPAH/HPAH (P < 0.05). On correlation analyses, left ventricular volumetric parameters were highly correlated with BNP and 6-min walk test distance in this population. CONCLUSION Despite comparable haemodynamic profiles, patients with post-operative PAH had less functional limitation than their IPAH/HPAH counterparts. This is potentially related to the differential biventricular adaptation pattern evident on CMR with better myocardial contractility and higher left ventricular volumes in post-operative patients with PAH, highlighting the importance of ventriculo-ventricular interaction in the setting of PAH.
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Affiliation(s)
- Zhuoyuan Xu
- Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Ruiyu Dou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Hongsheng Zhang
- Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Chen Zhang
- Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Qiangqiang Li
- Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
| | - Hong Gu
- Department of Paediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China 100029
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Central versus Peripheral CTEPH-Clinical and Hemodynamic Specifications. Medicina (B Aires) 2022; 58:medicina58111538. [PMID: 36363494 PMCID: PMC9696046 DOI: 10.3390/medicina58111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
Background and Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic progressive disease, resulting from persistent arterial obstruction combined with small-vessel remodeling. Central and peripheral CTEPH are distinguished, according to the dominant lesion's location. This is important for surgical or percutaneous interventional assessment or for medical treatment. Material and Methods: Eighty-one patients (51 male/30 female) with confirmed CTEPH were analyzed, while the CENTRAL type included 51 patients (63%) and the PERIPHERAL type 30 patients (37%). Results: A significant difference in CENTRAL type vs. PERIPHERAL type was determined in gender (male 72.5% vs. 46.7%; p = 0.0198). No difference was found in age, functional status, or echocardiographic parameters. Invasive hemodynamic parameters showed a significant difference in mean pulmonary arterial pressure (46 vs. 58 mmHg; p = 0.0002), transpulmonary gradient (34 vs. 47 mmHg; p = 0.0005), and cardiac index (2.04 vs. 2.5 L.min.m2; p = 0.02) but not in pulmonary vascular resistance. Risk factors showed a significant difference only in acute pulmonary embolism (93.8% vs. 60%; p = 0.0002) and malignancy (2% vs. 13.3%; p = 0.0426). Conclusions: Our study showed hemodynamic differences between CENTRAL type vs. PERIPHERAL type CTEPH with a worse hemodynamic picture in CENTRAL form. This may indicate a different pathophysiological response and/or possible additional influences contributing especially to the peripheral pulmonary bed affection.
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Differential serum lipid distribution in IPAH and CHD-PAH patients. Respir Med 2021; 191:106711. [PMID: 34890866 DOI: 10.1016/j.rmed.2021.106711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Abstract
Lipid homeostasis is dysregulated in pulmonary arterial hypertension (PAH). A decrease in serum high- and low-density lipoprotein cholesterol (HDL-C and LDL-C) is significantly associated with the worse prognosis of PAH. However, no study has investigated the differential distribution of lipids in various PAH subtypes. We enrolled 190 patients in this retrospective study, which includes 20 patients with congenital heart disease without PAH (CHD-nonPAH), 101 patients with PAH associated with congenital heart disease (CHD-PAH), 69 patients with idiopathic PAH (IPAH) and 81 healthy controls. Laboratory parameters such as liver and renal function, serum lipids, C-reactive protein, N-terminal pro-brain natriuretic peptide (NT-proBNP), echocardiography, right heart catheterization and 6-min walk distance (6MWD) were performed. All types of cholesterol including HDL-C, LDL-C and total cholesterol (CHOL) were significantly lower in IPAH patients in association with right heart function. Although LDL-C and CHOL were lower in CHD-PAH, they were not associated with disease severity or heart failure. Thus, we conclude that IPAH and CHD-PAH patients exhibited a differential distribution pattern of serum lipids.
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Gonzaga LRA, Gomes WJ, Rocco IS, Matos-Garcia BC, Bublitz C, Viceconte M, Tatani SB, Santos VB, Silva CMC, Tulloh R, Arena R, Guizilini S. Inflammatory markers in Eisenmenger syndrome and their association with clinical outcomes. A cross-sectional comparative study. Int J Cardiol 2021; 342:34-38. [PMID: 34171450 DOI: 10.1016/j.ijcard.2021.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/02/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Inflammation may be an important factor contributing to the progression of Eisenmenger syndrome (ES). The purpose of the current study was to: characterize the inflammatory profile in ES patients and compare measures to reference values for congenital heart disease and pulmonary arterial hypertension (CHD-PAH); and investigate whether inflammatory markers are associated with other clinical markers in ES. METHODS Twenty-seven ES patients were prospectively selected and screened for systemic inflammatory markers, including interleukin (IL)-1β, tumor necrosis factor-alpha (TNF-α) and IL-10. Clinical data and echocardiographic parameters were obtained, with concomitant analysis of ventricular function. Functional capacity was assessed using the 6-min walk test (6MWT). Renal function and blood homeostasis were evaluated by the level of blood urea nitrogen (BUN), creatinine, and plasma electrolytes. RESULTS Patients with ES expressed higher IL-10, IL-1β and TNF-α compared to reference values of patients with CHD-PAH. IL-10 was negatively associated with BUN (r = -0.39,p = 0.07), creatinine (r = -0.35, p = 0.002), sodium (r = -0.45, p = 0.03), and potassium (r = -0.68, p = 0.003). IL-10 was positively associated with bicarbonate (r = 0.45, p = 0.02) and trended toward a positive association with right ventricular fractional area change (RVFAC) (r = 0.35, p = 0.059). IL-1β was negatively associated with potassium (r = -0.5, p = 0.01). TNF-α demonstrated positive association with creatinine (r = 0.4,p = 0.006), BUN (r = 0.63,p = 0.003), sodium (r = 0.44, p = 0.04), potassium (r = 0.41, p = 0.04), and was negatively associated with RVFAC (r = -0.38,p = 0.03) and 6MWT distance (r = -0.54, p = 0.004). CONCLUSION ES patients exhibit a more severe inflammatory profile compared to reference values for CHD-PAH. Furthermore, inflammatory markers are related to renal dysfunction, right ventricular impairment and poorer functional capacity.
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Affiliation(s)
- Laion R A Gonzaga
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Rua Napoleão de Barros, 715 - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Walter J Gomes
- Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Federal University of Sao Paulo, Rua Napoleão de Barros, 715, 3 andar - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Isadora S Rocco
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Rua Napoleão de Barros, 715 - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Bruna C Matos-Garcia
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Rua Napoleão de Barros, 715 - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Caroline Bublitz
- Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Federal University of Sao Paulo, Rua Napoleão de Barros, 715, 3 andar - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Marcela Viceconte
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Rua Napoleão de Barros, 715 - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Solange B Tatani
- Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Federal University of Sao Paulo, Rua Napoleão de Barros, 715, 3 andar - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Vinicius B Santos
- Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Federal University of Sao Paulo, Rua Napoleão de Barros, 715, 3 andar - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Célia M C Silva
- Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Federal University of Sao Paulo, Rua Napoleão de Barros, 715, 3 andar - 04024002, Vila Clementino, Sao Paulo, Brazil
| | - Robert Tulloh
- Department of Congenital Heart Disease, Bristol Heart Institute, Bristol BS2 8BJ, United Kingdom
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Taylor Street, 454 AHSB, Chicago, IL 60612, USA
| | - Solange Guizilini
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Rua Napoleão de Barros, 715 - 04024002, Vila Clementino, Sao Paulo, Brazil; Department of Human Motion Sciences, Physical Therapy School, Federal University of Sao Paulo, Rua Silva Jardim, Edifício Central 136, 11015-020 Santos/SP, Brazil.
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Gbinigie H, Coats L, Parikh JD, Hollingsworth KG, Gan L. A 4D flow cardiovascular magnetic resonance study of flow asymmetry and haemodynamic quantity correlations in the pulmonary artery. Physiol Meas 2021; 42:025005. [PMID: 33482652 DOI: 10.1088/1361-6579/abdf3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In this paper we elucidate the asymmetric flow pattern and the haemodynamic quantity distributions and correlations in the pulmonary artery (PA) vasculature in healthy adults having structurally normal hearts, to provide reference on the flow characteristics in the PA and the right ventricle. APPROACH Velocity data are acquired non-invasively from 18 healthy volunteers by 4D flow magnetic resonance imaging, resolved to 20 phases with spatial resolution 3 × 3 × 3 mm3. Interpolation is applied to improve the accuracy in quantifying haemodynamic quantities including kinetic energy, rotational energy, helicity and energy dissipation rate. These quantities are volumetrically normalised to remove size dependency, representing densities or local intensity. MAIN RESULTS Flow asymmetry in the PA is quantified in terms of all the flow dynamic quantities and their correlations. The right PA has larger diameter and higher peak stroke velocity than the left PA. It also has the highest rotational energy intensity. Counter-rotating helical streams in the main PA appear to be associated with the unidirectional helical flow noticed in the left and the right PA near the peak systole. SIGNIFICANCE This study provides a fundamental basis of normal flow in the PA. It implies the validity to use these flow pattern-related quantitative measures to aid with the identification of abnormal PA flow non-invasively, specifically for detecting abnormalities in the pulmonary circulation and response to therapy, where haemodynamic flow is commonly characterised by increased vortical and helical formations.
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Affiliation(s)
- Henrike Gbinigie
- Department of Engineering, Durham University, Durham, DH1 3LE, United Kingdom
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6
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Papamichalis M, Xanthopoulos A, Papamichalis P, Skoularigis J, Triposkiadis F. Adult congenital heart disease with pulmonary arterial hypertension: mechanisms and management. Heart Fail Rev 2020; 25:773-794. [PMID: 31407139 DOI: 10.1007/s10741-019-09847-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Michail Papamichalis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | | | - John Skoularigis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece.
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7
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Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
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Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
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8
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Abstract
BACKGROUND Compared to primary pulmonary hypertension (PPH), the right ventricular (RV) contractile function is preserved for a long time in patients with Eisenmenger syndrome and is likely the most important determinant of relatively higher survival. The differences in myocardial perfusion have been purported to explain this discrepancy. The exact prevalence of myocardial perfusion abnormalities in Eisenmenger syndrome is not known. We sought to examine the prevalence of myocardial perfusion abnormalities in patients with Eisenmenger syndrome. METHODS In this prospective study, 20 consecutive adult patients with Eisenmenger syndrome were subjected to clinical assessment, six-minute walk test and echocardiography. Myocardial perfusion was assessed using one day stress-rest Gated Technetium-99 m Sestamibi single-photon emission computed tomography. RESULTS Nineteen (95%) patients were in New York Heart Association functional class I or II. All patients had RV hypertrophy. Five (25%) patients had RV systolic dysfunction. Left ventricular systolic function was normal in all except in three patients. Two (10%) patients had perfusion defects in the RV and 4 (20%) patients had perfusion defects in the left ventricle (LV). CONCLUSION Myocardial perfusion defects, both in RV and LV, occur even in asymptomatic or mildly symptomatic patients with Eisenmenger syndrome.
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Chaix MA, Gatzoulis MA, Diller GP, Khairy P, Oechslin EN. Eisenmenger Syndrome: A Multisystem Disorder-Do Not Destabilize the Balanced but Fragile Physiology. Can J Cardiol 2019; 35:1664-1674. [PMID: 31813503 DOI: 10.1016/j.cjca.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/13/2022] Open
Abstract
Eisenmenger syndrome is the most severe and extreme phenotype of pulmonary arterial hypertension associated with congenital heart disease. A large nonrestrictive systemic left-to-right shunt triggers the development of pulmonary vascular disease, progressive pulmonary arterial hypertension, and increasing pulmonary vascular resistance at the systemic level, which ultimately results in shunt reversal. Herein, we review the changing epidemiological patterns and pathophysiology of Eisenmenger syndrome. Multiorgan disease is an integral manifestation of Eisenmenger syndrome and includes involvement of the cardiac, hematological, neurological, respiratory, gastrointestinal, urinary, immunological, musculoskeletal, and endocrinological systems. Standardized practical guidelines for the assessment, management, risk stratification, and follow-up of this very fragile and vulnerable population are discussed. Multidisciplinary care is the best clinical practice. An approach to the prevention and management of a broad spectrum of complications is provided. Relevant therapeutic questions are discussed, including anticoagulation, noncardiac surgery, physical activity, transplantation, and advanced-care planning (palliative care). Advanced pulmonary arterial hypertension therapies are indicated in patients with Eisenmenger syndrome and World Health Organization functional class II or higher symptoms to improve functional capacity, quality of life, and-less well documented-survival. Specific recommendations regarding monotherapy or combination therapy are provided according to functional class and clinical response. The ultimate challenge for all care providers remains early detection and management of intracardiac and extracardiac shunts, considering that Eisenmenger syndrome is a preventable condition.
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Affiliation(s)
- Marie-A Chaix
- Adult Congenital Centre, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Gerhard-Paul Diller
- Department of Cardiology, Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany
| | - Paul Khairy
- Adult Congenital Centre, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Erwin N Oechslin
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Yin D, Wang Y, Zheng M, Wei H, Li M, Lv T, Bai Y, Tian J, Wu X. Comparison of Pulmonary Artery Pressure Measurement With Doppler Echocardiography or With Right Heart Catheterization in Patients With Congenital Heart Disease. Front Pediatr 2019; 7:421. [PMID: 31681718 PMCID: PMC6813640 DOI: 10.3389/fped.2019.00421] [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: 06/26/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Doppler echocardiography (D-ECHO) is a commonly used imaging tool for both diagnosis and follow-up examination of congenital heart disease (CHD). The goal of this study is to evaluate the accuracy of D-ECHO as used to measure an estimate sPAP in pediatric patients with CHD. Methods: A prospective study in 397 pediatric patients with CHD has been carried out to compare estimate sPAP measured with D-ECHO to that measured with right heart catheterization (RHC). Pearson correlation analyses were used to calculate the correlation coefficients between RHC and D-ECHO. Bland-Altman analyses were carried out to assess the agreement between the two methods. Results: Our data have demonstrated a significant underestimation of sPAP by D-ECHO compared to that by RHC. A strong correlation (r = 0.957, p < 0.01) was found between sPAP (36.1 ± 14.9 mmHg) and RVSP (36.0 ± 14.5 mmHg) measured with RHC. However, a relatively weak correlation (r = 0.219, p < 0.01) was observed between sPAP (36.1 ± 14.9 mmHg) measured during RHC and sPAP (28.7 ± 9.7 mmHg) as estimated using D-ECHO. The Bland-Altman analysis demonstrated that the bias for D-ECHO sPAP estimates was 6.6 mmHg with 95% limits of agreement ranging from -23.6 to 36.8 mmHg. A total of 57.5% of D-ECHO measurements were found to be accurate, with accuracy predefined as 95% of agreement within ±10 mmHg for sPAP estimates. Conclusions: sPAP measured with D-ECHO may be underestimated in pediatric patients with CHD.
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Affiliation(s)
- Dan Yin
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ying Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Min Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Huijing Wei
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mi Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Tiewei Lv
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yonghong Bai
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jie Tian
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoyun Wu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Van De Bruaene A, Meier L, Droogne W, De Meester P, Troost E, Gewillig M, Budts W. Management of acute heart failure in adult patients with congenital heart disease. Heart Fail Rev 2017; 23:1-14. [DOI: 10.1007/s10741-017-9664-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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The Changing Landscape of Pulmonary Arterial Hypertension in the Adult with Congenital Heart Disease. J Clin Med 2017; 6:jcm6040040. [PMID: 28358329 PMCID: PMC5406772 DOI: 10.3390/jcm6040040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/09/2017] [Accepted: 03/23/2017] [Indexed: 01/09/2023] Open
Abstract
Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a common type of pulmonary arterial hypertension (PAH) and a frequent complication of congenital heart disease (CHD). PAH-CHD represents a heterogeneous patient population and it is important to distinguish between the underlying cardiac defects considering the prognostic and therapeutic implications. Improved interventional techniques have enabled repair or palliation of most cardiac defects, though a substantial number of patients remain at high risk for PAH after closure. Traditionally, the treatment and management of PAH-CHD patients has been limited to palliative and supportive care, and based on expert opinion rather than clinical trials. Recently, however, the availability of advanced PAH-specific treatment has opened up a new field for the clinical management of this condition. Nevertheless, there is limited evidence on the optimal therapeutic approach for PAH-CHD. Herein, we discuss the current and novel therapeutic options for PAH-CHD as well as highlight several challenges in the clinical management at present.
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Gonzaga LR, Matos-Garcia BC, Rocco IS, Begot I, Bolzan DW, Tatani SB, Santos VB, Silva CM, Carvalho AC, Arena R, Gomes WJ, Guizilini S. Effects of acute oxygen supplementation on functional capacity and heart rate recovery in Eisenmenger syndrome. Int J Cardiol 2017; 231:110-114. [DOI: 10.1016/j.ijcard.2017.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/07/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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14
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Harries C, Armstrong I. A review of the management of pulmonary arterial hypertension associated with congenital heart disease. Eur J Cardiovasc Nurs 2017; 11:239-47. [DOI: 10.1016/j.ejcnurse.2010.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Badagliacca R, Poscia R, Pezzuto B, Nocioni M, Mezzapesa M, Francone M, Giannetta E, Papa S, Gambardella C, Sciomer S, Volterrani M, Fedele F, Dario Vizza C. Right ventricular remodeling in idiopathic pulmonary arterial hypertension: adaptive versus maladaptive morphology. J Heart Lung Transplant 2015; 34:395-403. [DOI: 10.1016/j.healun.2014.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/19/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022] Open
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Zhang DZ, Zhu XY, Lv B, Cui CS, Han XM, Sheng XT, Wang QG, Zhang P. Trial Occlusion to Assess the Risk of Persistent Pulmonary Arterial Hypertension After Closure of a Large Patent Ductus Arteriosus in Adolescents and Adults With Elevated Pulmonary Artery Pressure. Circ Cardiovasc Interv 2014; 7:473-81. [PMID: 25097200 DOI: 10.1161/circinterventions.113.001135] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Duan-zhen Zhang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xian-yang Zhu
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Bei Lv
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Chun-sheng Cui
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xiu-min Han
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Xiao-tang Sheng
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Qi-guang Wang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
| | - Po Zhang
- From the Department of Congenital Heart Disease, General Hospital of Shenyang Military Area Command, Shenyang, People’s Republic of China
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Guo K, Langleben D, Afilalo J, Shimony A, Leask R, Marelli A, Martucci G, Therrien J. Anatomical considerations for the development of a new transcatheter aortopulmonary shunt device in patients with severe pulmonary arterial hypertension. Pulm Circ 2013; 3:639-46. [PMID: 24618548 DOI: 10.1086/674328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract Morbidity from pulmonary arterial hypertension (PAH) ensues when the pulmonary pressure reaches suprasystemic levels. A transcatheter alternative to the Potts shunt would allow decompression of the right heart without the surgical risks. To aid development of a transcatheter aortopulmonary shunt (TAPS) device, we described the anatomic relationship between the left pulmonary artery (LPA) and the descending aorta (dAO) in adults with severe pulmonary hypertension. Adults with severe PAH (peak systolic pulmonary arterial pressure [PASP] ≥80 mmHg) who had computed tomography of the chest were enrolled. Measurements were taken on the axial plane at the level of the pulmonary artery bifurcation. Forty patients (male sex, 9 patients; median age ± standard deviation [SD], [Formula: see text] years; median PASP ± SD, [Formula: see text] mmHg) were identified. The mean distance (±SD) between the LPA and dAO was [Formula: see text] mm. The mean luminal dAO and LPA diameters (±SD) were [Formula: see text] mm and [Formula: see text] mm, respectively. The LPA and dAO approximated in 93% of patients, with 38% having aortic calcification at the contact site. The mean "landing zone" width and height (defining an area with distance <4 mm between the outer borders) of the two arteries were [Formula: see text] mm and [Formula: see text] mm, respectively, at a mean distance of [Formula: see text] mm from the main pulmonary artery bifurcation. This study shows that the landing zone is able to accommodate a TAPS device of up to 15 mm in diameter in the majority of patients with severe PAH.
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Affiliation(s)
- Kenneth Guo
- 1 McGill Adult Unit for Congenital Heart Disease Excellence, Royal Victoria Hospital, Montreal, Quebec, Canada
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Kaldarárová M, Šimková I, Valkovičová T, Remková A, Neuschl V. Pulmonary thromboembolism in congenital heart defects with severe pulmonary arterial hypertension. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2013.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Giusca S, Jurcut R, Coman IM, Ghiorghiu I, Catrina D, Popescu BA, Dima L, Ginghina C. Right Ventricular Function Predicts Clinical Response to Specific Vasodilator Therapy in Patients with Pulmonary Hypertension. Echocardiography 2012; 30:17-26. [DOI: 10.1111/j.1540-8175.2012.01809.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sorin Giusca
- Cardiology Department; Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu; Bucharest; Romania
| | | | | | - Ioana Ghiorghiu
- Cardiology Department; Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu; Bucharest; Romania
| | - Daniela Catrina
- Cardiology Department; Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu; Bucharest; Romania
| | - Bogdan A. Popescu
- University of Medicine and Pharmacy “Carol Davila; Bucharest; Romania
| | - Laura Dima
- Cardiology Department; Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu; Bucharest; Romania
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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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21
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Kempny A, Fernández-Jiménez R, Orwat S, Schuler P, Bunck AC, Maintz D, Baumgartner H, Diller GP. Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls. J Cardiovasc Magn Reson 2012; 14:32. [PMID: 22650308 PMCID: PMC3464868 DOI: 10.1186/1532-429x-14-32] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 05/31/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Parameters of myocardial deformation have been suggested to be superior to conventional measures of ventricular function in patients with tetralogy of Fallot (ToF), but have required non-routine, tagged cardiovascular magnetic resonance (CMR) techniques. We assessed biventricular myocardial function using CMR cine-based feature tracking (FT) and compared it to speckle tracking echocardiography (STE) and to simple endocardial border delineation (EBD). In addition, the relation between parameters of myocardial deformation and clinical parameters was assessed. METHODS Overall, 28 consecutive adult patients with repaired ToF (age 40.4 ± 13.3 years) underwent standard steady-state-free precession sequence CMR, echocardiography, and cardiopulmonary exercise testing. In addition, 25 healthy subjects served as controls. Myocardial deformation was assessed by CMR based FT (TomTec Diogenes software), CMR based EBD (using custom written software) and STE (TomTec Cardiac Performance Analysis software). RESULTS Feature tracking was feasible in all subjects. A close agreement was found between measures of global left (LV) and right ventricular (RV) global strain. Interobserver agreement for FT and STE was similar for longitudinal LV global strain, but FT showed better inter-observer reproducibility than STE for circumferential or radial LV and longitudinal RV global strain. Reproducibility of regional strain on FT was, however, poor. The relative systolic length change of the endocardial border measured by EBD yielded similar results to FT global strain. Clinically, biventricular longitudinal strain on FT was reduced compared to controls (P < 0.0001) and was related to the number of previous cardiac operations. In addition, FT derived RV strain was related to exercise capacity and VE/VCO2-slope. CONCLUSIONS Although neither the inter-study reproducibility nor accuracy of FT software were investigated, and its inter-observer reproducibility for regional strain calculation was poor, its calculations of global systolic strain showed similar or better inter-oberver reproducibility than those by STE, and could be applied across RV image regions inaccessible to echo. 'Global strain' calculated by EBD gave similar results to FT. Measurements made using FT related to exercise tolerance in ToF patients suggesting that the approach could have clinical relevance and deserves further study.
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Affiliation(s)
- Aleksander Kempny
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | | | - Stefan Orwat
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | - Pia Schuler
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | - Alexander C Bunck
- Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - David Maintz
- Department of Clinical Radiology, University Hospital of Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
| | - Gerhard-Paul Diller
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33,, 48149, Münster, Germany
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Van De Bruaene A, De Meester P, Voigt JU, Delcroix M, Pasquet A, De Backer J, De Pauw M, Naeije R, Vachiéry JL, Paelinck B, Morissens M, Budts W. Right ventricular function in patients with Eisenmenger syndrome. Am J Cardiol 2012; 109:1206-11. [PMID: 22277897 DOI: 10.1016/j.amjcard.2011.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/02/2011] [Accepted: 12/02/2011] [Indexed: 11/24/2022]
Abstract
To evaluate (1) whether right ventricular (RV) dysfunction, evaluated using tricuspid annular plane systolic excursion (TAPSE) is associated with a worse outcome in patients with the Eisenmenger syndrome, (2) which variables are related to RV dysfunction, and (3) whether differences exist among simple pretricuspid, simple post-tricuspid, and combined shunt lesions. Patients with Eisenmenger syndrome, aged >18 years, who underwent echocardiography, were selected from the Belgian Eisenmenger registry and prospectively followed up using a Web-based registry. Cox regression analysis was performed to evaluate the relation to outcomes, defined as all-cause mortality, transplantation, and hospitalization for cardiopulmonary causes. Comparative and bivariate analysis was performed, where applicable. A total of 58 patients (mean age 35.1 ± 13.2 years, 32.8% men) were included. During a mean follow-up of 3.2 years, 22 patients (37.9%) reached the predefined end point. Only TAPSE (hazard ratio 0.820, 95% confidence interval 0.708 to 0.950; p = 0.008) was related to the adverse outcomes on multivariate analysis. Patients with pretricuspid shunt lesions were older (p <0.0001) had greater left (p <0.0001) and right atrial (p <0.0001) dimensions, greater RV dimensions (p = 0.002), and more tricuspid regurgitation (p = 0.012) compared to patients with post-tricuspid lesions. Lower TAPSE was related to the presence of pulmonary artery thrombosis (R = -0.378; p = 0.006). In conclusion, in patients with Eisenmenger syndrome, RV dysfunction, evaluated using TAPSE, is related to worse outcomes. Patients with Eisenmenger syndrome with pretricuspid shunt lesions were older and had greater left atrial, right atrial, and RV dimensions compared to patients with post-tricuspid lesions, indicating a difference in the RV response. Lower TAPSE was associated with the presence of pulmonary artery thrombosis.
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23
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Lammers AE, Haworth SG, Diller GP. Atrial septostomy in patients with pulmonary hypertension: should it be recommended? Expert Rev Respir Med 2011; 5:363-76. [PMID: 21702659 DOI: 10.1586/ers.11.25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Treatment options for patients with advanced pulmonary hypertension (PH) are limited. Iatrogenic creation of an interatrial communication (i.e., atrial septostomy [AS]) has been suggested as a possible treatment option or as a bridge to transplantation in selected patients and has been incorporated into current PH guidelines. Uptake of the procedure has been slow and the worldwide experience with AS is limited to approximately 280 published cases, over a period of more than 25 years. The rationale for creating an AS has been provided by the observation that patients with congenital heart disease, shunt lesions and PH have a better survival compared with patients with idiopathic PH. We review pathophysiologic data and the published clinical experience and discuss the rationale, indication and potential pitfalls of AS in patients with severe PH.
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Affiliation(s)
- Astrid E Lammers
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London SW3 6NP, UK.
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Abstract
Pulmonary arterial hypertension (PAH) is a common problem in adult patients with congenital heart disease. We review available data on aetiology, clinical presentation, prognosis and management of PAH in this setting. In addition, we discuss general management strategies and emerging disease-targeting therapies.
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Affiliation(s)
- G-P Diller
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Centre (EMAH Zentrum), University Hospital Muenster, University of Muenster, Muenster, Germany.
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25
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Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography. Heart Fail Rev 2010; 15:39-61. [PMID: 19866357 DOI: 10.1007/s10741-009-9154-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
RV performance is difficult to evaluate, given its geometry, interrelationship with the left ventricle, and sensitivity to alterations in pulmonary pressure. This article focuses on some of the challenges related to the assessment of RV function in the setting of the RV's unique anatomic, physiologic, conventional and newer echocardiographic aspects, and therapeutic implications. The majority of proposed methods of echocardiographic assessment of RV function are based on volumetric approximations of the RV. Such approaches have inherent limitations, first as volume-related measures such as EF are load dependent, second because of the complex geometry of the RV. The issue of RV geometry is usually overcome using geometry-independent parameters such as tricuspid annular excursion and the Tei index. The recent introduction of real-time three-dimensional echocardiography and myocardial imaging echocardiography (tissue Doppler imaging, 1D-strain and 2D-strain echocardiography) implied a great progress in echocardiography. Tissue Doppler imaging allows the quantitative assessment of RV systolic and diastolic function by means of measurement of myocardial velocities. Strain measurements have been shown to correlate well with sonomicrometry segment length measurements both in the inflow and outflow tract of the RV and under different loading conditions. Other findings have been reported in chronic and acute clinical settings. Standard and novel echocardiographic methods of assessment of RV size and performance can help clinicians in the treatment of acute and chronic RV failure and contribute to a better understanding of the peculiar chamber-related functional mechanisms in the context of ventricular interdependent independency.
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Giannakoulas G, Dimopoulos K, Xu XY. Modelling in congenital heart disease. Art or science? Int J Cardiol 2009; 133:141-4. [PMID: 19046780 DOI: 10.1016/j.ijcard.2008.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 10/25/2008] [Indexed: 11/15/2022]
Abstract
Despite the advances in imaging modalities and surgical techniques, the management of adults with congenital heart disease (ACHD) over the years has remained largely empirical rather than evidence-based. Animal models have been difficult to develop and very costly, while clinical trials are difficult to design and perform in ACHD, leaving gaps in our understanding of the pathophysiology and treatment of congenital heart disease. Disease modelling, both hypothetical and patient-specific, provides an alternative solution to many of these problems. Advances in cardiovascular imaging and diagnostics have led to the easy acquisition of large quantities of structural and functional information, which cannot be handled "intuitively". Computational modelling introduces mathematical rigour in the analysis and utilisation of these data by quantitative simulation and testing of clinically relevant hypotheses through experimentally validated models. Close multidisciplinary collaboration between bioengineers and clinicians is essential for transforming data and images derived from models of disease into clinically useful information.
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28
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Pulmonary arterial hypertension in adults with congenital heart disease: distinct differences from other causes of pulmonary arterial hypertension and management implications. Curr Opin Cardiol 2008; 23:545-54. [DOI: 10.1097/hco.0b013e3283126954] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Dimopoulos K, Peset A, Gatzoulis MA. Evaluating operability in adults with congenital heart disease and the role of pretreatment with targeted pulmonary arterial hypertension therapy. Int J Cardiol 2008; 129:163-71. [DOI: 10.1016/j.ijcard.2008.02.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 02/22/2008] [Indexed: 11/29/2022]
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