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Li Q, Zhang Y, Cui X, Lu W, Ji Q, Zhang M. Optimal combination of right ventricular functional parameters using echocardiography in pulmonary arterial hypertension. ESC Heart Fail 2024; 11:2694-2706. [PMID: 38488337 PMCID: PMC11424360 DOI: 10.1002/ehf2.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/14/2024] [Accepted: 02/17/2024] [Indexed: 09/27/2024] Open
Abstract
AIMS Novel echocardiographic parameters of right ventricular (RV) function, including speckle-tracking-derived, three-dimensional, and RV-pulmonary artery coupling parameters, have emerged for the evaluation of pulmonary arterial hypertension (PAH). The relative role of these parameters in the risk stratification of PAH patients is unclear. We compared the performance of multiple RV parameters and sought to establish an optimal model for identifying the risk profile of patients with PAH. METHODS AND RESULTS Comprehensive risk assessments were performed for 70 patients with PAH. The risk profile of every patient was determined based on the guideline recommendations. Conventional parameters, including fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), novel speckle-tracking-derived RV longitudinal strain (RVLS), and three-dimensional RV ejection fraction (3D-RVEF), were used to evaluate RV function. Pressure-strain loops were measured for the assessment of RV myocardial work, including RV global wasted work (RVGWW). RV-pulmonary artery coupling was assessed by indexing RV parameters to the estimated pulmonary artery systolic pressure (PASP). The median age was 34 (30-43) years, and 62 (88.6%) patients were female. Forty-five patients were classified into the low-risk group, while 25 patients were classified into the intermediate-high-risk group. Most RV parameters could be used to determine the risk profile and exhibited significantly improved diagnostic performance after indexing to PASP (including FAC/PASP, TAPSE/PASP, and 3D-RVEF/PASP). RVLS/PASP showed the best performance, with an area under the curve of 0.895. In multivariate analysis (Model 1), only RVGWW (>90.5 mmHg%), RVLS (> -16.7%), and TAPSE (<17.5 mm) remained significant (all P < 0.05). Model 1 outperformed every single RV parameter, with a significantly larger area under the curve (all P < 0.05). With PASP indexing in Model 2, RVLS/PASP > -0.275 [odds ratio (OR) 20.63, 95% confidence interval (CI) 4.62-92.11, P < 0.001] and RVGWW > 90.5 mmHg% (OR 6.17, 95% CI 1.37-27.76, P = 0.018) independently identified a higher risk profile. The addition of RVGWW to two models determined incremental value in identification (continuous net reclassification improvement 1.058, 95% CI 0.639-1.477, P < 0.001). CONCLUSIONS The combination models for RV function outperformed any single parameter in identifying the risk profile of patients with PAH. Comprehensive assessment of RV-pulmonary artery coupling using multiparametric methods is clinically meaningful in patients with PAH.
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Affiliation(s)
- Qimou Li
- National Key Laboratory for Innovation and Transformation of Luobing TheoryShandong UniversityJinanChina
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesJinanChina
- Department of CardiologyQilu Hospital of Shandong UniversityNo. 107, Wen Hua Xi RoadJinanShandong250012China
| | - Yu Zhang
- National Key Laboratory for Innovation and Transformation of Luobing TheoryShandong UniversityJinanChina
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesJinanChina
- Department of CardiologyQilu Hospital of Shandong UniversityNo. 107, Wen Hua Xi RoadJinanShandong250012China
| | - Xiaopei Cui
- Department of Geriatric Medicine and Shandong Key Laboratory Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Weida Lu
- Department of Geriatric Medicine and Shandong Key Laboratory Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Qiushang Ji
- National Key Laboratory for Innovation and Transformation of Luobing TheoryShandong UniversityJinanChina
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesJinanChina
- Department of CardiologyQilu Hospital of Shandong UniversityNo. 107, Wen Hua Xi RoadJinanShandong250012China
| | - Mei Zhang
- National Key Laboratory for Innovation and Transformation of Luobing TheoryShandong UniversityJinanChina
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesJinanChina
- Department of CardiologyQilu Hospital of Shandong UniversityNo. 107, Wen Hua Xi RoadJinanShandong250012China
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2
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Hemnes AR, Celermajer DS, D'Alto M, Haddad F, Hassoun PM, Prins KW, Naeije R, Vonk Noordegraaf A. Pathophysiology of the right ventricle and its pulmonary vascular interaction. Eur Respir J 2024:2401321. [PMID: 39209482 DOI: 10.1183/13993003.01321-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024]
Abstract
The right ventricle and its stress response is perhaps the most important arbiter of survival in patients with pulmonary hypertension of many causes. The physiology of the cardiopulmonary unit and definition of right heart failure proposed in the 2018 World Symposium on Pulmonary Hypertension have proven useful constructs in subsequent years. Here, we review updated knowledge of basic mechanisms that drive right ventricular function in health and disease, and which may be useful for therapeutic intervention in the future. We further contextualise new knowledge on assessment of right ventricular function with a focus on metrics readily available to clinicians and updated understanding of the roles of the right atrium and tricuspid regurgitation. Typical right ventricular phenotypes in relevant forms of pulmonary vascular disease are reviewed and recent studies of pharmacological interventions on chronic right ventricular failure are discussed. Finally, unanswered questions and future directions are proposed.
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Affiliation(s)
- Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, CA, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kurt W Prins
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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3
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Bartoli-Leonard F, Harris AG, Saunders K, Madden J, Cherrington C, Sheehan K, Baquedano M, Parolari G, Bamber A, Caputo M. Altered Inflammatory State and Mitochondrial Function Identified by Transcriptomics in Paediatric Congenital Heart Patients Prior to Surgical Repair. Int J Mol Sci 2024; 25:7487. [PMID: 39000594 PMCID: PMC11242307 DOI: 10.3390/ijms25137487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
Congenital heart disease (CHD) remains the most common birth defect, with surgical intervention required in complex cases. Right ventricle (RV) function is known to be a major predictor of sustained cardiac health in these patients; thus, by elucidating the divergent profiles between CHD and the control through tissue analysis, this study aims to identify new avenues of investigation into the mechanisms surrounding reduced RV function. Transcriptomic profiling, in-silico deconvolution and functional network analysis were conducted on RV biopsies, identifying an increase in the mitochondrial dysfunction genes RPPH1 and RMPR (padj = 4.67 × 10-132, 2.23 × 10-107), the cytotoxic T-cell markers CD8a, LAGE3 and CD49a (p = 0.0006, p < 0.0001, and p = 0.0118) and proinflammatory caspase-1 (p = 0.0055) in CHD. Gene-set enrichment identified mitochondrial dysfunctional pathways, predominately changes within oxidative phosphorylation processes. The negative regulation of mitochondrial functions and metabolism was identified in the network analysis, with dysregulation of the mitochondrial complex formation. A histological analysis confirmed an increase in cellular bodies in the CHD RV tissue and positive staining for both CD45 and CD8, which was absent in the control. The deconvolution of bulk RNAseq data suggests a reduction in CD4+ T cells (p = 0.0067) and an increase in CD8+ T cells (p = 0.0223). The network analysis identified positive regulation of the immune system and cytokine signalling clusters in the inflammation functional network, as there were lymphocyte activation and leukocyte differentiation. Utilising RV tissue from paediatric patients undergoing CHD cardiac surgery, this study identifies dysfunctional mitochondrial pathways and an increase in inflammatory T-cell presence prior to reparative surgery.
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Affiliation(s)
- Francesca Bartoli-Leonard
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Amy G. Harris
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
| | - Kelly Saunders
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Julie Madden
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Carrie Cherrington
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Karen Sheehan
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Mai Baquedano
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
| | - Giulia Parolari
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
| | - Andrew Bamber
- North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
| | - Massimo Caputo
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol BS8 1UD, UK; (A.G.H.); (M.B.); (M.C.)
- Bristol Heart Institute, University Hospital Bristol and Weston NHS Foundation Trust, Bristol BS2 8ED, UK; (K.S.); (J.M.); (C.C.); (K.S.); (G.P.)
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4
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Pawar SG, Khan N, Salam A, Joshi M, Saravanan PB, Pandey S. The association of Pulmonary Hypertension and right ventricular systolic function - updates in diagnosis and treatment. Dis Mon 2024; 70:101635. [PMID: 37734967 DOI: 10.1016/j.disamonth.2023.101635] [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] [Indexed: 09/23/2023]
Abstract
Right ventricular (RV) systolic function is an essential but neglected component in cardiac evaluation, and its importance to the contribution to overall cardiac function is undermined. It is not only sensitive to the effect of left heart valve disease but is also more sensitive to changes in pressure overload than the left ventricle. Pulmonary Hypertension is the common and well-recognized complication of RV systolic dysfunction. It is also the leading cause of pulmonary valve disease and right ventricular dysfunction. Patients with a high pulmonary artery pressure (PAP) and a low RV ejection fraction have a seven-fold higher risk of death than heart failure patients with a normal PAP and RV ejection fraction. Furthermore, it is an independent predictor of survival in these patients. In this review, we examine the association of right ventricular systolic function with Pulmonary Hypertension by focusing on various pathological and clinical manifestations while assessing their impact. We also explore new 2022 ESC/ERS guidelines for diagnosing and treating right ventricular dysfunction in Pulmonary Hypertension.
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Affiliation(s)
| | - Nida Khan
- Jinnah Sindh Medical University, Pakistan
| | - Ajal Salam
- Government Medical College Kottayam, Kottayam, Kerala, India
| | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
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5
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Li Q, Zhang M. Echocardiography assessment of right ventricular-pulmonary artery coupling: Validation of surrogates and clinical utilities. Int J Cardiol 2024; 394:131358. [PMID: 37704177 DOI: 10.1016/j.ijcard.2023.131358] [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: 06/27/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
Right ventricular-pulmonary artery (RV-PA) coupling indicates efficiency of energy transfer from the right ventricle to the pulmonary circulation. The gold standard measurement, end-systolic elastance/arterial elastance ratio (Ees/Ea), is derived from invasive pressure-volume loop, which is technically demanding, expensive and limited in clinical practice. Recent studies have proposed various non-invasive surrogates of Ees/Ea based on echocardiography assessment, of which TAPSE/PASP ratio is an easily-obtained and validated parameter in severe pulmonary hypertension and rapidly applicated in the diagnosis and risk evaluation of various diseases and cardiac intervention. In this review, we summarized principles and validations of echocardiographic surrogates, and their clinical utilities and also limitations. The goal is to systematically review the research advances of echocardiography assessment of RV-PA coupling and help to guide clinical practice.
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Affiliation(s)
- Qimou Li
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Mei Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
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6
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Molnár AÁ, Sánta A, Merkely B. Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography. Diagnostics (Basel) 2023; 13:2470. [PMID: 37568832 PMCID: PMC10416971 DOI: 10.3390/diagnostics13152470] [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: 04/30/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Right ventricular function strongly predicts cardiac death and adverse cardiac events in patients with cardiac diseases. However, the accurate right ventricular assessment by two-dimensional echocardiography is limited due to its complex anatomy, shape, and load dependence. Advances in cardiac imaging and three-dimensional echocardiography provided more reliable information on right ventricular volumes and function without geometrical assumptions. Furthermore, the pathophysiology of right ventricular dysfunction and tricuspid regurgitation is frequently connected. Three-dimensional echocardiography allows a more in-depth structural and functional evaluation of the tricuspid valve. Understanding the anatomy and pathophysiology of the right side of the heart may help in diagnosing and managing the disease by using reliable imaging tools. The present review describes the challenging echocardiographic assessment of the right ventricle and tricuspid valve apparatus in clinical practice with a focus on three-dimensional echocardiography.
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Affiliation(s)
- Andrea Ágnes Molnár
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (A.S.); (B.M.)
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7
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Vraka A, Diamanti E, Kularatne M, Yerly P, Lador F, Aubert JD, Lechartier B. Risk Stratification in Pulmonary Arterial Hypertension, Update and Perspectives. J Clin Med 2023; 12:4349. [PMID: 37445381 DOI: 10.3390/jcm12134349] [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: 06/01/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Risk stratification in pulmonary arterial hypertension (PAH) is crucial in assessing patient prognosis. It serves a prominent role in everyday patient care and can be determined using several validated risk assessment scores worldwide. The recently published 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines underline the importance of risk stratification not only at baseline but also during follow-up. Achieving a low-risk status has now become the therapeutic goal, emphasising the importance of personalised therapy. The application of these guidelines is also important in determining the timing for lung transplantation referral. In this review, we summarise the most relevant prognostic factors of PAH as well as the parameters used in PAH risk scores and their evolution in the guidelines over the last decade. Finally, we describe the central role that risk stratification plays in the current guidelines not only in European countries but also in Asian countries.
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Affiliation(s)
- Argyro Vraka
- Pulmonary Division, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Eleni Diamanti
- Pulmonary Division, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Mithum Kularatne
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Patrick Yerly
- Division of Cardiology, Cardiovascular Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Frédéric Lador
- Pulmonary Division, Geneva University Hospital, 1211 Geneva, Switzerland
| | - John-David Aubert
- Pulmonary Division, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Benoit Lechartier
- Pulmonary Division, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
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8
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Škafar M, Ambrožič J, Toplišek J, Cvijić M. Role of Exercise Stress Echocardiography in Pulmonary Hypertension. Life (Basel) 2023; 13:1385. [PMID: 37374168 PMCID: PMC10302645 DOI: 10.3390/life13061385] [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: 05/01/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Resting and exercise right heart catheterisation is the gold standard method to diagnose and differentiate types of pulmonary hypertension (PH). As it carries technical challenges, the question arises if non-invasive exercise stress echocardiography may be used as an alternative. Exercise echocardiography can unmask exercise PH, detect the early stages of left ventricular diastolic dysfunction, and, therefore, differentiate between pre- and post-capillary PH. Regardless of the underlying aetiology, a developed PH is associated with increased mortality. Parameters of overt right ventricle (RV) dysfunction, including RV dilation, reduced RV ejection fraction, and elevated right-sided filling pressures, are detectable with resting echocardiography and are associated with worse outcome. However, these measures all fail to identify occult RV dysfunction. Echocardiographic measures of RV contractile reserve during exercise echocardiography are very promising and provide incremental prognostic information on clinical outcome. In this paper, we review pulmonary haemodynamic response to exercise, briefly describe the modalities for assessing pulmonary haemodynamics, and discuss in depth the contemporary key clinical application of exercise stress echocardiography in patients with PH.
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Affiliation(s)
- Mojca Škafar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (M.Š.); (J.A.); (J.T.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Jana Ambrožič
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (M.Š.); (J.A.); (J.T.)
| | - Janez Toplišek
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (M.Š.); (J.A.); (J.T.)
| | - Marta Cvijić
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; (M.Š.); (J.A.); (J.T.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Hameed A, Condliffe R, Swift AJ, Alabed S, Kiely DG, Charalampopoulos A. Assessment of Right Ventricular Function-a State of the Art. Curr Heart Fail Rep 2023; 20:194-207. [PMID: 37271771 PMCID: PMC10256637 DOI: 10.1007/s11897-023-00600-6] [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] [Accepted: 04/17/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) has a complex geometry and physiology which is distinct from the left. RV dysfunction and failure can be the aftermath of volume- and/or pressure-loading conditions, as well as myocardial and pericardial diseases. RECENT FINDINGS Echocardiography, magnetic resonance imaging and right heart catheterisation can assess RV function by using several qualitative and quantitative parameters. In pulmonary hypertension (PH) in particular, RV function can be impaired and is related to survival. An accurate assessment of RV function is crucial for the early diagnosis and management of these patients. This review focuses on the different modalities and indices used for the evaluation of RV function with an emphasis on PH.
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Affiliation(s)
- Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- NIHR Sheffield Biomedical Research Centre, Sheffield, UK
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
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10
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Cormack JM, Simon MA, Kim K. Backscatter tensor imaging and 3D speckle tracking for simultaneous ex vivo structure and deformation measurement of myocardium. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1238-1247. [PMID: 36858914 PMCID: PMC10050135 DOI: 10.1016/j.ultrasmedbio.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Biaxial mechanical testing is a common method for elucidation of mechanical properties of excised ventricular myocardium, especially in the context of structural remodeling that accompanies heart disease. Current imaging strategies in biaxial testing are based on optical camera imaging of the tissue surface, thus providing no information about the tissue microstructure and limiting strain measurements to two dimensions. Here, these limitations are overcome by replacing the camera with ultrasound imaging in order to measure both transmural fiber orientation and 3D tissue deformation during biaxial testing. METHODS Quasi-static biaxial mechanical testing is applied to four samples of excised porcine ventricular myocardium (two left- and two right-ventricular tissues). During testing, a rotational scan of an ultrasound linear array provides data for both backscatter tensor imaging and 3D speckle tracking, from which transmural fiber orientation and tissue deformation are computed, respectively. Ultrasound-derived fiber orientation and tissue strain are validated against histology and camera surface imaging, respectively. DISCUSSION Ultrasound-derived fiber angle and tissue strain exhibit good accuracy, with root-mean-square errors of 9.9° and 1.2% strain, respectively. Further investigation into the optimization of backscatter tensor imaging is warranted. Replacing the rotational scan of a linear array with volume imaging with a matrix array will improve the technique. CONCLUSION Ultrasound imaging can replace the optical camera measurement during biaxial mechanical testing of ventricular myocardium in order to accurately provide measurements of transmural fiber orientation and tissue strain. In situ knowledge of transmural fiber structure and tissue deformation can enhance the inverse problem used to determine tissue mechanical properties from biaxial testing.
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Affiliation(s)
- John M Cormack
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15261-1909, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
| | - Marc A Simon
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California 94143, USA
| | - Kang Kim
- Center for Ultrasound Molecular Imaging and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15261-1909, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
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11
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Ichimura K, Santana EJ, Kuznetsova T, Cauwenberghs N, Sabovčik F, Chun L, Francisco NLC, Kheyfets VO, Salerno M, Zamanian RT, Spiekerkoetter E, Haddad F. Novel left ventricular mechanical index in pulmonary arterial hypertension. Pulm Circ 2023; 13:e12216. [PMID: 37063750 PMCID: PMC10103585 DOI: 10.1002/pul2.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 03/25/2023] [Indexed: 04/18/2023] Open
Abstract
Ventricular interdependence plays an important role in pulmonary arterial hypertension (PAH). It can decrease left ventricular (LV) longitudinal strain (LVLS) and lead to a leftward displacement ("transverse shortening") of the interventricular septum (sTS). For this study, we hypothesized the ratio of LVLS/sTS would be a sensitive marker of systolic ventricular interactions in PAH. In a cross-sectional cohort of patients with PAH (n = 57) and matched controls (n = 57), we quantified LVLS and septal TS in the amplitude and time domain. We then characterized LV phenotypes using upset plots, ventricular interactions using network analysis, and longitudinal analysis in a representative cohort of 45 patients. We also measured LV metrics in mice subjected to pulmonary arterial banding (PAB) using a 7 T magnetic resonance imaging at baseline, Week 1, and Week 7 post-PAB (N = 9). Patients with PAH had significantly reduced absolute LVLS (15.4 ± 3.4 vs. 20.1 ± 2.3%, p < 0.0001), higher sTS (53.0 ± 12.2 vs. 28.0 ± 6.2%, p < 0.0001) and lower LVLS/sTS (0.30 ± 0.09 vs. 0.75 ± 0.16, p < 0.0001) compared to controls. Reduced LVLS/sTS was observed in 89.5% of patients, while diastolic dysfunction, impaired LVLS (<16%), and LV atrophy were observed in 73.7%, 52.6%, and 15.8%, respectively. In the longitudinal cohort, changes in LVLS/sTS were closely associated with changes in N-terminal pro B-type natriuretic peptide (r = 0.73, p < 0.0001) as well as survival. Mice subjected to PAB showed significant RV systolic dysfunction and decreased LVLS/sTS compared to sham animals. We conclude that in PAH, LVLV/sTS is a simple ratio that can reflect ventricular systolic interactions.
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Affiliation(s)
- Kenzo Ichimura
- Department of Medicine, Division of Pulmonary, Allergy and Critical CareStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Everton J. Santana
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
| | - Lindsey Chun
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | | | - Vitaly O. Kheyfets
- Pediatric Critical Care Medicine; Developmental Lung Biology and CVP Research Laboratories, School of MedicineUniversity of ColoradoAuroraColoradoUSA
| | - Michael Salerno
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Roham T. Zamanian
- Department of Medicine, Division of Pulmonary, Allergy and Critical CareStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Edda Spiekerkoetter
- Department of Medicine, Division of Pulmonary, Allergy and Critical CareStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
| | - Francois Haddad
- Vera Moulton Wall Center of Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
- Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
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12
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Han SW, Puelz C, Rusin CG, Penny DJ, Coleman R, Peskin CS. Computer simulation of surgical interventions for the treatment of refractory pulmonary hypertension. MATHEMATICAL MEDICINE AND BIOLOGY : A JOURNAL OF THE IMA 2023; 40:1-23. [PMID: 35984836 DOI: 10.1093/imammb/dqac011] [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: 11/24/2021] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022]
Abstract
This paper describes computer models of three interventions used for treating refractory pulmonary hypertension (RPH). These procedures create either an atrial septal defect, a ventricular septal defect or, in the case of a Potts shunt, a patent ductus arteriosus. The aim in all three cases is to generate a right-to-left shunt, allowing for either pressure or volume unloading of the right side of the heart in the setting of right ventricular failure, while maintaining cardiac output. These shunts are created, however, at the expense of introducing de-oxygenated blood into the systemic circulation, thereby lowering the systemic arterial oxygen saturation. The models developed in this paper are based on compartmental descriptions of human hemodynamics and oxygen transport. An important parameter included in our models is the cross-sectional area of the surgically created defect. Numerical simulations are performed to compare different interventions and various shunt sizes and to assess their impact on hemodynamic variables and oxygen saturations. We also create a model for exercise and use it to study exercise tolerance in simulated pre-intervention and post-intervention RPH patients.
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Affiliation(s)
- Seong Woo Han
- Courant Institute of Mathematical Sciences, New York University
- Department of Computer and Information Science, University of Pennsylvania
| | - Charles Puelz
- Courant Institute of Mathematical Sciences, New York University
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital
| | - Craig G Rusin
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital
| | - Daniel J Penny
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine and Texas Children's Hospital
| | - Ryan Coleman
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital
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13
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Kawakubo M, Moriyama D, Yamasaki Y, Abe K, Hosokawa K, Moriyama T, Triadyaksa P, Wibowo A, Nagao M, Arai H, Nishimura H, Kadokami T. Right ventricular strain and volume analyses through deep learning-based fully automatic segmentation based on radial long-axis reconstruction of short-axis cine magnetic resonance images. MAGMA (NEW YORK, N.Y.) 2022; 35:911-921. [PMID: 35585430 DOI: 10.1007/s10334-022-01017-3] [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: 02/01/2022] [Revised: 03/26/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We propose a deep learning-based fully automatic right ventricle (RV) segmentation technique that targets radially reconstructed long-axis (RLA) images of the center of the RV region in routine short axis (SA) cardiovascular magnetic resonance (CMR) images. Accordingly, the purpose of this study is to compare the accuracy of deep learning-based fully automatic segmentation of RLA images with the accuracy of conventional deep learning-based segmentation in SA orientation in terms of the measurements of RV strain parameters. MATERIALS AND METHODS We compared the accuracies of the above-mentioned methods in RV segmentations and in measuring RV strain parameters by Dice similarity coefficients (DSCs) and correlation coefficients. RESULTS DSC of RV segmentation of the RLA method exhibited a higher value than those of the conventional SA methods (0.84 vs. 0.61). Correlation coefficient with respect to manual RV strain measurements in the fully automatic RLA were superior to those in SA measurements (0.5-0.7 vs. 0.1-0.2). DISCUSSION Our proposed RLA realizes accurate fully automatic extraction of the entire RV region from an available CMR cine image without any additional imaging. Our findings overcome the complexity of image analysis in CMR without the limitations of the RV visualization in echocardiography.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.
| | - Daichi Moriyama
- Department of Health Sciences, School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Radiological Technology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Hosokawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuhiro Moriyama
- Institute of Mathematics for Industry, Kyushu University, Fukuoka, Japan
| | - Pandji Triadyaksa
- Department of Physics, Faculty of Science and Mathematics, Universitas Diponegoro, Semarang, Indonesia
| | - Adi Wibowo
- Department of Computer Science, Faculty of Science and Mathematics, Universitas Diponegoro, Semarang, Indonesia
| | - Michinobu Nagao
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideo Arai
- Fukuokaken Saiseikai, Futsukaichi Hospital, Fukuoka, Japan
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14
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Nakagawa A, Yasumura Y, Yoshida C, Okumura T, Tateishi J, Seo M, Yano M, Hayashi T, Nakagawa Y, Tamaki S, Yamada T, Sotomi Y, Nakatani D, Hikoso S, Sakata Y. Right Ventricular Dimension for Heart Failure With Preserved Ejection Fraction Involving Right Ventricular-Vascular Uncoupling. CJC Open 2022; 4:929-938. [PMID: 36444368 PMCID: PMC9700222 DOI: 10.1016/j.cjco.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background Right ventricular (RV) to pulmonary artery (PA) uncoupling is known to be important for the prognosis of not only heart failure (HF) with reduced ejection fraction but also HF with preserved ejection fraction (HFpEF). We further investigated key factors in the poor prognosis for HFpEF patients with RV-PA uncoupling. Methods We studied 817 patients with HFpEF who were discharged alive in a multicentred cohort using post hoc analyses, with a primary endpoint of cardiac mortality or HF readmission. A total of 288 RV-PA uncoupled patients were observed, namely those with a tricuspid annular plane systolic excursion (TAPSE)/PA systolic pressure (PASP) ratio < 0.46 mm/mm Hg. Results Among the RV-PA uncoupled patients, 101 adverse outcomes occurred over a median of 340 days. Echocardiographic RV dimension (RVD) was significantly important for prognosis in both univariable and multivariable Cox regression testing (hazard ratio 1.044, 95% confidence interval 1.014-1.074, P = 0.0042, and hazard ratio 1.036, 95% confidence interval 1.001-1.072, P = 0.0438, respectively) considered with the covariates of age, atrial fibrillation, renal function, N-terminal pro-brain natriuretic peptide, and other echocardiographic parameters. We further divided the patients into 4 groups, first into 2 groups with a TAPSE/PASP either ≥ or < 0.46 mm/mm Hg, and then into 4 groups by RVD medians of 31.9 mm and 33.3 mm, respectively. Kaplan-Meier curve analysis showed that outcomes were worst in patients with a low TAPSE/PASP ratio and larger RVD (log-rank P < 0.0001). Conclusions This multicentre observational study highlighted the further prognostic importance of larger RVD among HFpEF patients with RV-PA uncoupling.
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Affiliation(s)
- Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan
| | - Chikako Yoshida
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan
| | - Takahiro Okumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan
| | - Jun Tateishi
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Hyogo, Japan
| | - Shunsuke Tamaki
- Department of Cardiology, Rinku General Medical Centre, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Osaka CardioVascular Conference (OCVC)-Heart Failure Investigators
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Hyogo, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
- Division of Cardiology, Osaka Police Hospital, Osaka, Japan
- Division of Cardiology, Kawanishi City Hospital, Hyogo, Japan
- Department of Cardiology, Rinku General Medical Centre, Osaka, Japan
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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15
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Haddad F, Contrepois K, Amsallem M, Denault AY, Bernardo RJ, Jha A, Taylor S, Arthur Ataam J, Mercier O, Kuznetsova T, Vonk Noordegraaf A, Zamanian RT, Sweatt AJ. The Right Heart Network and Risk Stratification in Pulmonary Arterial Hypertension. Chest 2022; 161:1347-1359. [PMID: 34774527 PMCID: PMC9131051 DOI: 10.1016/j.chest.2021.10.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prognosis in pulmonary arterial hypertension (PAH) is closely related to indexes of right ventricular function. A better understanding of their relationship may provide important implications for risk stratification in PAH. RESEARCH QUESTION Can clinical network graphs inform risk stratification in PAH? STUDY DESIGN AND METHODS The study cohort consisted of 231 patients with PAH followed up for a median of 7.1 years. An undirected, correlation network was used to visualize the relationship between clinical features in PAH. This network was enriched for right heart parameters and included N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP), comprehensive echocardiographic parameters, and hemodynamics, as well as 6-min walk distance (6MWD), vital signs, laboratory data, and diffusing capacity for carbon monoxide (Dlco). Connectivity was assessed by using eigenvector and betweenness centrality to reflect global and regional connectivity, respectively. Cox proportional hazards regression was used to model event-free survival for the combined end point of death or lung transplantation. RESULTS A network of closely intertwined features centered around NT-proBNP with 6MWD emerging as a secondary hub were identified. Less connected nodes included Dlco, systolic BP, albumin, and sodium. Over the follow-up period, death or transplantation occurred in 92 patients (39.8%). A strong prognostic model was achieved with a Harrell's C-index of 0.81 (0.77-0.85) when combining central right heart features (NT-proBNP and right ventricular end-systolic remodeling index) with 6MWD and less connected nodes (Dlco, systolic BP, albumin, sodium, sex, connective tissue disease etiology, and prostanoid therapy). When added to the baseline risk model, serial change in NT-proBNP significantly improved outcome prediction at 5 years (increase in C-statistic of 0.071 ± 0.024; P = .003). INTERPRETATION NT-proBNP emerged as a central hub in the intertwined PAH network. Connectivity analysis provides explainability for feature selection and combination in outcome models.
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Affiliation(s)
- Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA.
| | - Kevin Contrepois
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Department of Genetics, Stanford University School of Medicine, Stanford, CA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA
| | - Andre Y Denault
- Department of Anesthesiology and Division of Critical Care, Montreal Heart Institute, University of Montréal, Montréal, QC, Canada
| | - Roberto J Bernardo
- Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
| | - Alokkumar Jha
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shalina Taylor
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Arthur Ataam
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Olaf Mercier
- Department of Cardiovascular and Thoracic Surgery, Centre Chirurgical Marie-Lannelongue, Paris-South University, Paris, France
| | - Tatiana Kuznetsova
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roham T Zamanian
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
| | - Andrew J Sweatt
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA; Vera Moulton Wall Center for Pulmonary Disease at Stanford University, Stanford, CA; Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA
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16
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Muraru D. 22nd Annual Feigenbaum Lecture Right Heart, Right Now: The Role of Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2022; 35:893-909. [DOI: 10.1016/j.echo.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Lattanzio M, Scelsi L, Golino M, Lattuada M, Raineri C, Turco A, Giuntini C, Ceriani F, Curti M, Bonelli A, Piacentino F, Venturini M, Ghiringhelli S, Morandi F, De Ponti R, Ghio S. Assessment of right ventricle in pulmonary arterial hypertension with three-dimensional echocardiography and cardiovascular magnetic resonance. J Cardiovasc Med (Hagerstown) 2021; 22:929-936. [PMID: 34482325 PMCID: PMC10414158 DOI: 10.2459/jcm.0000000000001250] [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: 03/11/2021] [Revised: 06/03/2021] [Accepted: 08/08/2021] [Indexed: 11/05/2022]
Abstract
AIM To correlate 3-D Echo and CMR RV parameters and to verify whether they are similarly related to the clinical conditions of patients with pulmonary arterial hypertension (PAH), a disease in which the RV plays a crucial prognostic role. METHODS We enrolled 34 consecutive PAH patients followed by our PAH clinics. All patients underwent a 3-D Echo and CMR assessment of RV volumes and functions in the same day. The presence or absence of correlation between major findings was investigated; functional RV parameters were also analyzed in relation to 6-min walking test (6MWT) results and BNP/Nt-proBNP plasma levels. Twenty-four subjects served as controls. RESULTS Good agreement was found between 3-D Echo and CMR measures of RV volumes [RV-end-diastolic volume (r = 0.72, P < 0.0001), RV-end-systolic volume (ESV) (r = 0.80, P < 0.0001)] and function [RV-EF (r = 0.73, P < 0.0001), RV-ESV/SV (r = 0.83, P = 0.001)] for all the subjects of the study. These correlations were stronger in PAH patients than in control subjects. Importantly, 3-D Echo and CMR RV-EF and RV to pulmonary arterial coupling (RV-ESV/SV) similarly correlated with BNP/Nt-proBNP levels and with functional capacity measured at 6MWT in the PAH patients group. CONCLUSIONS 3-D Echo demonstrated a significant agreement with CMR in the assessment of RV volume and function in PAH patients. Both techniques showed a similar correlation with clinical and prognostic parameters. The use of 3-D Echo should be amply boosted in the real-world clinical evaluation of PAH patients.
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Affiliation(s)
- Mariangela Lattanzio
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Michele Golino
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | - Maddalena Lattuada
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | - Claudia Raineri
- Division of Cardiology, Città della Salute e della Scienza, Ospedale Molinette, Torino
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Chiara Giuntini
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | - Francesca Ceriani
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | - Marco Curti
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo, University of Insubria, Varese
| | - Andrea Bonelli
- Division of Cardiology, Ospedali ‘Spedali Civili’, Brescia, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo, University of Insubria, Varese
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo, University of Insubria, Varese
| | - Sergio Ghiringhelli
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Varese
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
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18
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Wang S, Wang S, Zhu Q, Wang Y, Li G, Kong F, Yang J, Ma C. Reference Values of Right Ventricular Volumes and Ejection Fraction by Three-Dimensional Echocardiography in Adults: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:709863. [PMID: 34631816 PMCID: PMC8495027 DOI: 10.3389/fcvm.2021.709863] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: This study was conducted in order to determine the reference values for right ventricular (RV) volumes and ejection fraction (EF) using three-dimensional echocardiography (3DE) and to identify sources of variance through a systematic review and meta-analysis. Methods: This systematic review was preregistered with the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/) (CRD42020211002). Relevant studies were identified by searches of the PubMed, Embase, and Cochrane Library databases through October 12, 2020. Pooled reference values were calculated using the random-effects model weighted by inverse variance. Meta-regression analysis and Egger's test were used to determine the source of heterogeneity. A subgroup analysis was performed to evaluate the reference values across different conditions. Results: The search identified 25 studies of 2,165 subjects. The mean reference values were as follows: RV end-diastolic volume, 100.71 ml [95% confidence interval (CI), 90.92–110.51 ml); RV end-systolic volume, 44.19 ml (95% CI, 39.05–49.33 ml); RV end-diastolic volume indexed, 57.01 ml/m2 (95% CI, 51.93–62.08 ml/m2); RV end-systolic volume indexed, 25.41 ml/m2 (95% CI, 22.58–28.24 ml/m2); and RVEF, 56.20% (95% CI, 54.59–57.82%). The sex- and age-specific reference values were assessed according to the studies reporting the values of different sexes and age distributions, respectively. In addition, the vendor- and software-specific reference values were analyzed. The meta-regression analysis revealed that sex, frame rate, pulmonary artery systolic pressure, and software packages were associated with variations in RV volumes (P < 0.05). Inter-vendor and inter-software discrepancies may explain the variability of RVEF. Conclusions: The reference values for RV volumes and RVEF using 3DE were assessed. The confounders that impacted the variability in RV volumes or RVEF contained the sex, frame rate, pulmonary artery systolic pressure, inter-vendor discrepancies, and inter-software discrepancies.
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Affiliation(s)
- Shitong Wang
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shuyu Wang
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qing Zhu
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yonghuai Wang
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guangyuan Li
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fanxin Kong
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
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Clinical Significance of Right Ventricular Function in Pulmonary Hypertension. Keio J Med 2021; 70:60-67. [PMID: 33456013 DOI: 10.2302/kjm.2020-0015-ir] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease characterized by increased pulmonary vascular resistance that leads to right ventricular (RV) failure, a condition that determines its prognosis. This review focuses on the clinical value of the evaluation of RV function in PH. First, the pathophysiology of PH, including hemodynamics, RV function, and their interaction (known as ventriculoarterial coupling), are summarized. Next, non-invasive imaging modalities and the parameters of RV function, mainly assessed by echocardiography, are reviewed. Finally, the clinical impacts of RV function in PH are described. This review will compare the techniques that yield comprehensive information on RV function and their roles in the assessment of PH.
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20
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Unchanged right ventricular strain in repaired tetralogy of Fallot after pulmonary valve replacement with radial long-axis cine magnetic resonance images. Sci Rep 2021; 11:18879. [PMID: 34556756 PMCID: PMC8460644 DOI: 10.1038/s41598-021-98464-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
We measured right ventricular (RV) strain by applying a novel postprocessing technique to conventional short-axis cine magnetic resonance imaging in the repaired tetralogy of Fallot (TOF) and investigated whether pulmonary valve replacement (PVR) changes the RV strain. Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P = 0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P = 0.002 for both, before and after GLSs: P < 0.0001 and P = 0.0003). RV strains from radially reconstructed short-axis cine images revealed unchanged myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.
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Feasibility, Reproducibility and Validation of Right Ventricular Volume and Function Assessment Using Three-Dimensional Echocardiography. Diagnostics (Basel) 2021; 11:diagnostics11040699. [PMID: 33919794 PMCID: PMC8070805 DOI: 10.3390/diagnostics11040699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
Three-dimensional echocardiography (3DE) is advised for right ventricular (RV) assessment. Data regarding the optimal acquisition settings and optimization are still scarce. We aimed to evaluate the feasibility, reproducibility and validation of 3DE for RV volume and function assessment, using cardiac magnetic resonance (CMR) as gold standard. Thirty healthy volunteers and 36 consecutive patients were prospectively included. CMR was performed in the latter. Standard apical four-chamber view (A4CV), focused A4CV and modified A4CV were used for 3DE RV acquisition. Feasibility (and the effect of changes in settings) was evaluated. Intra and interobserver analyses were performed by three observers (expert vs. novice). RV parameters by echocardiography were compared to CMR. Feasibility of acquisition was 16.7% for A4CV, 80.0% for focused A4CV and 16.7% for modified A4CV. Changes in settings had no significant influence on feasibility and further analysis. Intraobserver variability was good in both expert and novice, interobserver variability was good between experienced observers. Compared to CMR, 3DE volumes were significantly lower with fair to moderate correlation (EDV: 91.1 ± 24.4 mL vs. 144.3 ± 43.0 mL (p < 0.001), r = 0.653 and ESV: 48.1 ± 16.4 mL vs. 60.4 ± 21.2 mL (p < 0.001), r = 0.530, by multi-beat 3DE and CMR respectively). These findings suggest that standardization is needed in order to implement this technique in clinical practice, thus further studies are required.
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22
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The Prognostic Value of Right Atrial Strain Imaging in Patients with Precapillary Pulmonary Hypertension. J Am Soc Echocardiogr 2021; 34:851-861.e1. [PMID: 33774108 DOI: 10.1016/j.echo.2021.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Right ventricular (RV) failure in patients with pulmonary hypertension (PH) is associated with unfavorable clinical events and a poor prognosis. Elevation of right atrial (RA) pressure is established as a marker for RV failure. However, the additive prognostic value of RA mechanical function is unclear. METHODS The authors tested the hypothesis that RA function by strain echocardiography has prognostic usefulness by studying 165 consecutive patients with precapillary PH defined invasively: mean pulmonary artery pressure ≥ 25 mm Hg and pulmonary capillary wedge pressure < 15 mm Hg. Speckle-tracking strain analyses of the right atrium and right ventricle were performed, along with routine measures. Peak RA strain values from six segments using generic speckle-tracking software were averaged to RA peak longitudinal strain, representing RA global reservoir function. The primary end point was all-cause mortality during 5 years of follow-up. RA strain was similarly analyzed in a control group of 16 normal subjects for comparison. RESULTS There were 151 patients with PH (mean age, 55 ± 16 years; 73% women; mean World Health Organization functional class, 2.6 ± 0.6), after 14 exclusions (three with atrial septal defects and 11 with left ventricular ejection fractions < 50%). RA strain measurement was feasible in 93% of patients and RV strain measurement in 88%. RA peak longitudinal strain was significantly reduced in patients with PH compared with control subjects, as expected (P < .001). During 5-year follow-up, 73 patients (48%) died. Patients with RA peak strain in the lowest quartile (<25%) had a significant risk for death (P = .006), even after correcting for confounding variables. RA strain was independently associated with survival in multivariate analysis (P = .039) and had additive prognostic value to RV strain (log-rank P = .01) in subgroup analysis. CONCLUSIONS RA peak longitudinal strain had additive prognostic usefulness to other clinical measures, including RV strain, RA area, and RA pressure, in patients with PH. RA mechanical function by strain imaging has potential for clinical applications in patients with PH.
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23
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Jone PN, Duchateau N, Pan Z, Ivy DD, Moceri P. Right ventricular area strain from 3-dimensional echocardiography: Mechanistic insight of right ventricular dysfunction in pediatric pulmonary hypertension. J Heart Lung Transplant 2021; 40:138-148. [PMID: 33268039 DOI: 10.1016/j.healun.2020.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is a major contributor to the outcome of pulmonary arterial hypertension (PAH). Adult studies demonstrated that regional and global changes in RV deformation are prognostic in PAH using 3-dimensional echocardiography (3DE). However, regional and global dynamic changes in RV mechanics have not been described in pediatric PAH. We compared 3DE RV regional and global deformation between pediatric patients who had associated PAH with congenital heart disease (APAH-CHD), pediatric patients who had idiopathic PAH (IPAH), and normal controls, and evaluated the clinical outcomes. METHODS A total of 48 controls, 47 patients with APAH-CHD, and 45 patients with IPAH were evaluated. 3DE RV sequences were analyzed and post-processed to extract global and regional deformation (circumferential, longitudinal, and area strain). Statistical analyses compared the sub-groups on the basis of global and regional deformation, and outcome analysis was performed. RESULTS Patients with PAH had significantl8y different global and regional deformation (p < 0.001) compared with controls. Patients with APAH-CHD and and those with IPAH significantly differed in global circumferential strain (p < 0.010), area strain (inlet septum, p = 0.041), and circumferential strain at the inlet septum (p < 0.019), apex free wall (p < 0.004), and inlet free wall (p < 0.004). Circumferential strain at the inlet free wall and circumferential, longitudinal, and area strain at the apex free wall were predictors of adverse events. CONCLUSIONS RV regional and global strain differ between controls and pediatric patients with PAH. RV apical free-wall area strain provides insight into the mechanism of RV dysfunction in pediatric patients with PAH, with regional strain emerging as outcome predictors, suggesting that this novel measure may be considered as a future measure of RV function.
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Affiliation(s)
- Pei-Ni Jone
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
| | - Nicolas Duchateau
- CREATIS, CNRS UMR 5220, INSERM U1206, Université Lyon 1, Lyon, France
| | - Zhaoxing Pan
- Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | - D Dunbar Ivy
- Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Pamela Moceri
- Universite Côte d'Azur UR2CA, Inria Epione Team, Department of Cardiology, Hôpital Pasteur, CHU de Nice, France
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24
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Beghetti M, Berger RMF, Bonnet D, Grill S, Lesage C, Lemarie JC, Ivy DD. Echocardiographic Changes and Long-Term Clinical Outcomes in Pediatric Patients With Pulmonary Arterial Hypertension Treated With Bosentan for 72 Weeks: A Post-hoc Analysis From the FUTURE 3 Study. Front Pediatr 2021; 9:681538. [PMID: 34222150 PMCID: PMC8242164 DOI: 10.3389/fped.2021.681538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/14/2021] [Indexed: 11/25/2022] Open
Abstract
FormUlation of bosenTan in pUlmonary arterial hypeRtEnsion (FUTURE) 3 was a 24-week open-label, prospective, and randomized phase 3 study that assessed the pharmacokinetics of bosentan 2 mg/kg b.i.d. or t.i.d. in children with pulmonary arterial hypertension (PAH). We report findings from a post-hoc analysis that explored the prognostic value of echocardiographic changes during FUTURE 3 in relation to clinical outcomes observed during the 24-week core study and 48-week extension. Patients aged ≥3 months to <12 years (n = 64) received oral doses of bosentan 2 mg/kg b.i.d. or t.i.d. (1:1) for 24 weeks, after which they were eligible to enter the extension with continued bosentan administration. Echocardiographic evaluations were performed at baseline, Week 12, and 24 of the core study via central reading, and analyzed post-hoc for correlation with clinical outcomes (time to PAH worsening, time to death, and vital status). Sixty-four patients were randomized in the core study [median (IQR) age 3.8 (1.7-7.8) years]; and 58 patients (90.6%) entered the 48-week extension. Most of the patients (68.8%) were receiving ≥1 PAH medication at baseline. Echocardiographic changes during the core study were small but with high variability. There were statistically significant associations at Week 24 between worsening of the parameters, systolic left ventricular eccentricity index (LVEIS) and E/A ratio mitral valve flow, and the outcomes of time to death and time to PAH worsening. Additional studies that utilize simple and reproducible echocardiographic assessments are needed to confirm these findings and subsequently identify potential treatment goals in pediatric PAH.
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Affiliation(s)
- Maurice Beghetti
- Paediatric Cardiology Unit, Children's Hospital, Geneva, Switzerland.,Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatriques, University of Lausanne, Lausanne, Switzerland
| | - Rolf M F Berger
- Department of Paediatric Cardiology, Centre for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Damien Bonnet
- M3C-Hospital Necker Enfants Malades, Department of Paediatric Cardiology, Université de Paris, Paris, France
| | - Simon Grill
- Actelion Pharmaceuticals Ltd., Allschwil, Switzerland
| | | | | | - D Dunbar Ivy
- Department of Pediatric Cardiology, Children's Hospital Colorado, Denver, CO, United States
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25
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Ventricular systolic dysfunction with and without altered myocardial contractility: Clinical value of echocardiography for diagnosis and therapeutic decision-making. Int J Cardiol 2020; 327:236-250. [PMID: 33285193 DOI: 10.1016/j.ijcard.2020.11.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
The inability of one of the two or both ventricles to contract normally and expel sufficient blood to meet the functional demands of the body results from a complex interplay between intrinsic abnormalities and extracardiac factors that limit ventricular pump function and is a major cause for heart failure (HF). Even if impaired myocardial contractile function was the primary cause for ventricular dysfunction, with the progression of systolic dysfunction, additionally developed diastolic dysfunction can also contribute to the severity of HF. Although at the first sight, the diagnosis of systolic HF appears quite easy because it is usually defined by reduction of the ejection fraction (EF), in reality this issue is far more complex because ventricular pumping performance depends not only on myocardial contractility, but also largely on loading conditions (preload and afterload), being also influenced by valvular function, ventricular interdependence, pericardial constraint, synchrony of ventricular contrac-tion and heart rhythm. Conventional echocardiography (ECHO) combined with new imaging techniques such as tissue Doppler and tissue tracking can detect early subclinical alteration of ventricular systolic function. However, no single ECHO parameter reveals alone the whole picture of systolic dysfunction. Multiparametric ECHO evaluation and the use of integrative approaches using ECHO-parameter combinations which include also the ventricular loading conditions appeared particularly useful especially for differentiation between primary (myocardial damage-induced) and secondary (hemodynamic overload-induced) systolic dysfunction. This review summarizes the available evidence on the usefulness and limitations of comprehensive evaluation of LV and RV systolic function by using all the currently available ECHO techniques.
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26
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Moriyama H, Kawakami T, Kataoka M, Hiraide T, Kimura M, Endo J, Kohno T, Itabashi Y, Seo Y, Fukuda K, Murata M. Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension. J Am Heart Assoc 2020; 9:e018096. [PMID: 33107377 PMCID: PMC7763406 DOI: 10.1161/jaha.120.018096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Right ventricular (RV) dysfunction is a prognostic factor for cardiovascular disease. However, its mechanism and pathophysiology remain unknown. We investigated RV function using RV-specific 3-dimensional (3D)-speckle-tracking echocardiography (STE) in patients with chronic thromboembolic pulmonary hypertension. We also assessed regional wall motion abnormalities in the RV and chronological changes during balloon pulmonary angioplasty (BPA). Methods and Results Twenty-nine patients with chronic thromboembolic pulmonary hypertension who underwent BPA were enrolled and underwent right heart catheterization and echocardiography before, immediately after, and 6 months after BPA. Echocardiographic assessment of RV function included both 2-dimensional-STE and RV-specific 3D-STE. Before BPA, global area change ratio measured by 3D-STE was significantly associated with invasively measured mean pulmonary artery pressure and pulmonary vascular resistance (r=0.671 and r=0.700, respectively). Dividing the RV into the inlet, apex, and outlet, inlet area change ratio showed strong correlation with mean pulmonary artery pressure and pulmonary vascular resistance before BPA (r=0.573 and r=0.666, respectively). Only outlet area change ratio was significantly correlated with troponin T values at 6 months after BPA (r=0.470), and its improvement after BPA was delayed compared with the inlet and apex regions. Patients with poor outlet area change ratio were associated with a delay in RV reverse remodeling after treatment. Conclusions RV-specific 3D-STE analysis revealed that 3D RV parameters were novel useful indicators for assessing RV function and hemodynamics in pulmonary hypertension and that each regional RV portion presents a unique response to hemodynamic changes during treatment, implicating that evaluation of RV regional functions might lead to a new guide for treatment strategies.
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Affiliation(s)
- Hidenori Moriyama
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Takashi Kawakami
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Masaharu Kataoka
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Takahiro Hiraide
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Mai Kimura
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Jin Endo
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Takashi Kohno
- Department of CardiologyKyorin University School of MedicineTokyoJapan
| | - Yuji Itabashi
- Department of Laboratory MedicineKeio University School of MedicineTokyoJapan
| | - Yoshihiro Seo
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Keiichi Fukuda
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University School of MedicineTokai University Hachioji HospitalTokyoJapan
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27
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Gorcsan J. Looking Rightward in Acute Left Heart Failure. J Card Fail 2020; 26:821-823. [DOI: 10.1016/j.cardfail.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
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28
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Bernardo RJ, Haddad F, Couture EJ, Hansmann G, de Jesus Perez VA, Denault AY, de Man FS, Amsallem M. Mechanics of right ventricular dysfunction in pulmonary arterial hypertension and heart failure with preserved ejection fraction. Cardiovasc Diagn Ther 2020; 10:1580-1603. [PMID: 33224775 PMCID: PMC7666917 DOI: 10.21037/cdt-20-479] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
Right ventricular (RV) dysfunction is the most important determinant of survival in patients with pulmonary hypertension (PH). The manifestations of RV dysfunction not only include changes in global RV systolic function but also abnormalities in the pattern of contraction and synchrony. The effects of PH on the right ventricle have been mainly studied in patients with pulmonary arterial hypertension (PAH). However, with the demographic shift towards an aging population, heart failure with preserved ejection fraction (HFpEF) has become an important etiology of PH in recent years. There are significant differences in RV mechanics, function and adaptation between patients with PAH and HFpEF (with or without PH), which are related to different patterns of remodeling and dysfunction. Due to the unique features of the RV chamber, its connection with the main pulmonary artery and the pulmonary circulation, an understanding of the mechanics of RV function and its clinical significance is mandatory for both entities. In this review, we describe the mechanics of the pressure overloaded right ventricle. We review the different mechanical components of RV dysfunction and ventricular dyssynchrony, followed by insights via analysis of pressure-volume loop, energetics and novel blood flow patterns, such as vortex imaging. We conduct an in-depth comparison of prevalence and characteristics of RV dysfunction in HFpEF and PAH, and summarize key outcome studies. Finally, we provide a perspective on needed and expected future work in the field of RV mechanics.
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Affiliation(s)
- Roberto J. Bernardo
- Division of Pulmonary, Allergy and Critical Care, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
| | - Francois Haddad
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Etienne J. Couture
- Department of Anesthesiology, Quebec Heart and Lung Institute, Quebec, Canada
- Intensive Care Medicine Division, Department of Medicine, Quebec Heart and Lung Institute, Quebec, Canada
- Research Center, Quebec Heart and Lung Institute, Quebec, Canada
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Vinicio A. de Jesus Perez
- Division of Pulmonary, Allergy and Critical Care, Stanford University School of Medicine, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
| | - André Y. Denault
- Department of Anesthesiology and Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Canada
- Division of Critical Care, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Frances S. de Man
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, PHEniX laboratory, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Myriam Amsallem
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA, USA
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cardiovascular Institute, Stanford, CA, USA
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29
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Mandoli GE, Sciaccaluga C, Bandera F, Cameli P, Esposito R, D'Andrea A, Evola V, Sorrentino R, Malagoli A, Sisti N, Nistor D, Santoro C, Bargagli E, Mondillo S, Galderisi M, Cameli M. Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings. Heart Fail Rev 2020; 26:263-275. [PMID: 32860180 PMCID: PMC7895796 DOI: 10.1007/s10741-020-10014-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cor pulmonale is the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process. Depending on the speed of onset of the pathological condition and subsequent effects on the right ventricle, it is possible to distinguish the acute cor pulmonale from the chronic type of disease. Echocardiography plays a central role in the diagnostic and therapeutic work-up of these patients, because of its non-invasive nature and wide accessibility, providing its greatest usefulness in the acute setting. It also represents a valuable tool for tracking right ventricular function in patients with cor pulmonale, assessing its stability, deterioration, or improvement during follow-up. In fact, not only it provides parameters with prognostic value, but also it can be used to assess the efficacy of treatment. This review attempts to provide the current standards of an echocardiographic evaluation in both acute and chronic cor pulmonale, focusing also on the findings present in the most common pathologies causing this condition.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Francesco Bandera
- Cardiology University Department, Heart Failure Unit, IRCCS, Policlinico San Donato, San Donato Milanese and Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Antonello D'Andrea
- Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Vincenzo Evola
- Department of Health Promotion Sciences, Maternal-Infant Care, Internal Medicine and Specialities of Excellence "G. D'Alessandro", University of Palermo, Cardiology Unit, University Hospital P. Giaccone, Palermo, Italy
| | - Regina Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, "S. Agostino-Estense" Public Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Dan Nistor
- Institute for Emergency Cardiovascular Diseases and Transplant Targu Mures, Targu Mures, Romania
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, AOUS Policlinico Santa Maria alle Scotte, University of Siena, Viale Bracci 1, 53100, Siena, Italy
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30
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Prognostic Value of Right Ventricular Two-Dimensional and Three-Dimensional Speckle-Tracking Strain in Pulmonary Arterial Hypertension: Superiority of Longitudinal Strain over Circumferential and Radial Strain. J Am Soc Echocardiogr 2020; 33:985-994.e1. [DOI: 10.1016/j.echo.2020.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
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31
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Right ventricular end-systolic remodeling index in the assessment of pediatric pulmonary arterial hypertension. The European Pediatric Pulmonary Vascular Disease Network (EPPVDN). Pediatr Res 2020; 88:285-292. [PMID: 31923914 DOI: 10.1038/s41390-020-0748-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 11/23/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Echocardiographic determination of the right ventricular end-systolic remodeling index (RVES RI) has clinical value for the assessment of pulmonary hypertension (PH) in adults. We aim to determine RVES RI values in pediatric PH and to correlate RVES RI data with echocardiographic variables and NYHA functional class (FC). METHODS Prospective echocardiography study in 49 children with PH. The 49 matched control subjects were chosen from 123 healthy children used to construct pediatric normal reference values. The associations with invasive hemodynamic variables were also investigated in a validation cohort of 12 PH children and matched controls. RESULTS RVES RI was increased in children with PH vs. healthy controls (1.45 ± 0.16 vs. 1.16 ± 0.06; p < 0.01; confirmed in the validation cohort). RVES RI was associated with invasive hemodynamic variables, i.e. the mean pulmonary artery pressure. RVES RI values increased with worsening NYHA-FC. The highest RVES RI values were observed in PH children with NYHA FC 3 (1.60 ± 0.12). CONCLUSIONS RVES RI is a useful indicator of RV remodeling and dilation in the setting of increased RV pressure load, especially when the degree of regurgitation of the tricuspid and pulmonary valves is insufficient to numerically estimate RV systolic pressure and mPAP, due to incomplete Doppler envelopes.
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32
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Badano LP, Addetia K, Pontone G, Torlasco C, Lang RM, Parati G, Muraru D. Advanced imaging of right ventricular anatomy and function. Heart 2020; 106:1469-1476. [PMID: 32620556 DOI: 10.1136/heartjnl-2019-315178] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Abstract
Right ventricular (RV) size and function are important predictors of cardiovascular morbidity and mortality in patients with various conditions. However, non-invasive assessment of the RV is a challenging task due to its complex anatomy and location in the chest. Although conventional echocardiography is widely used, its limitations in RV assessment are well recognised. New techniques such as three-dimensional and speckle tracking echocardiography have overcome the limitations of conventional echocardiography allowing a comprehensive, quantitative assessment of RV geometry and function without geometric assumptions. Cardiac magnetic resonance (CMR) and CT provide accurate assessment of RV geometry and function, too. In addition, tissue characterisation imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV that has clinical applications for diagnosis and prognosis in a broad range of cardiac conditions. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. Hybrid imaging, which is able to integrate anatomical information (usually obtained by CT or CMR) with physiological and molecular data (usually obtained with positron emission tomography), can provide optimal in vivo evaluation of Rv functional impairment. This review summarises the clinically useful applications of advanced echocardiography techniques, CMR and CT for comprehensive assessment of RV size, function and mechanics.
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Affiliation(s)
- Luigi P Badano
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy .,Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Denisa Muraru
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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33
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Hahn RT, Waxman AB, Denti P, Delhaas T. Anatomic Relationship of the Complex Tricuspid Valve, Right Ventricle, and Pulmonary Vasculature: A Review. JAMA Cardiol 2020; 4:478-487. [PMID: 30994879 DOI: 10.1001/jamacardio.2019.0535] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Severe functional or secondary tricuspid regurgitation (TR) is associated with poor long-term outcomes in natural history studies as well as specific disease states. An understanding of the physiologic causes of the TR is lacking precluding a systematic approach to treatment. Observations The complex anatomic relationship between the tricuspid valve apparatus and structure of the right side of the heart lends insight into the functional changes seen with secondary TR. The association of these changes with changes in pulmonary vascular hemodynamics can lead to a cascade of events that result in disease progression. Conclusions and Relevance Appreciating the role of pulmonary vascular hemodynamics on right ventricular and tricuspid valve morphology and function improves our understanding of the pathophysiology of secondary TR. The limitations of current therapeutic approaches for secondary TR have stimulated interest in improving outcomes with this morbid disease. Changes in timing or approach to intervention require a more comprehensive understanding of the pathophysiology.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Division of Cardiology/New York Presbyterian Hospital, New York-Presbyterian/Columbia University Medical Center, New York
| | - Aaron B Waxman
- Brigham and Women's Hospital Heart and Vascular and Lung Center, Harvard Medical School, Boston, Massachusetts
| | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | - Tammo Delhaas
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center/Maastricht University, Maastricht, the Netherlands
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Wang L, Chen X, Wan K, Gong C, Li W, Xu Y, Wang J, He J, Wen B, Han Y, Zeng R, Chen Y. Diagnostic and prognostic value of right ventricular eccentricity index in pulmonary artery hypertension. Pulm Circ 2020; 10:2045894019899778. [PMID: 32313641 DOI: 10.1177/2045894019899778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/18/2019] [Indexed: 02/05/2023] Open
Abstract
The right ventricle experiences dynamic changes under pressure overload in pulmonary artery hypertension. This study aimed to evaluate the diagnostic and prognostic value of right ventricular eccentricity index (RVEI) in pulmonary artery hypertension. A total of 100 pulmonary artery hypertension patients (mean age, 36.85 (SD, 13.60) years; males, 30.0%) confirmed by right heart catheterization and 147 healthy volunteers (mean age 45.58 (SD, 17.58) years; males, 42.50%) were enrolled in this prospective study. All participants underwent cardiac magnetic resonance imaging (MRI) examination, and balanced steady-state free precession (bSSFP) cine sequences were acquired. RVEI was measured on short-axis cine images at the mid-ventricular level of the right ventricle in end systole. The study found that RVEI was significantly lower in pulmonary artery hypertension patients than in healthy volunteers (1.84 (SD, 0.40) vs. 2.46 (SD, 0.40); p < 0.001). In pulmonary artery hypertension patients, RVEI was correlated with log(NT-proBNP) (r = -0.388; p < 0.001), right ventricular end-diastolic volume index (r = -0.452; p < 0.001), right ventricular end-systolic volume index (r = -0.518; p < 0.001), and right ventricular ejection fraction (r = 0.552; p < 0.001). RVEI could discriminate pulmonary artery hypertension patients from healthy volunteers with 91.8% sensitivity and 68.0% specificity. Over median follow-up of 14.8 months (interquartile range: 6.7-26.9 months), RVEI was demonstrated to be an independent predictor for adverse outcome (HR = 0.076; 95% CI, 0.013-0.458; p = 0.005). In conclusion, MRI-derived RVEI appears to be a useful diagnostic and prognostic value in pulmonary artery hypertension, and it provides incremental value to risk stratification strategy.
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Affiliation(s)
- Lili Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Xiaoling Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chao Gong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Juan He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Bi Wen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA, USA
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, P. R. China
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Liu BY, Wu WC, Zeng QX, Liu ZH, Niu LL, Tian Y, Luo Q, Zhao ZH, Quan RL, Lin JR, Wang H, He JG, Xiong CM. Comparison of the capability of risk stratification evaluation between two- and three-dimensional speckle-tracking strain in pre-capillary pulmonary hypertension. Pulm Circ 2019; 9:2045894019894525. [PMID: 31908764 PMCID: PMC6935885 DOI: 10.1177/2045894019894525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023] Open
Abstract
To investigate and compare the value of right ventricular longitudinal strain detected by two-dimensional and three-dimensional speckle-tracking echocardiography in risk stratification evaluation in pre-capillary pulmonary hypertension. We consecutively screened 66 patients diagnosed with pre-capillary pulmonary hypertension in our center. According to the risk assessment recommended by 2015 European Society of Cardiology Guidelines, all participants were classified into low- and intermediate-high-risk group. Two-dimensional and three-dimensional strains were measured using off-line softwares (GE EchoPAC version 201 and TomTec, 4D RV Function 2.0). Fifty-seven pre-capillary pulmonary hypertension patients (average 35 years old, 18 males and 39 females) were finally enrolled in our study, 32 (56.1%) were classified in low-risk group, while 25 (43.9%) were in the intermediate-high-risk group. Clinical data associated with disease severity, such as N-terminal pro-brain natriuretic peptide (r = 0.574, P < 0.001), peak oxygen consumption (r = -0.484, P < 0.001), and 6-min walking distance (r = -0.356, P = 0.008) were significantly correlated with two-dimensional right ventricular longitudinal strain; while the correlations with three-dimensional right ventricular longitudinal strain were weaker. Receiver operating characteristic curves for the detection of intermediate-high risk stratification showed two-dimensional right ventricular longitudinal strain had the best predictive capacity (area under curve, 0.82, 95% CI: 0.71-0.93, P < 0.001). Univariate and Multivariate Logistic regression analyses identified two-dimensional right ventricular longitudinal strain as an independent predictor (OR: 1.42, 95% CI: 1.18-1.71, P < 0.001) of intermediate-high risk stratification in this cohort of pre-capillary pulmonary hypertension patients, the predictive capacity retained (OR: 1.45, 95% CI: 1.18-1.78, P < 0.001) after adjusted by age, gender, and body mass index, while three-dimensional speckle-tracking echocardiography parameters were not. In conclusion, when used for the detection of intermediate-high risk stratification in pre-capillary pulmonary hypertension, two-dimensional right ventricular longitudinal strain was better than three-dimensional right ventricular longitudinal strain.
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Affiliation(s)
- Bing-Yang Liu
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Qi-Xian Zeng
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Zhi-Hong Liu
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Li-Li Niu
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Yue Tian
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Qin Luo
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Zhi-Hui Zhao
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Rui-Lin Quan
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Jing-Ru Lin
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Jian-Guo He
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Chang-Ming Xiong
- Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
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36
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Liu BY, Wu WC, Zeng QX, Liu ZH, Niu LL, Tian Y, Luo Q, Zhao ZH, Quan RL, Lin JR, Wang H, He JG, Xiong CM. The value of three-dimensional echocardiography in risk stratification in pulmonary arterial hypertension: a cross-sectional study. Int J Cardiovasc Imaging 2019; 36:577-584. [PMID: 31853819 DOI: 10.1007/s10554-019-01743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
To explore the value of right ventricular (RV) parameters detected by three-dimensional echocardiography (3DE) in risk stratification in pulmonary arterial hypertension (PAH) patients. We prospectively recruited 130 pulmonary hypertension patients from National Center for Cardiovascular Diseases, Fuwai Hospital. Each participant was performed a transthoracic echocardiography and 3DE parameters were measured using an off-line software (4D RV Function 2.0, TomTec). Patients were classified into low, intermediate-high risk group based on 2015 ESC Guidelines. A total of 91 PAH patients (34 ± 12 years old, 25 males) were enrolled, among which, 42 were classified into low risk group, while 49 were intermediate-high risk group. Compared with low-risk patients, those with intermediate-high risk had significantly larger 3DE-RV volumes, worse ejection fraction (EF) and tricuspid annular plane systolic excursion, and decreased longitudinal strain (LS). Receive operating characteristic curves illustrated all the 3DE parameters were able to predict intermediate-high risk stratification, especially 3D-RVEF (area under curve, 0.82, 95% CI 0.73-0.91, P < 0.001). And 3D-RVEF < 26.39% had a 81.6% sensibility and 73.8% specificity to predict intermediate-high risk stratification. Univariate and multivariate Logistic regression analyses identified 3D-RV end-diastolic (OR 1.02, 95% CI 1.01-1.03, P = 0.002) and end-systolic (OR 1.03, 95% CI 1.01-1.04, P < 0.001) volumes, 3D-RVEF (OR 0.82, 95% CI 0.75-0.90, P < 0.001) and LS of free wall (OR 1.17, 95% CI 1.05-1.31, P = 0.005) as independent predictors of intermediate-high risk stratification. In conclusion, RV volumes, EF and free wall strain detected by 3DE were independent predictors of intermediate-high risk stratification in PAH patients, among which, RVEF showed the best predictive capacity.
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Affiliation(s)
- Bing-Yang Liu
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Wei-Chun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Qi-Xian Zeng
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Zhi-Hong Liu
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Li-Li Niu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yue Tian
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Qin Luo
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Zhi-Hui Zhao
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Rui-Lin Quan
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Jing-Ru Lin
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Hao Wang
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jian-Guo He
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Chang-Ming Xiong
- Department of Cardiology, Pulmonary Vascular Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
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Lang RM, Addetia K, Narang A, Mor-Avi V. 3-Dimensional Echocardiography: Latest Developments and Future Directions. JACC Cardiovasc Imaging 2019; 11:1854-1878. [PMID: 30522687 DOI: 10.1016/j.jcmg.2018.06.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 01/03/2023]
Abstract
The ongoing refinements in 3-dimensional (3D) echocardiography technology continue to expand the scope of this imaging modality in clinical cardiology by offering new features that stem from the ability to image the heart in its complete dimensionality. Over the years, countless publications have described these benefits and tested new frontiers where 3D echocardiographic imaging seemed to offer promising ways to improve patients' care. These include improved techniques for chamber quantification and novel ways to visualize cardiac valves, including 3D printing, virtual reality, and holography. The aims of this review article are to focus on the most important developments in the field in the recent years, discuss the current utility of 3D echocardiography, and highlight several interesting future directions.
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Affiliation(s)
- Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Akhil Narang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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38
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Kawakubo M, Nagao M, Ishizaki U, Shiina Y, Inai K, Yamasaki Y, Yoneyama M, Sakai S. Feature-Tracking MRI Fractal Analysis of Right Ventricular Remodeling in Adults with Congenitally Corrected Transposition of the Great Arteries. Radiol Cardiothorac Imaging 2019; 1:e190026. [PMID: 33778517 DOI: 10.1148/ryct.2019190026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Abstract
Purpose To assess a recently available technique for quantification of right ventricular (RV) trabeculae that is based on fractal analysis performed by using cardiac MRI feature tracking, in patients with congenitally corrected transposition of the great arteries (cc-TGA). Materials and Methods A total of 19 patients (eight men, 11 women; mean age, 35 years ± 10 [standard deviation]) with consecutive cc-TGA who underwent cardiac MRI were enrolled in the study. For analysis, patients were divided into two groups: six patients (four men, two women; mean age, 34 years ± 14) with an end-systolic RV volume index higher than 72 mL/m2 (indicative of adverse RV remodeling) and 13 patients (four men, nine women; mean age, 36 years ± 9) in whom this index was lower than or equal to 72 mL/m2 (indicative of adapted RV). The following outcomes were quantified in the midsection of the RV: fractional fractal dimension (FD) and diastolic FD, circumferential strain, and radial strain. Receiver operating characteristic (ROC) analysis was performed to determine the cutoff FD values for the detection of adverse RV remodeling. Correlations among fractional FD, diastolic FD, circumferential strain, and radial strain were calculated by using Pearson correlation coefficient (r) analysis. Results The following ROC values were identified for fractional and diastolic FD: cutoff, 0.09 and 1.39, respectively; area under the ROC curve, 0.95 and 0.68, respectively; sensitivity, 1.00 and 0.33, respectively; and specificity, 0.92 and 1.00, respectively. Fractional FD correlated with circumferential strain and radial strain (r = -0.70 and 0.69, respectively; P < .01), as did diastolic FD (r = 0.37 and -0.38, respectively; P < .05). Conclusion The fractional FD derived from cardiac MRI feature-tracking analysis correlates with adverse RV remodeling, including a changed strain pattern and trabeculae, in patients with cc-TGA.© RSNA, 2019.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Michinobu Nagao
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Umiko Ishizaki
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Yumi Shiina
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Kei Inai
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Yuzo Yamasaki
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Masami Yoneyama
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
| | - Shuji Sakai
- Department of Health Sciences, Faculty of Medical Sciences (M.K.), and Department of Clinical Radiology, Graduate School of Medical Sciences (Y.Y.), Kyushu University, Fukuoka, Japan; Department of Diagnostic Imaging and Nuclear Medicine (M.N., U.I., S.S.) and Department of Pediatric Cardiology and Adult Congenital Cardiology (Y.S., K.I.), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; and Philips Japan, Tokyo, Japan (M.Y.)
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Chowdhury MA, Moukarbel GV, Gupta R, Frank SM, Anderson AM, Liu LC, Khouri SJ. Endothelin 1 Is Associated with Heart Failure Hospitalization and Long-Term Mortality in Patients with Heart Failure with Preserved Ejection Fraction and Pulmonary Hypertension. Cardiology 2019; 143:124-133. [PMID: 31514181 DOI: 10.1159/000501100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is increasing. We aim to study the role of big endothelin 1 (Big ET1), endothelin 1 (ET1), and neprilysin (NE) in HFpEF with PH. METHOD This was a single center prospective cohort study including 90 HFpEF patients; 30 with no PH, 30 with postcapillary PH, and 30 with combined post- and precapillary PH. After enrollment, pulmonary venous and pulmonary arterial samples of Big ET1, ET1, and NE were collected during right heart catheterization. Subjects were then followed long term for adverse outcomes which included echocardiographic evidence of right ventricular dysfunction, heart failure hospitalization, and all-cause mortality. RESULTS Patients with HFpEF-PH were found to have increased ET1 in pulmonary veins (endothelin from the wedge; ET1W) compared to controls (2.3 ± 1.4 and 1.6 ± 0.9 pg/mL, respectively). ET1W levels were associated with both PH (OR 2.7, 95% CI 1.5-4.7, p = 0.01) and pulmonary vascular resistance (OR 1.6, 95% CI 1.04-2.3, p = 0.03). No evidence of right ventricular dysfunction was observed after 1 year of follow-up. ET1W (OR 1.8, 95% CI 1.2-2.6, p = 0.01) and ET1 gradient (ET1G; OR 1.4, 95% CI 1.04-2, p = 0.03) were predictive of 1-year hospitalization. ET1G ≥0.2 pg/mL was associated with long-term mortality (log-rank 4.8, p = 0.03). CONCLUSION In HFpEF patients, ET1W and ET1G are predictive of 1-year heart failure hospitalization, while elevated ET1G levels were found to be associated with long-term mortality in HFpEF. This study highlights the role of ET1 in developing PH in HFpEF patients and also explores the potential of ET1 as a prognostic biomarker.
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Affiliation(s)
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Stephanie Marie Frank
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ann M Anderson
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Lijun C Liu
- Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Samer J Khouri
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA,
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40
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Bashline MJ, Simon MA. Use of Tricuspid Annular Plane Systolic Excursion/Pulmonary Artery Systolic Pressure As a Non-Invasive Method to Assess Right Ventricular-PA Coupling in Patients With Pulmonary Hypertension. Circ Cardiovasc Imaging 2019; 12:e009648. [PMID: 31500450 DOI: 10.1161/circimaging.119.009648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Michael J Bashline
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pennsylvania (M.J.B., M.A.S.)
| | - Marc A Simon
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pennsylvania (M.J.B., M.A.S.).,Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh and University of Pittsburgh Medical Center, Pennsylvania (M.A.S.)
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41
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Addetia K, Muraru D, Badano LP, Lang RM. New Directions in Right Ventricular Assessment Using 3-Dimensional Echocardiography. JAMA Cardiol 2019; 4:936-944. [DOI: 10.1001/jamacardio.2019.2424] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Karima Addetia
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano–Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS San Luca Hospital, Milan, Italy
| | - Luigi P. Badano
- Department of Medicine and Surgery, University of Milano–Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS San Luca Hospital, Milan, Italy
| | - Roberto M. Lang
- Section of Cardiology, Department of Medicine, The University of Chicago, Chicago, Illinois
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Guazzi M. Use of TAPSE/PASP ratio in pulmonary arterial hypertension: An easy shortcut in a congested road. Int J Cardiol 2019; 266:242-244. [PMID: 29887455 DOI: 10.1016/j.ijcard.2018.04.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Marco Guazzi
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Piazza E. Malan 1, San Donato Milanese, 20097 Milan, Italy; Department of Cardiology University, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy.
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43
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Cordina RL, Playford D, Lang I, Celermajer DS. State-of-the-Art Review: Echocardiography in Pulmonary Hypertension. Heart Lung Circ 2019; 28:1351-1364. [PMID: 31109891 DOI: 10.1016/j.hlc.2019.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 02/01/2023]
Abstract
Pulmonary hypertension is a progressive and often fatal disease that frequently presents with dyspnoea on exertion and results in increased right ventricular afterload and right ventricular failure. Although cardiac catheterisation is required for a formal diagnosis, transthoracic echocardiography (TTE) has a central role as a screening tool in those with symptoms and those at risk for developing pulmonary vascular disease. Echocardiographic techniques can be employed to estimate pulmonary artery pressure and resistance, right atrial pressure as well as to derive indirect information about right heart structure and function. Potential causes for pulmonary hypertension may also be identified such as congenital heart disease or left ventricular diastolic dysfunction. An increasing body of evidence has demonstrated the important prognostic utility of echocardiographic data in pulmonary hypertension and highlighted the potential for TTE to help clinicians understand whether treatment responses have been adequate or an escalation in therapy is necessary, as therapeutic options continue to expand for patients with pulmonary arterial hypertension. Although traditional echocardiographic techniques only allow surrogate measures of right ventricular systolic function due to the complex shape of the chamber, newer techniques have enabled three-dimensional assessment of the right ventricle to assess right ventricular volume and contractility. This review will discuss traditional methods as well as newer echocardiographic methods in the setting of pulmonary hypertension.
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Affiliation(s)
- Rachael L Cordina
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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44
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Right ventricular load adaptability metrics in patients undergoing left ventricular assist device implantation. J Thorac Cardiovasc Surg 2019; 157:1023-1033.e4. [DOI: 10.1016/j.jtcvs.2018.08.095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 11/21/2022]
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Moceri P, Duchateau N, Baudouy D, Schouver ED, Leroy S, Squara F, Ferrari E, Sermesant M. Three-dimensional right-ventricular regional deformation and survival in pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2019. [PMID: 28637308 DOI: 10.1093/ehjci/jex163] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Survival in pulmonary hypertension (PH) relates to right ventricular (RV) function. However, the RV unique anatomy and structure limit 2D analysis and its regional 3D function has not been studied yet. The aim of this study was to assess the implications of global and regional 3D RV deformation on clinical condition and survival in adults with PH and healthy controls. Methods and results We collected a prospective longitudinal cohort of 104 consecutive PH patients and 34 healthy controls between September 2014 and December 2015. Acquired 3D transthoracic RV echocardiographic sequences were analysed by semi-automatic software (TomTec 4D RV-Function 2.0). Output meshes were post-processed to extract regional motion and deformation. Global and regional statistics provided deformation patterns for each subgroup of subjects. RV lateral and inferior regions showed the highest deformation. In PH patients, RV global and regional motion and deformation [both circumferential, longitudinal, and area strain (AS)] were affected in all segments (P < 0.001 against healthy controls). Deformation patterns gradually worsened with the clinical condition. Over 6.7 [5.8-7.2] months follow-up, 16 (15.4%) patients died from cardio-pulmonary causes. Right atrial pressure, global RV AS, tricuspid annular plane systolic excursion, 3D RV ejection fraction, and end-diastolic volume were independent predictors of survival. Global RV AS > -18% was the most powerful RV function parameter, identifying patients with a 48%-increased risk of death (AUC 0.83 [0.74-0.90], P < 0.001). Conclusion Right ventricular strain patterns gradually worsen in PH patients and provide independent prognostic information in this population.
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Affiliation(s)
- Pamela Moceri
- Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France.,Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.,Faculté de médecine, Université Côte d'Azur, 28 avenue Valombrose 06107 NICE, France
| | - Nicolas Duchateau
- Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France
| | - Delphine Baudouy
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France
| | - Elie-Dan Schouver
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.,Faculté de médecine, Université Côte d'Azur, 28 avenue Valombrose 06107 NICE, France
| | - Sylvie Leroy
- Department of Pneumology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France
| | - Fabien Squara
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France
| | - Emile Ferrari
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Avenue de la voie romaine, CS 51069, 06001 Nice, France.,Faculté de médecine, Université Côte d'Azur, 28 avenue Valombrose 06107 NICE, France
| | - Maxime Sermesant
- Université Côte d'Azur, Inria Asclepios Research Project, 2004 route des Lucioles - BP 93, 06902 Sophia Antipolis, France
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Tamborini G, Cefalù C, Celeste F, Fusini L, Garlaschè A, Muratori M, Ghulam Ali S, Gripari P, Berna G, Pepi M. Multi-parametric "on board" evaluation of right ventricular function using three-dimensional echocardiography: feasibility and comparison to traditional two-and three dimensional echocardiographic measurements. Int J Cardiovasc Imaging 2018; 35:275-284. [PMID: 30430329 DOI: 10.1007/s10554-018-1496-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/02/2018] [Indexed: 12/01/2022]
Abstract
Three-dimensional echocardiographic (3DE) of right ventricle (RV) has been validated in many clinical settings. However, the necessity of complicated and off-line dedicated software has reduced its diffusion. A new simplified "on board" 3DE software (OB) has been developed to obtain RV volumes and ejection fraction (EF) together with several conventional parameters automatically derived from 3DE: tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS). Aims of this study were to evaluate feasibility and accuracy of OB RV analysis. A complete 2DE and 3DE with OB 3DRV evaluation was obtained in 35 normal subjects and 105 patients with different pathologies. Results were compared with the conventional off-line software (OFL) and with the 2D-derived corresponding values. A subgroup of 22 patients underwent also cardiac CMR. OB 3DRV was feasible in 133/140 cases (95%) in a mean time of 97.5 ± 33 s lower than OFL analysis (129 ± 52 s plus dataset loading 80 ± 24 s). Imaging quality was good in 84%. OB and OFL 3DE RV volumes and EF were similar. 3DE derived FSA and LS (but not TAPSE) were similar to 2DE values and correlated with tissue Doppler systolic peak velocity, dP/dt, systolic pulmonary pressure and myocardial performance index. OB RV volumes and EF well correlated with CMR. (bias + SD: - 21.5 ± 20 mL for EDV; - 8.2 ± 12.4 mL for ESV; - 1 ± 5.9% for EF). OB 3DE method is feasible, simple, time saving. It easily provides 3DE RV volumes and multiple functional parameters. Off-line operator border adjustment may improve accuracy of 3DE TAPSE.
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Affiliation(s)
- Gloria Tamborini
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy.
| | - Claudia Cefalù
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Fabrizio Celeste
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Anna Garlaschè
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Sarah Ghulam Ali
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Giovanni Berna
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy
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Cavalcante JL, Simon MA, Chan SY. Comprehensive Right-Sided Assessment for Transcatheter Aortic Valve Replacement Risk Stratification: Time for a Change. J Am Soc Echocardiogr 2018; 30:47-51. [PMID: 28063482 DOI: 10.1016/j.echo.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- João L Cavalcante
- Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh/UPMC, Pittsburgh, Pennsylvania.
| | - Marc A Simon
- Division of Cardiology, Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Y Chan
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Amsallem M, Mercier O, Kobayashi Y, Moneghetti K, Haddad F. Forgotten No More: A Focused Update on the Right Ventricle in Cardiovascular Disease. JACC-HEART FAILURE 2018; 6:891-903. [PMID: 30316939 DOI: 10.1016/j.jchf.2018.05.022] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022]
Abstract
In the last decade, there has been renewed interest in the study of the right ventricle. It is now well established that right ventricular function is a strong predictor of mortality, not only in heart failure but also in pulmonary hypertension, congenital heart disease, and cardiothoracic surgery. The right ventricle is part of a cardiopulmonary unit with connections to the pulmonary circulation, venous return, atria, and left ventricle. In this context, ventriculoarterial coupling, interventricular interactions, and pericardial constraint become important to understand right ventricular adaptation to injury or abnormal loading conditions. This state-of-the-art review summarizes major advances that occurred in the field of right ventricular research over the last decade. The first section focuses on right ventricular physiology and pulmonary circulation. The second section discusses the emerging data on right ventricular phenotyping, highlighting the importance of myocardial deformation (strain) imaging and assessment of end-systolic dimensions. The third section reviews recent clinical trials involving patients at risk for or with established right ventricular failure, focusing on beta blockade, phosphodiesterase inhibition, and mechanical support of the failing right heart. The final section presents a perspective on active areas of research that are most likely to translate in clinical practice in the next decade.
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Affiliation(s)
- Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California; Vera Moulton Wall Center at Stanford, Stanford, California; Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Olaf Mercier
- Research and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, Le Plessis Robinson, France; Department of Cardiothoracic Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | - Kegan Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California; Vera Moulton Wall Center at Stanford, Stanford, California.
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D'Arsigny CL, Archer SL. A Step Closer to Understanding How Riociguat Results in Remodelling of the Right Ventricle in Chronic Thromboembolic Pulmonary Hypertension. Can J Cardiol 2018; 34:1098-1101. [PMID: 30170664 DOI: 10.1016/j.cjca.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christine L D'Arsigny
- Department of Medicine, Queen's University, Kingston, Ontario, Canada, and Queen's Cardiopulmonary Unit (QCPU), Department of Medicine, Queen's University, Kingston, Ontario, Canada. christine.d'
| | - Stephen L Archer
- Department of Medicine, Queen's University, Kingston, Ontario, Canada, and Queen's Cardiopulmonary Unit (QCPU), Department of Medicine, Queen's University, Kingston, Ontario, Canada
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50
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Dong Y, Sun J, Yang D, He J, Cheng W, Wan K, Liu H, Greiser A, Zhou X, Han Y, Chen Y. Right ventricular septomarginal trabeculation hypertrophy is associated with disease severity in patients with pulmonary arterial hypertension. Int J Cardiovasc Imaging 2018; 34:1439-1449. [DOI: 10.1007/s10554-018-1347-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/28/2018] [Indexed: 12/15/2022]
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