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Keskin B, Karagoz A, Hakgor A, Kultursay B, Tanyeri S, Tokgoz HC, Kulahcioglu S, Tosun A, Bulus C, Sekban A, Tanboga IH, Ozdemir N, Kaymaz C. A novel method for the evaluation of right ventricular dysfunction in acute pulmonary embolism: Myocardial work indices. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38760961 DOI: 10.1002/jcu.23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE The presence of right ventricular dysfunction indicates a higher risk status in patients with pulmonary embolism (PE). The RV strain evaluated by speckle-tracking echocardiography seems to be more reliable method in the evaluation of RV dysfunction as compared to standard echocardiographic measures. In this study, we aimed to determine the value of myocardial-work indices in evaluating serial changes of RV function in acute PE. METHODS Our study comprised 83 consecutive acute PE patients who admitted to our tertiary cardiovascular hospital. Echocardiography was performed within the first 24-hours of hospitalization, and RV and LV myocardial-work parameters were obtained along with standard echocardiographic parameters. The change in the RV/LVr detected on tomography was selected as the primary outcome measure, and its' predictors were analyzed with classical linear regression and a generalized additive model (GAM). RESULTS Among the LV-RV strain and myocardial work parameters, the RV global longitudinal strain (GLS) has borderline statistical significance in predicting the RV/LVr change whereas the RV global work efficiency (RV-GWE) strongly predicted RV/LVr change (p: 0.049 and <0.001, respectively). CONCLUSION In this study, classical linear regression and GAM analyses showed that RV-GWE seems to offer a better prediction of RV/LVr change in patients with acute PE.
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Affiliation(s)
- Berhan Keskin
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Turkey
| | - Ali Karagoz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | | | - Barkın Kultursay
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Seda Tanyeri
- Department of Cardiology, Kocaeli City Hospital, Kocaeli, Turkey
| | - Hacer Ceren Tokgoz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Seyhmus Kulahcioglu
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ayhan Tosun
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cagdas Bulus
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Sekban
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim H Tanboga
- Department of Cardiology, Nisantası University, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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2
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Dissabandara T, Lin K, Forwood M, Sun J. Validating real-time three-dimensional echocardiography against cardiac magnetic resonance, for the determination of ventricular mass, volume and ejection fraction: a meta-analysis. Clin Res Cardiol 2024; 113:367-392. [PMID: 37079054 PMCID: PMC10881629 DOI: 10.1007/s00392-023-02204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Real-time three-dimensional echocardiography (RT3DE) is currently being developed to overcome the challenges of two-dimensional echocardiography, as it is a much cheaper alternative to the gold standard imaging method, cardiac magnetic resonance (CMR). The aim of this meta-analysis is to validate RT3DE by comparing it to CMR, to ascertain whether it is a practical imaging method for routine clinical use. METHODS A systematic review and meta-analysis method was used to synthesise the evidence and studies published between 2000 and 2021 were searched using a PRISMA approach. Study outcomes included left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left ventricular mass (LVM), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV) and right ventricular ejection fraction (RVEF). Subgroup analysis included study quality (high, moderate), disease outcomes (disease, healthy and disease), age group (50 years old and under, over 50 years), imaging plane (biplane, multiplane) and publication year (2010 and earlier, after 2010) to determine whether they explained the heterogeneity and significant difference results generated on RT3DE compared to CMR. RESULTS The pooled mean differences for were - 5.064 (95% CI - 10.132, 0.004, p > 0.05), 4.654 (95% CI - 4.947, 14.255, p > 0.05), - 0.783 (95% CI - 5.630, 4.065, p > 0.05, - 0.200 (95% CI - 1.215, 0.815, p > 0.05) for LVEF, LVM, RVESV and RVEF, respectively. We found no significant difference between RT3DE and CMR for these variables. Although, there was a significant difference between RT3DE and CMR for LVESV, LVEDV and RVEDV where RT3DE reports a lower value. Subgroup analysis indicated a significant difference between RT3DE and CMR for studies with participants with an average age of over 50 years but no significant difference for those under 50. In addition, a significant difference between RT3DE and CMR was found in studies using only participants with cardiovascular diseases but not in those using a combination of diseased and healthy participants. Furthermore, for the variables LVESV and LVEDV, the multiplane method shows no significant difference between RT3DE and CMR, as opposed to the biplane showing a significant difference. This potentially indicates that increased age, the presence of cardiovascular disease and the biplane analysis method decrease its concordance with CMR. CONCLUSION This meta-analysis indicates promising results for the use of RT3DE, with limited difference to CMR. Although in some cases, RT3DE appears to underestimate volume, ejection fraction and mass when compared to CMR. Further research is required in terms of imaging method and technology to validate RT3DE for routine clinical use.
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Affiliation(s)
- Thilini Dissabandara
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, Australia
| | - Kelly Lin
- Schools of Medicine and Dentistry, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Mark Forwood
- School of Pharmacy and Medical Science, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jing Sun
- Schools of Medicine and Dentistry, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
- Institute for Integrated Intelligence and Systems, Griffith University, Brisbane, Australia.
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De Bosscher R, Claeys M, Dausin C, Goetschalckx K, Claus P, Herbots L, Ghekiere O, Van De Heyning C, Paelinck BP, Janssens K, Wright L, Flannery MD, La Gerche A, Willems R, Heidbuchel H, Bogaert J, Claessen G. Three-dimensional echocardiography of the athlete's heart: a comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2023; 39:295-306. [PMID: 36151432 DOI: 10.1007/s10554-022-02726-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023]
Abstract
Three-dimensional echocardiography (3DE) is the most accurate cardiac ultrasound technique to assess cardiac structure. 3DE has shown close correlation with cardiac magnetic resonance imaging (CMR) in various populations. There is limited data on the accuracy of 3DE in athletes and its value in detecting alterations during follow-up. Indexed left and right ventricular end-diastolic volume (LVEDVi, RVEDVi), end-systolic volume, ejection fraction (LVEF, RVEF) and left ventricular mass (LVMi) were assessed by 3DE and CMR in two-hundred and one competitive endurance athletes (79% male) from the Pro@Heart trial. Sixty-four athletes were assessed at 2 year follow-up. Linear regression and Bland-Altman analyses compared 3DE and CMR at baseline and follow-up. Interquartile analysis evaluated the agreement as cardiac volumes and mass increase. 3DE showed strong correlation with CMR (LVEDVi r = 0.91, LVEF r = 0.85, LVMi r = 0.84, RVEDVi r = 0.84, RVEF r = 0.86 p < 0.001). At follow up, the percentage change by 3DE and CMR were similar (∆LVEDVi r = 0.96 bias - 0.3%, ∆LVEF r = 0.94, bias 0.7%, ∆LVMi r = 0.94 bias 0.8%, ∆RVESVi r = 0.93, bias 1.2%, ∆RVEF r = 0.87 bias 0.4%). 3DE underestimated volumes (LVEDVi bias - 18.5 mL/m2, RVEDVi bias - 25.5 mL/m2) and the degree of underestimation increased with larger dimensions (Q1vsQ4 LVEDVi relative bias - 14.5 versus - 17.4%, p = 0.016; Q1vsQ4 RVEDVi relative bias - 17 versus - 21.9%, p = 0.005). Measurements of cardiac volumes, mass and function by 3DE correlate well with CMR and 3DE accurately detects changes over time. 3DE underestimates volumes and the relative bias increases with larger cardiac size.
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Affiliation(s)
- Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. .,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium. .,Department of Cardiovascular Medicine, University Hospitals Leuven, B-3000, Leuven, Belgium.
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Herbots
- Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium.,REVAL/BIOMED, Hasselt University, Diepenbeek, Belgium
| | - Olivier Ghekiere
- REVAL/BIOMED, Hasselt University, Diepenbeek, Belgium.,Department of Radiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Caroline Van De Heyning
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Bernard P Paelinck
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Kristel Janssens
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Leah Wright
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Heidbuchel
- Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium.,Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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4
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Farrell C, Balasubramanian A, Hays AG, Hsu S, Rowe S, Zimmerman SL, Hassoun PM, Mathai SC, Mukherjee M. A Clinical Approach to Multimodality Imaging in Pulmonary Hypertension. Front Cardiovasc Med 2022; 8:794706. [PMID: 35118142 PMCID: PMC8804287 DOI: 10.3389/fcvm.2021.794706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50-70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.
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Affiliation(s)
- Christine Farrell
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Rowe
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Stefan L. Zimmerman
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M. Hassoun
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
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5
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Hamdy RM, Habib SA, Mohamed LA, Abd Elaziz OH. The Usefulness of 4D Echocardiographic Modality for Assessing RV Affection in Uncontrolled Hypertensive Patients. J Cardiovasc Imaging 2022; 30:279-289. [PMID: 36280269 PMCID: PMC9592253 DOI: 10.4250/jcvi.2021.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/08/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In many cardiovascular disorders, the contractile performance of the right ventricle (RV) is the primary determinant of prognosis. For evaluating RV volumes and function, 4 dimensional (4D)-echocardiography has become common. This research used 2D and 4D modalities to assess RV contractile performance in hypertensive patients. METHODS A total of 150 patients with essential hypertension were enrolled in this study, along with 75 age and sex-matched volunteers. Clinical evaluation and echocardiographic examination (including M-mode, tissue Doppler imaging, and 2D speckle tracking) were conducted on all participants. RV volumes, 4D-ejection fraction (EF), 4D-fractional area change (FAC), 4D-tricuspid annular plane systolic excursion (TAPSE), 4D-septal and free wall (FW) strain were all measured using 4D-echocardiography. RESULTS Hypertensive patients showed 2D-RV systolic and diastolic dysfunction (including TAPSE, 2D-right ventricular global longitudinal strain, RV-myocardial performance index and average E/EaRV) and 4D-RV impairment (including right ventricular EF, FAC, RV strain and TAPSE, right ventricular end-diastolic volume and right ventricular end-systolic volume) compared to the control group. We verified the prevalence of RV systolic dysfunction in hypertension patients using the following parameters: 1) 15% of them had 2D-TAPSE < 17 mm vs. 40% by 4D-TAPSE; 2) 25% of them had 2D-GLS < 19% vs. 42% by 4D-septal strain and 35% by 4D FW strain; 3) 35% of hypertensive patients had 4D-EF < 45%; and finally; 4) 25% of hypertensive patients had 2D-FAC < 35% compared to 45% by 4D-FAC. CONCLUSIONS The incidence of RV involvement was greater in 4D than in 2D-modality trans-thoracic echocardiography. We speculated that 4D-echocardiography with 4D-strain imaging would be more beneficial for examining RV morphology and function in hypertensive patients than 2D-echocardiography, since 4D-echocardiography could estimate RV volumes and function without making geometric assumptions.
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Affiliation(s)
- Rehab M. Hamdy
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Shaimaa A Habib
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Layla A Mohamed
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Ola H. Abd Elaziz
- Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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6
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Li Y, Liang L, Guo D, Yang Y, Gong J, Zhang X, Zhang D, Jiang Z, Lu X. Right Ventricular Function Predicts Adverse Clinical Outcomes in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study. Front Med (Lausanne) 2021; 8:697396. [PMID: 34497813 PMCID: PMC8419302 DOI: 10.3389/fmed.2021.697396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 01/29/2023] Open
Abstract
Background: Right ventricular (RV) function plays a vital role in the prognosis of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We used new machine learning (ML)-based fully automated software to quantify RV function using three-dimensional echocardiography (3DE) to predict adverse clinical outcomes in CTEPH patients. Methods: A total of 151 consecutive CTEPH patients were registered in this prospective study between April 2015 and July 2019. New ML-based methods were used for data management, and quantitative analysis of RV volume and ejection fraction (RVEF) was performed offline. RV structural and functional parameters were recorded using 3DE. CTEPH was diagnosed using right heart catheterization, and 62 patients underwent cardiac magnetic resonance to assess right heart function. Adverse clinical outcomes were defined as PH-related hospitalization with hemoptysis or increased RV failure, including conditions requiring balloon pulmonary angioplasty or pulmonary endarterectomy, as well as death. Results: The median follow-up time was 19.7 months (interquartile range, 0.5–54 months). Among the 151 CTEPH patients, 72 experienced adverse clinical outcomes. Multivariate Cox proportional-hazard analysis showed that ML-based 3DE analysis of RVEF was a predictor of adverse clinical outcomes (hazard ratio, 1.576; 95% confidence interval (CI), 1.046~2.372; P = 0.030). Conclusions: The new ML-based 3DE algorithm is a promising technique for rapid 3D quantification of RV function in CTEPH patients.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Clinical Epidemiology & Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dichen Guo
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juanni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xinyuan Zhang
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Di Zhang
- Clinical Epidemiology & Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhe Jiang
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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7
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Mandoli GE, De Carli G, Pastore MC, Cameli P, Contorni F, D'Alessandro M, Bargagli E, Mondillo S, Cameli M. Right cardiac involvement in lung diseases: a multimodality approach from diagnosis to prognostication. J Intern Med 2021; 289:440-449. [PMID: 32996153 DOI: 10.1111/joim.13179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 02/04/2023]
Abstract
Lung diseases are amongst the main healthcare issues in the general population, having a high burden of morbidity and mortality. The cardiovascular system has a key role in patients affected by respiratory disorders. More specifically, the right ventricle (RV) enables the impaired lung function to be overcome in an initial stage of disease process, reducing the severity of dyspnoea. In addition, two of the main causes of death in this setting are RV failure and sudden cardiac death (SCD). Echocardiography is regarded as a useful and easily available tool in assessing RV function. Several noninvasive echocardiographic parameters of elevated pulmonary pressures and RV function have been proposed. The combination of different parameters and imaging methods is paramount and researches regarding RV impairment using these indices has been specifically addressed in relation to the chronic obstructive and restrictive lung disease in order to guide the clinicians in the management of these patients. Cardiac involvement in lung diseases is often observed, and RV changes are reported also in early stages of pulmonary diseases. The role of right ventricle in chronic respiratory disease patients has to be evaluated in detail to describe the response to therapy and the degree of disease progression through multimodality and advanced imaging techniques. The aim of this review is to describe the different pathophysiological mechanisms of cardiac impairment in primary lung disease (such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF) and sarcoidosis) and to summarize the role of cardiac multimodality imaging in the diagnosis and the prognosis of these diseases.
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Affiliation(s)
- G E Mandoli
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - G De Carli
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M C Pastore
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - P Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - F Contorni
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M D'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - E Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - S Mondillo
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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8
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Saidova MA, Loskutova AS, Belevskaya AA, Stukalova OV. [The assessment of right ventricular structure and function in patients with different cardiovascular diseases using modern echocardiographic technologies and magnetic resonance imaging]. TERAPEVT ARKH 2020; 92:24-29. [PMID: 33346427 DOI: 10.26442/00403660.2020.09.000507] [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: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
AIM To perform comparative analysis of right ventricular (RV) structure and function in patients with various cardiovascular diseases using modern echocardiographic technologies in comparison with magnetic resonance imaging (MRI). MATERIALS AND METHODS The study included 85 patients. Group 1 consisted of 32 patients with idiopathic pulmonary hypertension (IPH) (mean age 35.910.2 years). Group 2 included 27 patients with arterial hypertension (AH) grade 3 (mean age 58.612.3 years). Group 3 consisted of 26 patients with chronic heart failure (CHF) (mean age 56.115.3 years). Control group included 28 healthy volunteers (mean age 38.710.9 years). The main method was transthoracic echocardiography (TTE) using modern technologies, such as three-dimensional echocardiography (3DE), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). In some patients and healthy volunteers 3DE data were compared with MRI data. RESULTS Patients with IPH and CHF had minimal RV ejection fraction (EF) both according to 3DE and MRI. Correlation analysis revealed close correlation between RV volumes and EF according to 3DE and MRI. Minimal values of systolic indicator STV according to TDI were observed in patients with CHF. In all groups, including control group, the highest values of STV were obtained at the level of the basal segments and the lowest values at the level of apical segments. STE revealed the same pattern as TDI. According to STE minimal RV strain was observed in IPH and CHF groups and significantly differed not only from control group, but also from AH group. CONCLUSION The lowest values of RV EF and strain were observed in IPH and CHF groups. There were no significant differences in these indicators between the groups, that dictates the need for thorough assessment of RV structure and function not only in patients with precapillary, but also with postcapillary pulmonary hypertension. The results of the study confirm good comparability of 3DE and MRI in assessing RV volumes and EF.
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Affiliation(s)
- M A Saidova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | | | - A A Belevskaya
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
| | - O V Stukalova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center for Cardiology
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9
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Zhou F, Niu L, Zhao M, Ni WX, Liu J. Real-time three-dimensional echocardiography predicts cardiotoxicity induced by postoperative chemotherapy in breast cancer patients. World J Clin Cases 2020; 8:2542-2553. [PMID: 32607331 PMCID: PMC7322441 DOI: 10.12998/wjcc.v8.i12.2542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/01/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The anthracycline chemotherapeutic drugs are cardiotoxic. Studies have found some indicators related to cardiotoxicity. However, there is currently no accurate indicator that can predict cardiac toxicity early.
AIM To explore the diagnostic value of real-time three-dimensional echocardiography (RT3DE) in predicting cardiac toxicity in breast cancer patients undergoing chemotherapy.
METHODS Female breast cancer patients who underwent radical mastectomy and postoperative chemotherapy at the Affiliated Hanzhou First People’s Hospital, Zhejiang University School of Medicine were recruited. All patients were routinely administered with chemotherapy for four cycles (T1-T4) after surgery. Two-dimensional (2D) echocardiography, RT3DE, and serological examinations were performed after each cycle of chemotherapy. Patients were divided into a toxic group and a non-toxic group based on whether patients had Δ left ventricular ejection fraction > 10% after one year of chemotherapy. Repeated measurement analysis of variance was used to compare the changes in 2D echocardiographic indicators, serological indicators, and RT3DE indicators before and after chemotherapy. Multivariate logistic regression was used to identify independent predictive indicators for cardiac toxicity in postoperative chemotherapy patients. Receiver operating characteristics (ROC) curve analysis was performed to analyze the diagnostic value of potential indicators in the diagnosis of cardiotoxicity.
RESULTS A total of 107 female breast cancer patients were included in the study. T4 maximum peak velocity in early diastole (E peak)/mitral annulus lateral tissue Doppler (e' peak) (E/e'), serological indicators [T4 cardiac troponin I (cTnI) and T4 pro-brain natriuretic peptide (Pro-BNP)], T3 minimum left atrial volume (LAV), T4 LAVmin, T3 LAV before the start of the P wave (LAVprep), and T4 LAVprep in the toxicity group were significantly higher than those in the non-toxic group. Multivariate logistic regression found that T4 cTnI, T4 Pro-BNP, T3 LAVmin, T4 LAVmin, T3 LAVprep, and T4 LAVprep had potential predictive value for cardiac toxicity (P < 0.05). ROC results showed that T4 LAVmin had the highest accuracy for diagnosing cardiac toxicity [area under the curve (AUC) = 0.947; sensitivity = 78.57%; specificity = 94.62%], followed by T4 LAVprep (AUC = 0.899; sensitivity = 100%; specificity = 66.67%). The accuracies of LAVprep and LAVprep in predicting cardiac toxicity were higher than those of T3 LAVmin and T3 LAVprep.
CONCLUSION RT3DE of left atrial volume can be used to predict the cardiotoxicity caused by chemotherapy, and it is expected to guide the clinical adjustment of dose and schedule in time.
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Affiliation(s)
- Fang Zhou
- Department of Breast Surgery, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Lin Niu
- Department of Ultrasound, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Min Zhao
- Department of Ultrasound, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Wei-Xing Ni
- Department of Ultrasound, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Jian Liu
- Department of Breast Surgery, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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10
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Rengier F, Melzig C, Derlin T, Marra AM, Vogel-Claussen J. Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 2018; 35:1407-1420. [DOI: 10.1007/s10554-018-1448-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
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11
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Han B, Wang Q. Study on the clinical efficacy of specific phosphodiesterase inhibitor in patients with pulmonary hypertension due to left heart disease. Exp Ther Med 2018; 16:1175-1186. [PMID: 30112056 PMCID: PMC6090457 DOI: 10.3892/etm.2018.6310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
Pulmonary hypertension due to left heart disease (PH-LHD) is caused by left ventricular (LV) systolic and/or diastolic dysfunction and left heart valve disease. LV diseases lead to left ventricular filling pressure increases, pulmonary venous obstruction and pulmonary venous pressure increases, and thus to secondary PH. Exercise tolerance is lower and fatality rates are higher in patients with PH-LHD than those in subjects with normal pulmonary arterial pressure. In spite of the progress in the study of the mechanisms of PH-LHD in recent years, no specific treatment is currently available. The efficacy and safety of targeted therapies for pulmonary arterial hypertension remain to be fully established. In the present study, PH-LHD patients were treated with milrinone injection. It was concluded that milrinone significantly reduces pulmonary artery systolic pressure (PASP) in patients with PH-LHD, and significantly improves the cardiac structure, cardiac function and biochemical indexes. PASP was significantly correlated with the left atrial diameter, LV end diastolic diameter, LV ejection fraction, tricuspid annular plane systolic excursion, right ventricular fractional area change, N-terminal pro-B-type natriuretic peptide and hypersensitive C-reactive protein.
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Affiliation(s)
- Bing Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,Intensive Care Unit, The Sixth People's Hospital of Jinan, Jinan, Shandong 250200, P.R. China
| | - Qingli Wang
- Internal Medicine Cardiovascular Department, The Sixth People's Hospital of Jinan, Jinan, Shandong 250200, P.R. China
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12
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Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e578-e622. [DOI: 10.1161/cir.0000000000000560] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose:
The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF.
Methods:
The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations.
Results:
Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking.
Conclusions:
RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.
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13
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Dutta T, Aronow WS. Echocardiographic evaluation of the right ventricle: Clinical implications. Clin Cardiol 2017; 40:542-548. [PMID: 28295398 DOI: 10.1002/clc.22694] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 12/17/2022] Open
Abstract
Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S', and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV.
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Affiliation(s)
- Tanya Dutta
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York
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14
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Hsu S, Houston BA, Tampakakis E, Bacher AC, Rhodes PS, Mathai SC, Damico RL, Kolb TM, Hummers LK, Shah AA, McMahan Z, Corona-Villalobos CP, Zimmerman SL, Wigley FM, Hassoun PM, Kass DA, Tedford RJ. Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension. Circulation 2016; 133:2413-22. [PMID: 27169739 PMCID: PMC4907868 DOI: 10.1161/circulationaha.116.022082] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/28/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis than idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. METHODS AND RESULTS RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; P=0.039). At matched exercise (25 W), SSc-PAH patients did not augment contractility (end-systolic elastance) whereas IPAH did (P<0.001). RV afterload assessed by effective arterial elastance rose similarly in both groups; thus, ventricular-vascular coupling declined in SSc-PAH. Both end-systolic and end-diastolic RV volumes increased in SSc-PAH patients to offset contractile deficits, whereas chamber dilation was absent in IPAH (+37±10% versus +1±8%, P=0.004, and +19±4% versus -1±6%, P<0.001, respectively). Exercise-associated RV dilation also strongly correlated with resting ventricular-vascular coupling in a larger cohort. CONCLUSIONS RV contractile reserve is depressed in SSc-PAH versus IPAH subjects, associated with reduced calcium recycling. During exercise, this results in ventricular-pulmonary vascular uncoupling and acute RV dilation. RV dilation during exercise can predict adverse ventricular-vascular coupling in PAH patients.
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Affiliation(s)
- Steven Hsu
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brian A Houston
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Emmanouil Tampakakis
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Anita C Bacher
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Parker S Rhodes
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Stephen C Mathai
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Rachel L Damico
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Todd M Kolb
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Laura K Hummers
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ami A Shah
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Zsuzsanna McMahan
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Celia P Corona-Villalobos
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Stefan L Zimmerman
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Fredrick M Wigley
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Paul M Hassoun
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - David A Kass
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Ryan J Tedford
- From Divisions of Cardiology (S.H., B.A.H., E.T., A.C.B., P.S.R., D.A.K., R.J.T.), Pulmonary and Critical Care (S.C.M., R.L.D., T.M.K., P.M.H.), and Rheumatology (L.K.H., A.A.S., Z.M., F.M.W.), Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD; and Departments of Radiology (C.P.C.-V., S.L.Z.) and Biomedical Engineering (D.A.K.), Johns Hopkins Medical Institutions, Baltimore, MD.
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15
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Koestenberger M, Friedberg MK, Nestaas E, Michel-Behnke I, Hansmann G. Transthoracic echocardiography in the evaluation of pediatric pulmonary hypertension and ventricular dysfunction. Pulm Circ 2016; 6:15-29. [PMID: 27162612 PMCID: PMC4860554 DOI: 10.1086/685051] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Eirik Nestaas
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; and Department of Paediatrics, Vestfold Hospital Trust, Vestfold, Norway
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
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