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Druelle A, Mouhat B, Zbitou O, Castagna O. Static Immersion and Negative Static Lung Load-Induced Right Ventricle Systolic Function Adaptation: A Risk Factor for Immersion Pulmonary Edema. Chest 2024:S0012-3692(24)00558-0. [PMID: 38759727 DOI: 10.1016/j.chest.2024.03.042] [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: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/31/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Immersion pulmonary edema (IPE) is a form of hemodynamic edema likely involving individual susceptibility. RESEARCH QUESTION Can assessing right ventricle (RV) systolic adaptation during immersion be a marker for IPE susceptibility? STUDY DESIGN AND METHODS Twenty-eight divers participated: 15 study participants with a history of IPE (IPE group; mean ± SD age, 40.2 ± 8.2 years; two women) and 13 control participants (no IPE group; mean ± SD age, 43.1 ± 8.5 years; two women) underwent three transthoracic echocardiography studies under three different conditions: dry (participants were in the supine position on an examination table without immersion), surface immersion (participants were floating prone on the water's surface and breathing through a snorkel), and immersion and negative static lung load (divers were submerged 20 cm below the water's surface in the prone position using a specific snorkel connected to the surface for breathing). Echocardiographic measurements included tricuspid annular plane systolic excursion (TAPSE), tissue S' wave, and right ventricle global strain (RVGLS). RESULTS For all divers, immersion increased RV preload. In the no IPE group, the increase in RV preload induced by immersion was accompanied by an improvement in the contractility of the RV, as evidenced by increases in TAPSE (17.08 ± 1.15 mm vs 20.89 ± 1.32 mm), S' wave (14.58 ± 2.91 cm/s vs. 16.26 ± 2.77 cm/s), and RVGLS (25.37 ± 2.79 % vs. 27.09 ± 2.89 %). Negative SLL amplified these RV adaptations. In contrast, among divers with IPE, the increase in RV preload did not coincide with an improvement in RV contractility, indicating altered adaptive responses. In the IPE group, the TAPSE values changed from 17.19 ± 1.28 mm to 21.69 ± 1.67 mm and then to 23.55 ± 0.78 mm, respectively, in the dry, surface immersion, and immersion and negative SLL conditions. The S' wave values changed from 13.42 ± 2.94 cm/s to 13.26 ± 2.96 cm/s and then to 12.49 ± 0.77 cm/s, respectively, and the RVGLS values changed from -24.09% ± 2.91% to -23.99% ± 3.38% and then to -21.96% ± 0.55%, respectively. INTERPRETATION Changes in RV systolic function induced by immersion (especially with the addition of negative static lung load) vary among divers based on the history of IPE. Analyzing ventricular contractility during immersion, particularly RVGLS, could help to identify individual susceptibility in divers. These findings provide insights for the development of preventive strategies. TRIAL REGISTRY Comité de Protection des Personnes; No.: 21.05.05.35821; Recherche Impliquant la Personne Humaine de type 1 (RIPH1) HPS; No.: 2021-A01225-36.
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Affiliation(s)
- Arnaud Druelle
- Diving Medicine Consultation Services and Hyperbaric Chamber, Ste Anne Military Hospital (HIA Ste Anne), Toulon, France
| | - Basile Mouhat
- Department of Cardiology, University Hospital, Besançon, France
| | - Oumaima Zbitou
- Department of Cardiology, University Hospital, Besançon, France
| | - Olivier Castagna
- Diving Medicine Consultation Services and Hyperbaric Chamber, Ste Anne Military Hospital (HIA Ste Anne), Toulon, France; Underwater Research Team-ERRSO, Military Biomedical Research Institute (IRBA), Toulon, France; LAMHESS (UPR 6312), Université de Nice, Nice, France.
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Merino-Caviedes S, Martín-Fernández M, Pérez Rodríguez MT, Martín-Fernández MÁ, Filgueiras-Rama D, Simmross-Wattenberg F, Alberola-López C. Computing thickness of irregularly-shaped thin walls using a locally semi-implicit scheme with extrapolation to solve the Laplace equation: Application to the right ventricle. Comput Biol Med 2024; 169:107855. [PMID: 38113681 DOI: 10.1016/j.compbiomed.2023.107855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
Cardiac Magnetic Resonance (CMR) Imaging is currently considered the gold standard imaging modality in cardiology. However, it is accompanied by a tradeoff between spatial resolution and acquisition time. Providing accurate measures of thin walls relative to the image resolution may prove challenging. One such anatomical structure is the cardiac right ventricle. Methods for measuring thickness of wall-like anatomical structures often rely on the Laplace equation to provide point-to-point correspondences between both boundaries. This work presents limex, a novel method to solve the Laplace equation using ghost nodes and providing extrapolated values, which is tested on three different datasets: a mathematical phantom, a set of biventricular segmentations from CMR images of ten pigs and the database used at the RV Segmentation Challenge held at MICCAI'12. Thickness measurements using the proposed methodology are more accurate than state-of-the-art methods, especially with the coarsest image resolutions, yielding mean L1 norms of the error between 43.28% and 86.52% lower than the second-best methods on the different test datasets. It is also computationally affordable. Limex has outperformed other state-of-the-art methods in classifying RV myocardial segments by their thickness.
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Affiliation(s)
- Susana Merino-Caviedes
- Laboratorio de Procesado de Imagen, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
| | - Marcos Martín-Fernández
- Laboratorio de Procesado de Imagen, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
| | | | | | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Novel Arrhythmogenic Mechanisms Program, Madrid, Spain.
| | | | - Carlos Alberola-López
- Laboratorio de Procesado de Imagen, ETSI Telecomunicación, Universidad de Valladolid, Valladolid, Spain.
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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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Rahmianti ND, Dinarti LK, Mumpuni H, Triastuti F. Global Longitudinal Strain Right Ventricle (GLS RV) as a Predictor for Mean Pulmonary Artery Pressure (MPAP) on Secundum Atrial Septal Defect (ASD) with Pulmonary Hypertension. J Cardiovasc Echogr 2023; 33:83-87. [PMID: 37772046 PMCID: PMC10529289 DOI: 10.4103/jcecho.jcecho_14_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 09/30/2023] Open
Abstract
Objectives The objectives of the study were to determine the association between global longitudinal strain right ventricle (GLS-RV) and mean pulmonary artery pressure (mPAP) on secundum atrial septal defect (ASD) with pulmonary hypertension (PH). Methods This study was an analytic observational with the cross-sectional approach. This study was conducted with secundum ASD patients who underwent right heart catheterization (RHC) from February 2019 to July 2019 at Sardjito General Teaching Hospital Yogyakarta. Demographic data were collected and echocardiographic parameters were evaluated based on the standard examination. The results were statistically analyzed using the correlation hypothesis test. If the data were normally distributed, the Pearson's correlation test was used, if the data were not normally distributed, Spearman's correlation test was used to analyze the correlation. Results Thirty-four patients were enrolled in this study. There was strongly significant positive correlation between GLS-RV and mPAP found in patients with Secundum ASD (P = 0.0001, r = 90.5%). Conclusions This is the first study in Indonesia that analyzed the association between GLS-RV and mPAP in Secundum ASD patients. There was a strongly significant positive correlation between GLS-RV and mPAP in patients with Secundum ASD after RHC. We assume that the association is influenced by progressivity and degree of disease severity.
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Affiliation(s)
- Nia Dyah Rahmianti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Lucia Kris Dinarti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Dr. Sardjito Teaching Hospital, Yogyakarta, Indonesia
| | - Hasanah Mumpuni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Gadjah Mada University, Dr. Sardjito Teaching Hospital, Yogyakarta, Indonesia
| | - Fita Triastuti
- Master Program in Basic Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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Wang A, Su H, Duan Y, Jiang K, Li Y, Deng M, Long X, Wang H, Zhang M, Zhang Y, Cao Y. Pulmonary Hypertension Caused by Fibrosing Mediastinitis. JACC: ASIA 2022; 2:218-234. [PMID: 36338410 PMCID: PMC9627819 DOI: 10.1016/j.jacasi.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022]
Abstract
Pulmonary hypertension (PH) is a progressive and severe disorder in pulmonary hemodynamics. PH can be fatal if not well managed. Fibrosing mediastinitis (FM) is a rare and benign fibroproliferative disease in the mediastinum, which may lead to pulmonary vessel compression and PH. PH caused by FM (PH-FM) is a pathologic condition belonging to group 5 in the World Health Organization PH classification. PH-FM has a poor prognosis because of a lack of effective therapeutic modalities and inappropriate diagnosis. With the development of percutaneous pulmonary vascular interventional therapy, the prognosis of PH-FM has been greatly improved in recent years. This article provides a comprehensive review on the epidemiology, pathophysiologic characteristics, clinical manifestations, diagnostic approaches, and treatment modalities of PH-FM based on data from published reports and our medical center with the goal of facilitating the diagnosis and treatment of this fatal disease. PH-FM, as a type of rare condition in group 5 PH, has a poor prognosis because of a lack of effective therapeutic modalities and frequent misdiagnosis and underdiagnosis. The most prevalent trigger of FM is H-FM in the United States and TB-FM in China. Imaging findings, including mismatched perfusion defects in the V/Q scan, FM dyad, and FM triad are important diagnostic clues, and clinical classification facilitates decision making in diagnosis and therapeutics. Because of the limited efficacy of drug therapy as well as the uncertain effectiveness and high risk of surgical treatment, endovascular interventional modality is currently the preferred therapeutic option, although procedure-related complications and intrastent restenosis after PV intervention need to be addressed.
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Goh ZM, Johns CS, Julius T, Barnes S, Dwivedi K, Elliot C, Sharkey M, Alkanfar D, Charalampololous T, Hill C, Rajaram S, Condliffe R, Kiely DG, Swift AJ. Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16853.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). Methods: In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Results: Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar’s and the medical student’s were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). Conclusions: MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.
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Fathala A, Aldurabi A. Frequency of computed tomography abnormalities in patients with chronic thromboembolic pulmonary hypertension: a comparative study between lung perfusion scan and computed tomography pulmonary angiography. Multidiscip Respir Med 2021; 16:753. [PMID: 34322231 PMCID: PMC8273626 DOI: 10.4081/mrm.2021.753] [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: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the leading causes of pulmonary hypertension. Diagnosis of CTEPH can be established using various imaging techniques, including ventilation-perfusion scintigraphy (VQ) and multidetector computed tomography pulmonary angiography (CTPA). The aim of this study was to determine the frequency of direct pulmonary vascular, parenchymal lung, and cardiac abnormalities on CTPA in patients with CTEPH and to compare the diagnostic accuracy of both VQ scan CTPA in detecting CTEPH. Methods We retrospectively included 54 patients who had been referred for pulmonary hypertension service (20 males, 34 females). All patients had VQ scan and CTPA within 15 days and underwent pulmonary artery endarterectomy (PEA) thereafter. VQ scans were reported according to modified PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria. CTPA was considered as diagnostic for CTEPH if it showed presence of thrombus, webs, stenosis, or perfusion lung abnormalities. Results The mean age of the study population was 41±10 years. The mean pulmonary artery pressure was 53±13 mmHg. Fifty-three out of 54 patients in the study population had high probability VQ scan and one patient had intermediate probability. CTPA was suggestive of CTEPH in all patients. The most frequent CTPA findings in the central pulmonary arteries and peripheral arteries were presence of thrombotic materials, abnormal vessel tapering and abrupt vessels-cut off (76% vs 65%, 67% vs 48%, and 48% vs 22%), respectively. The mosaic lung perfusion was present in 78% of the patients, and various cardiac morphology abnormalities were present and most common was abnormal right to left ventricle ratio (69%). Conclusion Our findings indicate that both VQ scan and CTPA are highly sensitive for the detection of CTEPH confirmed by PEA. Most CTEPH patients had several pulmonary vascular, parenchymal lung and cardiac abnormalities. There was no sign with 100% sensitivity on CTPA for CTEPH detection.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital and Research Center, Riyadh
| | - Alaa Aldurabi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
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Kim HY, Kim KH. How to Determine Right Ventricular Dysfunction in Pulmonary Hypertension. J Cardiovasc Imaging 2021; 29:252-254. [PMID: 34080341 PMCID: PMC8318816 DOI: 10.4250/jcvi.2021.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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Kazimierczyk R, Malek LA, Szumowski P, Nekolla SG, Blaszczak P, Jurgilewicz D, Hladunski M, Sobkowicz B, Mysliwiec J, Grzywna R, Musial WJ, Kaminski KA. Multimodal assessment of right ventricle overload-metabolic and clinical consequences in pulmonary arterial hypertension. J Cardiovasc Magn Reson 2021; 23:49. [PMID: 33966635 PMCID: PMC8108462 DOI: 10.1186/s12968-021-00743-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In pulmonary arterial hypertension (PAH) increased afterload leads to adaptive processes of the right ventricle (RV) that help to maintain arterio-ventricular coupling of RV and preserve cardiac output, but with time the adaptive mechanisms fail. In this study, we propose a multimodal approach which allows to estimate prognostic value of RV coupling parameters in PAH patients. METHODS Twenty-seven stable PAH patients (49.5 ± 15.5 years) and 12 controls underwent cardiovascular magnetic resonance (CMR). CMR feature tracking analysis was performed for RV global longitudinal strain assessment (RV GLS). RV-arterial coupling was evaluated by combination of RV GLS and three proposed surrogates of RV afterload-pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR) and pulmonary artery compliance (PAC). 18-FDG positron emission tomography (PET) analysis was used to assess RV glucose uptake presented as SUVRV/LV. Follow-up time of this study was 25 months and the clinical end-point was defined as death or clinical deterioration. RESULTS Coupling parameters (RV GLS/PASP, RV GLS/PVR and RV GLS*PAC) significantly correlated with RV function and standardized uptake value (SUVRV/LV). Patients who experienced a clinical end-point (n = 18) had a significantly worse coupling parameters at the baseline visit. RV GLS/PASP had the highest area under curve in predicting a clinical end-point and patients with a value higher than (-)0.29%/mmHg had significantly worse prognosis. It was also a statistically significant predictor of clinical end-point in multivariate analysis (adjusted R2 = 0.68; p < 0.001). CONCLUSIONS Coupling parameters are linked with RV hemodynamics and glucose metabolism in PAH. Combining CMR and hemodynamic measurements offers more comprehensive assessment of RV function required for prognostication of PAH patients. TRIAL REGISTRATION NCT03688698, 09/26/2018, retrospectively registered; Protocol ID: 2017/25/N/NZ5/02689.
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Affiliation(s)
| | - Lukasz A Malek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Szumowski
- Laboratory of Molecular Imaging, Medical University of Bialystok, Białystok, Poland
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | - Piotr Blaszczak
- Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland
| | - Dorota Jurgilewicz
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Marcin Hladunski
- Laboratory of Molecular Imaging, Medical University of Bialystok, Białystok, Poland
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Bozena Sobkowicz
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland
| | - Janusz Mysliwiec
- Department of Nuclear Medicine, Medical University of Bialystok, Białystok, Poland
| | - Ryszard Grzywna
- Department of Nuclear Medicine, Technical University Munich, Munich, Germany
| | | | - Karol A Kaminski
- Department of Cardiology, Medical University of Bialystok, Białystok, Poland.
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Waszyngtona 13a, Białystok, 15-269, Poland.
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Chaturvedi A, Baran TM, Ambrosini R, Krishnamoorthy V. Improving CT assessment for pulmonary hypertension in patients with severe aortic stenosis, correlation with right heart catheterization. Clin Imaging 2021; 77:122-129. [PMID: 33676129 DOI: 10.1016/j.clinimag.2021.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE To identify CT parameters useful for assessment of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS). MATERIALS AND METHODS Retrospective study of 165 patients who had undergone right heart catheterization (RHC), and CTA of the thorax for preoperative aortic valve replacement (TAVR) planning. These were divided into groups based on mean pulmonary artery (PA) pressure (mPAP) of 25 mm Hg on RHC (85 cases and 80 controls). Diameters of main pulmonary artery diameter (MPAD), left pulmonary artery (LPA), right pulmonary artery (RPA), and maximal long axis and short axis diameters of the right atrium (RA) and ventricle (RV) were measured on the axial plane. Univariate and multivariate statistical analysis was utilized to identify metrics predictive of PH. RESULTS MPAD, LPA, and RPA were higher in subjects with mPAP >25 mm Hg (p < 0.0001 for all). Thresholds of 30.5 mm for MPAD (68.4% sensitivity, 82.7% specificity), and 27.5 mm for LPA and RPA (LPA: 51.9% sensitivity, 78.8% specificity; RPA: 62.0% sensitivity, 78.8% specificity) provided the best discrimination of elevated mPAP. Compared to literature values for MPAD (28.9 mm in men and 26.9 mm in women), these thresholds provide lower sensitivity but greatly increased specificity. Inclusion of RA enlargement to MPAD increased specificity to 98.5%, while inclusion of RV enlargement increased specificity to 100%. CONCLUSION Threshold to identify PH in patients with AS using PA enlargement is higher than previously reported range for normal. Inclusion of RA and RV enlargement improves the ability of CT to more accurately identify PH in patients with AS.
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Affiliation(s)
- Abhishek Chaturvedi
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
| | - Timothy M Baran
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert Ambrosini
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Vijay Krishnamoorthy
- Department of Medicine: Cardiology, University of Rochester Medical Center, Rochester, NY, USA
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Nayak K, Razak A, Megha A, Padmakumar R, Samantha J, Varghese S. Impact of Right Ventricular Function on Left Ventricular Torsion and Ventricular Deformations in Pulmonary Artery Hypertension Patients. Cardiovasc Hematol Disord Drug Targets 2021; 21:78-86. [PMID: 33797382 DOI: 10.2174/1871529x21666210401150404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Ventricular interdependence in pulmonary arterial hypertension (PAH) by the use of most recent echocardiographic techniques is still rare. The current case-controlled study aims to assess left ventricular (LV) torsion in patients with PAH. METHODS The study included 42 cases of moderate to severe PAH and 42 age and gender-matched healthy controls between March 2016 and January 2018. All the patients and controls undergo routine practice echocardiography using the Vivid 7-echocardiography (2.5MHz transducer) system. RESULTS The LV twisting parameters, peak basal rotation, peak apical rotation, and twist were similar among both cases and controls, however, LV torsion was significantly (p=0.04) impacted. Right ventricular (RV) longitudinal deformation was clinically significant in the cases compared to controls: RV systolic strain imaging (p=0.001, 95% CI-9.75 to -2.65), RV systolic strain rate (p=0.01, 95% CI-0.99 to -0.09), and RV late diastolic strain rate (p=0.01, 95% CI-0.64 to -0.85). Although PAH did not impact longitudinal LV deformations significantly. At basal level circumferential strain and strain rate were significantly impacted (p=0.005, 95% CI-4.38 to -0.70; p=0.004, 95% CI-0.35 to -0.07) in the PAH group, while the radial strain was preserved. All RV echocardiographic parameters and LV end-diastolic dimension, LV end-systolic volume in the PAH were affected significantly (p=0.002, 95% CI-19.91 to -4.46; p=0.01, 95% CI-8.44 to -2.77). However, only a weak correlation (p=0.05, r =-0.20) was found between tricuspid annular plane systolic excursion and LV Tei index. CONCLUSION RV pressure overload directly affects RV longitudinal systolic deformation further influences the interventricular septal and LV geometry, which impaired LV torsion.
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Affiliation(s)
- Krishnananda Nayak
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Abdul Razak
- Department of Cardiology Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - A Megha
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - R Padmakumar
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Samantha
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Sara Varghese
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Subramanyam P, Abouzeid C, Groner LK. Multimodality Imaging of Pulmonary Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Erley J, Tanacli R, Genovese D, Tapaskar N, Rashedi N, Bucius P, Kawaji K, Karagodin I, Lang RM, Kelle S, Mor-Avi V, Patel AR. Myocardial strain analysis of the right ventricle: comparison of different cardiovascular magnetic resonance and echocardiographic techniques. J Cardiovasc Magn Reson 2020; 22:51. [PMID: 32698811 PMCID: PMC7376701 DOI: 10.1186/s12968-020-00647-7] [Citation(s) in RCA: 20] [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: 11/27/2019] [Accepted: 06/12/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Right ventricular (RV) strain is a useful predictor of prognosis in various cardiovascular diseases, including those traditionally believed to impact only the left ventricle. We aimed to determine inter-modality and inter-technique agreement in RV longitudinal strain (LS) measurements between currently available cardiovascular magnetic resonance (CMR) and echocardiographic techniques, as well as their reproducibility and the impact of layer-specific strain measurements. METHODS RV-LS was determined in 62 patients using 2D speckle tracking echocardiography (STE, Epsilon) and two CMR techniques: feature tracking (FT) and strain-encoding (SENC), and in 17 healthy subjects using FT and SENC only. Measurements included global and free-wall LS (GLS, FWLS). Inter-technique agreement was assessed using linear regression and Bland-Altman analysis. Reproducibility was quantified using intraclass correlation (ICC) and coefficients of variation (CoV). RESULTS We found similar moderate agreement between both CMR techniques and STE in patients: r = 0.57-0.63 for SENC; r = 0.50-0.62 for FT. The correlation between SENC and STE was better for GLS (r = 0.63) than for FWLS (r = 0.57). Conversely, the correlation between FT and STE was higher for FWLS (r = 0.60-0.62) than GLS (r = 0.50-0.54). FT-midmyocardial strain correlated better with SENC and STE than FT-subendocardial strain. The agreement between SENC and FT was fair (r = 0.36-0.41, bias: - 6.4 to - 10.4%) in the entire study group. All techniques except FT showed excellent reproducibility (ICC: 0.62-0.96, CoV: 0.04-0.30). CONCLUSIONS We found only moderate inter-modality agreement with STE in RV-LS for both FT and SENC and poor agreement when comparing between the CMR techniques. Different modalities and techniques should not be used interchangeably to determine and monitor RV strain.
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Affiliation(s)
- Jennifer Erley
- Department of Internal Medicine / Cardiology, German Heart Center, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine / Cardiology, German Heart Center, Berlin, Germany
| | - Davide Genovese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Natalie Tapaskar
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
| | - Nina Rashedi
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
| | - Paulius Bucius
- Department of Internal Medicine / Cardiology, German Heart Center, Berlin, Germany
| | - Keigo Kawaji
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL USA
| | - Ilya Karagodin
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
| | - Roberto M. Lang
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
| | - Sebastian Kelle
- Department of Internal Medicine / Cardiology, German Heart Center, Berlin, Germany
- Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
| | - Amit R. Patel
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Avenue, MC9067, Chicago, IL 60637 USA
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Jang AY, Shin MS. Echocardiographic Screening Methods for Pulmonary Hypertension: A Practical Review. J Cardiovasc Imaging 2020; 28:1-9. [PMID: 31997604 PMCID: PMC6992915 DOI: 10.4250/jcvi.2019.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a debilitating condition defined as mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg. The importance of impaired right ventricular (RV) hemodynamics is increasingly being recognized in treatment of patients with PH. In World Health Organization Group 1 patients with pulmonary arterial hypertension, upfront combination therapy has recently been proposed to improve long-term survival. Also, the mPAP in Group 2 and 3 PH patients has been shown to be strongly associated with clinical outcomes. Thus, screening and monitoring of RV hemodynamics are becoming increasingly important. The gold standard for measuring RV hemodynamics is right heart catheterization (RHC). Although RHC can obtain the most accurate results, it is invasive, cumbersome to patients, and often associated with complications, making it unsuitable for a screening or monitoring modality. Echocardiography is useful in estimating hemodynamic parameters that can be obtained from RHC. Accordingly, the role of echocardiography in evaluating such patients with PH is becoming more important. In this article, we review practical echocardiographic methods in approximating RV hemodynamics for PH.
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Affiliation(s)
| | - Mi Seung Shin
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.,Gachon University, College of Medicine, Incheon, Korea.
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15
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Kim HY, Kim KH, Kim J, Park JC. Multimodality cardiovascular imaging in pulmonary embolism. Cardiol J 2019; 28:150-160. [PMID: 31478557 DOI: 10.5603/cj.a2019.0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/25/2022] Open
Abstract
Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular (CV) morbidity and mortality. To select appropriate therapeutic strategy and/or to minimize the mortality and morbidity, rapid and correct identification of life-threatening APE is very important. Also, right ventricular (RV) failure usually precedes acute hemodynamic compromise or death, and thus the identification of RV failure is another important step in risk stratification or treatment of APE. With advances in diagnosis and treatment, the prognosis of APE has been dramatically improving in most cases, but inadequate therapy or recurrent episodes of pulmonary embolism (PE) may result in negative outcomes or, so called, chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a condition characterized by remaining chronic thromboembolic material in the pulmonary vasculature and subsequent chronic pulmonary hypertension. Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating CTEPH from APE. Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality CV imaging. Here, the advantages or pitfalls of each imaging modality in diagnosis, risk stratification, or management of PE will be discussed.
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Affiliation(s)
- Hyung Yoon Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kye Hun Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea, Republic Of
| | - Jong Chun Park
- Chonnam National University Hospital, Gwangju, Republic of Korea
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16
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Park JH. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circ J 2019; 49:908-931. [PMID: 31456367 PMCID: PMC6753023 DOI: 10.4070/kcj.2019.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 01/14/2023] Open
Abstract
Echocardiography is the first and is the most-available imaging modality for many cardiovascular diseases, and echocardiographic parameters can give much important information for diagnosis, treatment, and prognostic evaluations. Left ventricular ejection fraction (LVEF) is the most commonly used echocardiographic parameter for left ventricular (LV) systolic function. Although LVEF is used routinely in daily practice, it is calculated from volumetric change without representing true myocardial properties. Recently, strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Although strain echocardiography has been applied to measure the right ventricle and left atrium, in addition to analyzing the LV, many cardiologists who are not imaging specialists are unaware of its clinical use and importance. Therefore, this review describes the measurement and clinical utility of 2-dimensional strain analysis in various cardiovascular diseases.
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Affiliation(s)
- Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
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17
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Ramani G, Chen W, Patel S, Judy J, Ton VK. Noninvasive Assessment of Right Ventricular Function in Patients with Pulmonary Arterial Hypertension and Left Ventricular Assist Device. Curr Cardiol Rep 2019; 21:82. [PMID: 31278558 DOI: 10.1007/s11886-019-1156-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW Right ventricular (RV) failure in patients with pulmonary arterial hypertension (PAH) and left ventricular assist device (LVAD) is associated with increased hospitalizations, worsening functional class, and poor survival. Accurate RV function assessment is essential in diagnosing RV failure, guiding therapies, and determining prognosis. Noninvasive imaging techniques provide fast and reliable quantification of RV morphology and function. RECENT FINDINGS We review echocardiography, nuclear medicine, and cardiac magnetic resonance imaging (MRI) uses for RV function assessment in patients with PAH and LVAD. We identify current knowledge gaps in utilizing noninvasive tests to assess RV function. Echocardiography is most widely used to quantify RV function in patients with PAH and LVAD, followed by cardiac MRI for RV morphology and function measurement in PAH patients. The first-pass radionuclide angiography with radiolabeled RBC is the gold standard for calculating RV function. Gated blood pool SPECT can be an alternative as it separates the cardiac chambers well and provides accurate assessment of the RV function with high reproducibility, which is particularly useful for monitoring treatment. More research is needed to compare and validate these modalities in evaluating RV function.
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Affiliation(s)
- Gautam Ramani
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, 110 S. Paca St., Baltimore, MD, 21201, USA
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sonika Patel
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, 110 S. Paca St., Baltimore, MD, 21201, USA
| | - Jean Judy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van-Khue Ton
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, 110 S. Paca St., Baltimore, MD, 21201, USA.
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