Abstract
BackgroundEchocardiography is the most convenient method used to evaluate right ventricular function, and several echocardiographic parameters were studied in previous studies. But the value of these parameters to assess the right ventricular function in patients with pulmonary arterial hypertension (PAH) has not been well defined.MethodsPatients with PAH were observed prospectively. Right heart catheterization, echocardiography and cardiac magnetic resonance (CMR) were performed within 1 week interval. The correlations between echocardiographic parameters and right ventricular ejection fraction (RVEF) derived from CMR as well as hemodynamics were analyzed.ResultsThirty patients were enrolled including 24 with idiopathic PAH, 5 with PAH associated with connective tissue diseases and 1 with hereditary PAH. All echocardiographic parameters except right ventricular myocardial performance index (RVMPI) correlated significantly with RVEF (tricuspid annual plane systolic excursion [TAPSE], r = 0.440, P = 0.015; tricuspid annular systolic excursion velocity [S’], r = 0.444, P = 0.016; isovolumic acceleration [IVA], r = 0.600, P = 0.001; right ventricular fraction area change [RVFAC], r = 0.416, P = 0.022; ratio of right ventricular transverse diameter to left ventricular transverse diameter [RVETD/LVETD], r = −0.649, P<0.001; RVMPI, r = −0.027, P = 0.888). After adjusted for mean right atrial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance (PVR), only IVA and RVETD/LVETD could independently predict RVEF. Four echocardiographic parameters displayed significant correlations with PVR (TAPSE, r = −0.615, P<0.001; S’, r = −0.557, P = 0.002; RVFAC, r = −0.454, P = 0.012; RVETD/LVETD, r = 0.543, P = 0.002).ConclusionsThe echocardiographic parameters IVA and RVETD/LVETD can reflect RVEF independently regardless of hemodynamics in patients with PAH. In addition, TAPSE, S’, RVFAC and RVETD/LVETD can also reflect PVR in PAH patients.
Highlights
Pulmonary arterial hypertension (PAH), caused by vascular remodeling of the small pulmonary arteries, is characterized by mean pulmonary arterial pressure $25 mmHg and pulmonary capillary wedge pressure (PCWP) #15 mmHg at rest assessed by right heart catheterization (RHC)
RVEF that can reflect intrinsic right ventricle (RV) contractility has been demonstrated to be an independent predictor of survival. [2,3] Cardiac magnetic resonance (CMR) imaging can accurately assess RV end-diastolic and end-systolic volume to calculate right ventricular ejection fraction (RVEF), [4,5] which has become the reference standard technique for assessment of RV structure and function
Echocardiography is the most common and convenient method used to evaluate RV function and hemodynamics of pulmonary circulation, and several echocardiographic parameters have been studied in previous studies, including RV fractional area changes
Summary
Pulmonary arterial hypertension (PAH), caused by vascular remodeling of the small pulmonary arteries, is characterized by mean pulmonary arterial pressure (mPAP) $25 mmHg and pulmonary capillary wedge pressure (PCWP) #15 mmHg at rest assessed by right heart catheterization (RHC). [1] With pulmonary vascular resistance (PVR) increasing, the overloaded right ventricle (RV) changes morphologically and functionally, which impairs the capacity and survival of patients. [2] Recently, the role of the RV in PAH patients gains increasing attention from clinicians and researchers.Pulmonary vascular remodeling and the RV dysfunction both play important roles in the pathophysiological process of PAH.Comprehensive evaluation of the condition of pulmonary hypertension (PH) patients requires the consideration of both the pulmonary circulation and RV function. Echocardiography is the most common and convenient method used to evaluate RV function and hemodynamics of pulmonary circulation, and several echocardiographic parameters have been studied in previous studies, including RV fractional area changes (RVFAC), RV myocardial performance index (RVMPI), [6,7,8] tricuspid annular plane systolic excursion (TAPSE), tricuspid annular plane systolic velocity(S’) [9] and myocardial acceleration during isovolumic contraction (IVA). Echocardiography is the most convenient method used to evaluate right ventricular function, and several echocardiographic parameters were studied in previous studies. The value of these parameters to assess the right ventricular function in patients with pulmonary arterial hypertension (PAH) has not been well defined
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