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Woo JL, DiLorenzo MP, Rosenzweig E, Pasumarti N, Villeda GV, Berman-Rosenzweig E, Krishnan U. Correlation Between Right Ventricular Echocardiography Measurements and Functional Capacity in Patients With Pulmonary Arterial Hypertension. Tex Heart Inst J 2022; 49:488231. [PMID: 36350291 PMCID: PMC9809095 DOI: 10.14503/thij-21-7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Accelerometry is an emerging option for real-time evaluation of functional capacity in patients with pulmonary arterial hypertension (PAH). This prospective pilot study assesses the relationship between functional capacity by accelerometry and right ventricular measurements on echocardiography for this high-risk cohort. METHODS Patients with PAH were prospectively enrolled and underwent 6-Minute Walk Test and cardiopulmonary exercise testing. They were given a Fitbit, which collected steps and sedentary time per day. Echocardiographic data included right ventricular global longitudinal, free wall, and septal strain; tricuspid regurgitant peak velocity; tricuspid annular plane systolic excursion; tricuspid annular plane systolic velocity; right ventricular myocardial performance index; and pulmonary artery acceleration time. Pairwise correlations were performed. RESULTS The final analysis included 22 patients aged 13 to 59 years. Tricuspid regurgitant peak velocity had a negative correlation with 6-Minute Walk Test (r = -0.58, P = .02), peak oxygen consumption on exercise testing (r = -0.56, P = .03), and average daily steps on accelerometry (r = -0.59, P = .03), but a positive correlation with median sedentary time on accelerometry (r = 0.64, P = .02). Pulmonary artery acceleration time positively correlated with peak oxygen consumption on exercise testing (r = 0.64, P = .002). There was no correlation between right ventricular strain measurements and functional capacity testing. CONCLUSION In this pilot study, tricuspid regurgitant jet and pulmonary artery acceleration time were the echocardiographic variables that correlated most with accelerometry data. With further echocardiographic validation, accelerometry can be a useful, noninvasive, and cost-effective tool to monitor disease progression in patients with PAH.
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Affiliation(s)
- Joyce L. Woo
- Department of Pediatrics, Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael P. DiLorenzo
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Eliana Rosenzweig
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Nikhil Pasumarti
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | | | - Erika Berman-Rosenzweig
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
| | - Usha Krishnan
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Medical Center, New York, New York
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Schnell F, Claessen G, La Gerche A, Claus P, Bogaert J, Delcroix M, Carré F, Heidbuchel H. Atrial volume and function during exercise in health and disease. J Cardiovasc Magn Reson 2017; 19:104. [PMID: 29254488 PMCID: PMC5735907 DOI: 10.1186/s12968-017-0416-9] [Citation(s) in RCA: 21] [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: 08/02/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although atrial function has prognostic significance in many cardiovascular conditions, changes during exercise have not previously been assessed. The aim of this study was to evaluate left atrial (LA) and right atrial (RA) volume and function during incremental exercise, both in normal individuals, healthy athletes, and in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS Fifteen healthy non-athletes, 15 athletes and 15 CTEPH patients underwent multi-slice real-time cardiovascular magnetic resonance imaging at rest and during supine bicycle exercise with simultaneous invasive hemodynamic measurements. RESULTS At rest, athletes had larger indexed maximal RA and LA volumes (iRAVmax, iLAVmax) than CTEPH patients and non-athletes, the latter two groups having similar values. CTEPH patients had lower RA and LA emptying functions (EmF) at rest. During exercise, RA volumes (maximum and minimum) increased in CTEPH patients, whilst decreasing in athletes and non-athletes (P < 0.001). The exercise-induced change in iLAVmax was similar between groups, but iLAVmin did not decrease in CTEPH patients. Thus exercise-induced increases in RAEmF and LAEmF, as seen in normal physiology, were significantly impaired in CTEPH patients. At peak exercise, RA volumes (maximum and minimum) and EmF correlated strongly with RA pressure (R = 0.70; P = 0.005; R = 0.83; P < 0.001; R = -0.87; P < 0.001). On multivariate analysis, peak exercise RAEmF and iLAVmin were independent predictors of VO2peak in CTEPH patients and together explained 72% of the variance in VO2peak (ß =0.581 and ß = -0.515, respectively). CONCLUSIONS In normal physiology, RAEmF and LAEmF increase with exercise, whereas CTEPH patients have impaired LAEmF and RAEmF, which becomes more apparent during exercise. Therefore, the changes in atrial volumes and function during exercise enable a far better distinction between physiological and pathological atrial remodeling than resting measures of volumes which are prone to confounding factors (e.g. endurance training). Peak exercise RAEmF is a good marker of poor functional state in CTEPH patients.
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Affiliation(s)
- Frédéric Schnell
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Sport Medicine, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | - Guido Claessen
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - André La Gerche
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University of Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - Marion Delcroix
- Department of Pneumology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | - François Carré
- Department of Sport Medicine, University Hospital Pontchaillou, Rennes 1 University, Rennes, France
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Diagnostic and Prognostic Implications of Exercise Treadmill and Rest First-Pass Radionuclide Angiography in Patients With Pulmonary Hypertension. Clin Nucl Med 2017; 42:e392-e399. [PMID: 28590298 DOI: 10.1097/rlu.0000000000001720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pulmonary hypertension (PH) is characterized by abnormally increased pulmonary vascular pressure, leading to deteriorated right ventricular function and premature death. Pulmonary mean transit time (PMTT) and biventricular function response to exercise in first-pass radionuclide angiography (FP-RNA) may provide early detection and timely disease monitoring of PH. This study aimed to investigate the diagnostic and prognostic values of this imaging modality in PH patients. METHODS Left and right ventricular ejection fraction (LVEF/RVEF) and PMTT at rest and immediately after exercise treadmill test were measured by FP-RNA in 77 consecutive patients with clinical presentations suggestive of PH (aged 46 ± 15 years, 33 men), mostly with symptoms of unexplained progressive dyspnea. These parameters, along with other clinical variables, were correlated with right-sided heart catheterization data and clinical outcomes. RESULTS Fifty patients (64.9%) were diagnosed as having definite PH. Besides higher N-terminal pro-B-type natriuretic peptide levels, right atrial pressure, and pulmonary vascular resistance, PH patients had significantly longer PMTT, lower LVEF after exercise and rest, and lower poststress RVEF (all P < 0.05), compared with non-PH subjects. Moreover, PH patients exhibited stress-induced right ventricular dysfunction and stationary poststress PMTT. Poststress PMTT and echocardiography had comparable diagnostic utility (area under the curve, 0.80 vs 0.84, respectively). Eighteen patients died during a median follow-up period of 380 days. Failure of exercise treadmill test, lower peak heart rate response, and stress/rest LVEF ratio of less than 90% using exercise treadmill FP-RNA were independent predictors of mortality in PH patients. CONCLUSIONS Exercise treadmill and rest FP-RNA provided diagnostic value and had prognostic implications in patients with PH.
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Amano H, Abe S, Hirose S, Waku R, Masuyama T, Sakuma M, Toyoda S, Taguchi I, Inoue T, Tei C. Comparison of echocardiographic parameters to assess right ventricular function in pulmonary hypertension. Heart Vessels 2017; 32:1214-1219. [PMID: 28527022 DOI: 10.1007/s00380-017-0991-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/12/2017] [Indexed: 01/18/2023]
Abstract
Although measurement of right ventricular ejection fraction (RVEF) may be relevant for evaluation of therapeutic efficacy and/or prognosis in patients with pulmonary hypertension, RVEF obtained by echocardiography has limited accuracy. In contrast, radionuclide and/or magnetic resonance imaging can measure RVEF more reliably. In this study, we investigated the relationship between RVEF measured by radionuclide angiography and the echocardiographic parameters that are recommended by the American Society of Echocardiography as representative of right heart function. There were 23 study participants with pulmonary hypertension who underwent radionuclide angiography and 2-dimensional and Doppler echocardiography (n = 30 measurements). RVEF measured by radionuclide angiography correlated with right ventricular Tei index (RV Tei index) measured by Doppler echocardiography (r = -0.601, P < 0.0005). Receiver operating characteristic curve analysis showed that an RV Tei index cut-off value of 0.371 was the best of predictor of RVEF ≤35% (area under the curve = 0.768, sensitivity = 0.857, selectivity = 0.667). Multiple regression analysis showed that RVEF was correlated with the RV Tei index, and this association was independent of other echocardiographic right ventricular function parameters (r = -0.644, P < 0.005). The RV Tei index measured by Doppler echocardiography may be an acceptable surrogate marker of RVEF in patients with pulmonary hypertension.
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Affiliation(s)
- Hirohisa Amano
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shichiro Abe
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Suguru Hirose
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Ryutaro Waku
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Taiki Masuyama
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Masashi Sakuma
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shigeru Toyoda
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Isao Taguchi
- The Department of Cardiology, Koshigaya Hospital, Dokkyo Medical University School of Medicine, Koshigaya, Japan
| | - Teruo Inoue
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Chuwa Tei
- The Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.,Waon Therapy Research Institute, Tokyo, Japan
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Lin ACW, Strugnell WE, Seale H, Schmitt B, Schmidt M, O'Rourke R, Slaughter RE, Kermeen F, Hamilton-Craig C, Morris NR. Exercise cardiac MRI-derived right ventriculo-arterial coupling ratio detects early right ventricular maladaptation in PAH. Eur Respir J 2016; 48:1797-1800. [PMID: 27660512 DOI: 10.1183/13993003.01145-2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/23/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Aaron C W Lin
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, Australia .,Menzies Health Institute Queensland and Griffith University, Southport, Australia
| | - Wendy E Strugnell
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, Australia.,Menzies Health Institute Queensland and Griffith University, Southport, Australia
| | - Helen Seale
- Physiotherapy Dept, The Prince Charles Hospital, Brisbane, Australia
| | | | | | - Rachael O'Rourke
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Richard E Slaughter
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, Australia
| | - Fiona Kermeen
- Pulmonary Hypertension Unit, The Prince Charles Hospital, Brisbane, Australia
| | - Christian Hamilton-Craig
- Richard Slaughter Centre of Excellence in Cardiovascular MRI, The Prince Charles Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Norman R Morris
- Menzies Health Institute Queensland and Griffith University, Southport, Australia
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Truong U, Patel S, Kheyfets V, Dunning J, Fonseca B, Barker AJ, Ivy D, Shandas R, Hunter K. Non-invasive determination by cardiovascular magnetic resonance of right ventricular-vascular coupling in children and adolescents with pulmonary hypertension. J Cardiovasc Magn Reson 2015; 17:81. [PMID: 26376972 PMCID: PMC4574020 DOI: 10.1186/s12968-015-0186-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/21/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pediatric pulmonary hypertension (PH) remains a disease with high morbidity and mortality in children. Understanding ventricular-vascular coupling, a measure of how well matched the ventricular and vascular function are, may elucidate pathway leading to right heart failure. Ventricular vascular coupling ratio (VVCR), comprised of effective elastance (Ea, index of arterial load) and right ventricular maximal end-systolic elastance (Ees, index of contractility), is conventionally determined by catheterization. Here, we apply a non-invasive approach to determining VVCR in pediatric subjects with PH. METHODS This retrospective study included PH subjects who had a cardiovascular magnetic resonance (CMR) study within 14 days of cardiac catheterization. PH was defined as mean pulmonary artery pressure (mPAP) ≥ 25 mmHg on prior or current catheterization. A non-invasive measure of VVCR was derived from CMR-only (VVCRm) and compared to VVCR estimated by catheterization-derived single beat estimation (VVCRs). Indexed pulmonary vascular resistance (PVRi) and pulmonary vascular reactivity were determined during the catheterization procedure. Pearson correlation coefficients were calculated between PVRi and VVCRm. Receiver operating characteristic (ROC) curve analysis determined the diagnostic value of VVCRm in predicting vascular reactivity. RESULTS Seventeen subjects (3 months-23 years; mean 11.3 ± 7.4 years) were identified between January 2009-August 2013 for inclusion with equal gender distributions. Mean mPAP was 35 mmHg ± 15 and PVRi was 8.5 Woods unit x m2 ± 7.8. VVCRm (range 0.43-2.82) increased with increasing severity as defined by PVRi (p < 0.001), and was highly correlated with PVRi (r = 0.92, 95 % CI 0.79-0.97, p < 0.0001). Regression of VVCRm and PVRi demonstrated differing lines when separated by reactivity. VVCRm was significantly correlated with VVCRs (r = 0.79, CI 0.48-0.99, p <0.0001). ROC curve analysis showed high accuracy of VVCRm in determining vascular reactivity (VVCR = 0.85 had a sensitivity of 100 % and a specificity of 80 %) with an area under the curve of 0.89 (p = 0.008). CONCLUSION Measurement of VVCRm in pediatrics is feasible. Pulmonary vascular non-reactivity may be contribute to ventricular-vascular decoupling in severe PH. Therapeutic intervention to maintain a low vascular afterload in reactive patients may preserve right ventricular functional reserve and delay the onset of RV-PA decoupling. Use of VVCRm may have significant prognostic implication.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
- Department for Pediatrics, Division of Cardiology, Children's Hospital Colorado, University of Colorado Anschultz Medical Center, 13123 E. 16th Avenue, B100, Aurora, CO, 80045, USA.
| | - Sonali Patel
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Vitaly Kheyfets
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
| | - Jamie Dunning
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
| | - Brian Fonseca
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, IL, USA.
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Robin Shandas
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
| | - Kendall Hunter
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
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7
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Right Ventricular Geometry and Function in Pulmonary Hypertension: Non-Invasive Evaluation. Diseases 2014. [DOI: 10.3390/diseases2030274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: Retrospective single center analysis. Int J Cardiol 2014; 175:333-9. [DOI: 10.1016/j.ijcard.2014.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/13/2014] [Accepted: 06/01/2014] [Indexed: 01/15/2023]
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9
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Sato T, Tsujino I, Oyama-Manabe N, Ohira H, Ito YM, Sugimori H, Yamada A, Takashina C, Watanabe T, Nishimura M. Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension. Int J Cardiovasc Imaging 2013; 29:1799-805. [DOI: 10.1007/s10554-013-0286-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/26/2013] [Indexed: 11/30/2022]
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10
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Henein M, Waldenström A, Mörner S, Lindqvist P. The normal impact of age and gender on right heart structure and function. Echocardiography 2013; 31:5-11. [PMID: 23822635 DOI: 10.1111/echo.12289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As the proportion of elderly population increases rapidly, it might be difficult to differentiate physiological changes in cardiac function due to age from the pathophysiological ones. In addition, cardiac function variations with gender are well established. The right ventricular (RV) plays an important role in the overall cardiac function, but reference values varying with age and gender are lacking. MATERIAL AND METHODS We studied 255 healthy individuals from a general population register, mean age of 58 ± 19 (range 22-89) years, 125 were females. We used 2D and M-mode echocardiography to measure RV inflow tract (RVIT) and RV outflow tract (RVOT) dimensions and fractional shortening (fs). Spectral Doppler echocardiography was also used. RESULTS We found a modest decrease in RVIT dimensions (P < 0.05), but increase in RVOT dimensions with advancing age (P < 0.05). A small decrease in RVOT fs with age was also found (P < 0.05). Estimated pulmonary pressures and pulmonary vascular resistance increased (P < 0.001) as did RVOT wall thickness (P < 0.001), but RV diastolic function was not altered (P < 0.001) with age. Despite correction for the BSA, males showed larger RVIT dimensions (P < 0.001 for both), but RVOT end-diastolic dimension was larger in females (P < 0.05). RVIT and RVOT fractional shortening were increased in females (P < 0.01 for both). CONCLUSION In a cohort of normal individuals, age has significant impact on RV structure and function, inlet area falls and outflow tract dimensions increase and fractional shortening also increase in females. In addition, RVOT wall thickness significantly increases and Doppler markers of pulmonary vascular resistance show a consistent rise. The age-related changes should carefully be considered when commenting on normality and when using absolute values.
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Affiliation(s)
- Michael Henein
- Department of Cardiology, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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11
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Freed BH, Patel AR, Lang RM. Redefining the Role of Cardiovascular Imaging in Patients with Pulmonary Arterial Hypertension. Curr Cardiol Rep 2012; 14:366-73. [DOI: 10.1007/s11886-012-0253-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Freed BH, Gomberg-Maitland M, Chandra S, Mor-Avi V, Rich S, Archer SL, Jamison EB, Lang RM, Patel AR. Late gadolinium enhancement cardiovascular magnetic resonance predicts clinical worsening in patients with pulmonary hypertension. J Cardiovasc Magn Reson 2012; 14:11. [PMID: 22296860 PMCID: PMC3311144 DOI: 10.1186/1532-429x-14-11] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 02/01/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) occurs at the right ventricular (RV) insertion point (RVIP) in patients with pulmonary hypertension (PH) and has been shown to correlate with cardiovascular magnetic resonance (CMR) derived RV indices. However, the prognostic role of RVIP-LGE and other CMR-derived parameters of RV function are not well established. Our aim was to evaluate the predictive value of contrast-enhanced CMR in patients with PH. METHODS RV size, ejection fraction (RVEF), and the presence of RVIP-LGE were determined in 58 patients with PH referred for CMR. All patients underwent right heart catheterization, exercise testing, and N-terminal pro-brain natriuretic peptide (NT-proBNP) evaluation; results of which were included in the final analysis if performed within 4 months of the CMR study. Patients were followed for the primary endpoint of time to clinical worsening (death, decompensated right ventricular heart failure, initiation of prostacyclin, or lung transplantation). RESULTS Overall, 40/58 (69%) of patients had RVIP-LGE. Patients with RVIP- LGE had larger right ventricular volume index, lower RVEF, and higher mean pulmonary artery pressure (mPAP), all p < 0.05. During the follow-up period of 10.2 ± 6.3 months, 19 patients reached the primary endpoint. In a univariate analysis, RVIP-LGE was a predictor for adverse outcomes (p = 0.026). In a multivariate analysis, CMR-derived RVEF was an independent predictor of clinical worsening (p = 0.036) along with well-established prognostic parameters such as exercise capacity (p = 0.010) and mPAP (p = 0.001). CONCLUSIONS The presence of RVIP-LGE in patients with PH is a marker for more advanced disease and poor prognosis. In addition, this study reveals for the first time that CMR-derived RVEF is an independent non-invasive imaging predictor of adverse outcomes in this patient population.
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MESH Headings
- Adult
- Aged
- Biomarkers/blood
- Blood Pressure
- Cardiac Catheterization
- Chi-Square Distribution
- Chicago
- Contrast Media
- Disease Progression
- Exercise Test
- Female
- Gadolinium DTPA
- Heart Failure/etiology
- Heart Failure/physiopathology
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/mortality
- Hypertension, Pulmonary/physiopathology
- Kaplan-Meier Estimate
- Linear Models
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Multivariate Analysis
- Natriuretic Peptide, Brain/blood
- Peptide Fragments/blood
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Pulmonary Artery/physiopathology
- Risk Assessment
- Risk Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Right/blood
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/mortality
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Benjamin H Freed
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Mardi Gomberg-Maitland
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Sonal Chandra
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Victor Mor-Avi
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Stuart Rich
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Stephen L Archer
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - E Bruce Jamison
- Department of Radiology, University of Chicago Medical Center
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
- Department of Radiology, University of Chicago Medical Center
| | - Amit R Patel
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
- Department of Radiology, University of Chicago Medical Center
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Grapsa J, Gibbs JSR, Cabrita IZ, Watson GF, Pavlopoulos H, Dawson D, Gin-Sing W, Howard LSGE, Nihoyannopoulos P. The association of clinical outcome with right atrial and ventricular remodelling in patients with pulmonary arterial hypertension: study with real-time three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012; 13:666-72. [DOI: 10.1093/ehjci/jes003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Progressive Right Ventricular Dysfunction in Patients With Pulmonary Arterial Hypertension Responding to Therapy. J Am Coll Cardiol 2011; 58:2511-9. [DOI: 10.1016/j.jacc.2011.06.068] [Citation(s) in RCA: 602] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/07/2011] [Indexed: 11/18/2022]
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15
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Bradlow WM, Hughes ML, Keenan NG, Bucciarelli-Ducci C, Assomull R, Gibbs JSR, Mohiaddin RH. Measuring the heart in pulmonary arterial hypertension (PAH): implications for trial study size. J Magn Reson Imaging 2010; 31:117-24. [PMID: 20027579 DOI: 10.1002/jmri.22011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To calculate the sample size for a theoretical pulmonary arterial hypertension (PAH) randomized controlled trial (RCT) by using cardiovascular magnetic resonance (CMR) imaging to determine the repeatability of measures between two scans. MATERIALS AND METHODS Two same-day examinations from 10 PAH patients were analyzed manually and semiautomatically. Study size was calculated from the standard deviation (SD) of repeatability. Different approaches to right-ventricle (RV) mass were investigated, agreement between methods tested and interobserver reproducibility measured by Bland-Altman analysis to explore how the PAH heart might be best measured. RESULTS Repeatability was good for almost all manually-measured indices but poor for semiautomated measurement of RV mass and left-ventricle (LV) end-diastolic volume (EDV). Thus, for an RCT (power, 80%; significance level, 5%) analyzing "outcome" indices (RVEDV, LVEDV, RV ejection fraction, and RV mass; anticipated change: 10 mL, 10 mL, 3%, and 10 g, respectively) manually, 34 patients are required compared to 78 if analysis is semiautomated. RV mass was repeatable if the interventricular septum was divided between ventricles or if wholly apportioned to the LV. Limits of agreement between manual and semiautomated analyses were unsatisfactory for RV measures and interobserver reproducibility was worse for semiautomated than manual analysis. CONCLUSION Manual is more robust than semiautomated analysis and at present should be favored in RCTs in PAH as it leads to lower sample size requirements.
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Affiliation(s)
- William M Bradlow
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
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Sallach JA, Tang WW, Borowski AG, Tong W, Porter T, Martin MG, Jasper SE, Shrestha K, Troughton RW, Klein AL. Right Atrial Volume Index in Chronic Systolic Heart Failure and Prognosis. JACC Cardiovasc Imaging 2009; 2:527-34. [DOI: 10.1016/j.jcmg.2009.01.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 01/05/2009] [Accepted: 01/09/2009] [Indexed: 11/25/2022]
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Aho MR, Gebregziabher M, Schoepf UJ, Suranyi P, Lee H, Gregg D, Costello P, Zwerner PL. Impact of right ventricular contrast attenuation on the accuracy of right ventricular function analysis at cardiac multi-detector-row CT. Eur J Radiol 2009; 73:560-5. [PMID: 19167178 DOI: 10.1016/j.ejrad.2008.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 11/03/2008] [Accepted: 12/11/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the impact of right ventricle (RV) contrast attenuation on the accuracy of RV function analysis at cardiac CT performed for coronary imaging. MATERIALS AND METHODS We analyzed multi-phase cardiac dual-source CT studies of 40 consecutive patients (mean age 60.9+/-12.3 years; 13 women) with normal valve function. Function analyses of both the right and left ventricle (RV and LV) were performed using dedicated post processing software and stroke volumes (SV) were computed for each ventricle. The accuracy of the RV-SV measurements was determined based upon comparison to LV-SV measurement. The level of contrast attenuation of the RV was recorded at three separate regions of interest-below the pulmonary valve, mid-ventricular, and inferior RV. The accuracy of RV function assessment was correlated with the level of attenuation using regression analyses. RESULTS There was a statistically significant correlation between the accuracy of RV function assessment and the level of RV attenuation in the inferior RV (adjusted R(2)=73.1%, p<0.0001). When compared to LV-SV measurements, in studies with low RV attenuation (<175 HUs, n=19) the mean deviation of RV-SV from LV-SV was 29.0+/-10.8 ml (42.1+/-13.9%). In studies with high RV attenuation (> or =175 HUs, n=21) the mean deviation of RV-SV from LV-SV was significantly lower 6.9+/-10.5 ml (9.9+/-16.0%). CONCLUSION The accuracy of RV function analysis is dependent on the level of contrast medium attenuation achieved in the inferior RV. There should be at least intermediate attenuation (>175 HUs) to enable accurate functional analysis. At low attenuation levels RV function parameters are prone to underestimation.
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Affiliation(s)
- Michael R Aho
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
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The role of first-pass radionuclide angiography in the era of gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2008; 15:838-40. [PMID: 18984460 DOI: 10.1007/bf03007366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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