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Vieira MLC, Branco CEDB, Gazola ASL, Vieira PPAC, Benvenuti LA, Demarchi LMMF, Gutierrez PS, Aiello VD, Tarasoutchi F, Sampaio RO. 3D Echocardiography for Rheumatic Heart Disease Analysis: Ready for Prime Time. Front Cardiovasc Med 2021; 8:676938. [PMID: 34355026 PMCID: PMC8329529 DOI: 10.3389/fcvm.2021.676938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.
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Affiliation(s)
- Marcelo Luiz Campos Vieira
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Flávio Tarasoutchi
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil
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Kanemaru E, Yoshitani K, Fukushima S, Fujita T, Ohnishi Y. Effect of left ventricular assist device implantation on right ventricular function: Assessment based on right ventricular pressure-volume curves. Artif Organs 2020; 44:1192-1201. [PMID: 32530056 DOI: 10.1111/aor.13749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/16/2020] [Accepted: 06/02/2020] [Indexed: 12/21/2022]
Abstract
Right ventricular (RV) failure is significantly associated with morbidity and mortality after left ventricular assist device (LVAD) implantation. However, it remains unclear whether LVAD implantation could worsen RV function. Therefore, we aimed to investigate the effect of LVAD implantation on RV function by comparing RV energetics derived from the RV pressure-volume curve between before and after LVAD implantation. This exploratory observational study was performed between September 2016 and January 2018 at a national center in Japan. Twenty-two patients who underwent LVAD implantation were included in the analysis. We measured RV energetics parameters: RV stroke work index (RVSWI), which was calculated by integrating the area within the RV pressure-volume curve; RV minute work index (RVMWI), which was calculated as RVSWI × heart rate; and right ventriculo-arterial coupling, which was estimated as RV stroke volume/RV end-systolic volume. We compared RV energetics between before and after LVAD implantation. Although RVSWI was similar [424.4 mm Hg · mL/m2 (269.5-510.3) vs. 379.9 mm Hg · mL/m2 (313.1-608.8), P = 0.485], RVMWI was significantly higher after LVAD implantation [29 834.1 mm Hg · mL/m2 /min (18 272.2-36 357.1) vs. 38 544.8 mm Hg · mL/m2 /min (29 016.0-57 282.8), P = 0.001], corresponding to a significantly higher cardiac index [2.0 L/min/m2 (1.4-2.2) vs. 3.7 L/min/m2 (3.3-4.1), P < 0.001] to match LVAD flow. Right ventriculo-arterial coupling was significantly higher after LVAD implantation [0.360 (0.224-0.506) vs. 0.480 (0.343-0.669), P = 0.025], suggesting that the efficiency of RV performance improved. In conclusion, higher RVMWI with higher cardiac index to match LVAD flow and improved efficiency of RV performance indicate that LVAD implantation might not worsen RV function.
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Affiliation(s)
- Eiki Kanemaru
- Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kenji Yoshitani
- Department of Transfusion, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Suita, Japan
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Kanemaru E, Yoshitani K, Kato S, Fujii T, Tsukinaga A, Ohnishi Y. Comparison of Right Ventricular Function Between Patients With and Without Pulmonary Hypertension Owing to Left-Sided Heart Disease: Assessment Based on Right Ventricular Pressure–Volume Curves. J Cardiothorac Vasc Anesth 2020; 34:143-150. [DOI: 10.1053/j.jvca.2019.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/11/2022]
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Acquatella H, Asch FM, Barbosa MM, Barros M, Bern C, Cavalcante JL, Echeverria Correa LE, Lima J, Marcus R, Marin-Neto JA, Migliore R, Milei J, Morillo CA, Nunes MCP, Campos Vieira ML, Viotti R. Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC). J Am Soc Echocardiogr 2018; 31:3-25. [DOI: 10.1016/j.echo.2017.10.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kiernan MS, French AL, DeNofrio D, Parmar YJ, Pham DT, Kapur NK, Pandian NG, Patel AR. Preoperative Three-Dimensional Echocardiography to Assess Risk of Right Ventricular Failure After Left Ventricular Assist Device Surgery. J Card Fail 2015; 21:189-97. [DOI: 10.1016/j.cardfail.2014.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 11/21/2014] [Accepted: 12/16/2014] [Indexed: 12/31/2022]
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Shi D, Zhang J, Liu X, Zhang G, Cui L. Evaluation of the right ventricular function in pneumoconiosis patients using volume-time curves obtained by real-time three-dimensional echocardiography. Cell Biochem Biophys 2014; 70:1553-7. [PMID: 25005772 DOI: 10.1007/s12013-014-0092-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study was aimed to evaluate the right ventricular function in pneumoconiosis patients by real-time three-dimensional echocardiography. A total of 80 individuals including 44 consecutive pneumoconiosis patients and 36 age- and gender-matched healthy volunteers as controls were prospectively recruited for the study. All the patients underwent two- and three-dimensional echocardiography. Measurements of the right ventricle included tricuspid regurgitation pressure (TRPG), anterior and posterior wall thickness and range of motion (TH1, TH2, M1, M2), right end-diastolic volume and end-systolic volume. The right ventricular ejection fraction (RVEF) was also calculated. The RVEF of healthy volunteers ranged from 50 to 78 %, whereas that of the pneumoconiosis patients varied from 29 to 73 %. An increase in TRPG caused a significant (p = 0.006) decrease in RVEF (by 77.3 %), suggesting the two variables were negatively correlated (r = -0.643, p < 0.01). In comparison with normal, the volume-time curves of the pneumoconiosis patients showed a lower trough. Use of real-time three-dimensional echocardiography provides with added clinical information needed to evaluate right ventricular function in pneumoconiosis patients.
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Affiliation(s)
- Doufei Shi
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, NO. 324 Jing Wu Road, Jinan, 250021, People's Republic of China
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Vieira MLC, Oliveira WA, Cordovil A, Rodrigues ACT, Mônaco CG, Afonso T, Lira Filho EB, Perin M, Fischer CH, Morhy SS. 3D Echo pilot study of geometric left ventricular changes after acute myocardial infarction. Arq Bras Cardiol 2013; 101:43-51. [PMID: 23740401 PMCID: PMC3998181 DOI: 10.5935/abc.20130112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 03/25/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Left ventricular remodeling (LVR) after AMI characterizes a factor of poor prognosis. There is little information in the literature on the LVR analyzed with three-dimensional echocardiography (3D ECHO). OBJECTIVE To analyze, with 3D ECHO, the geometric and volumetric modifications of the left ventricle (VE) six months after AMI in patients subjected to percutaneous primary treatment. METHODS Prospective study with 3D ECHO of 21 subjects (16 men, 56 ± 12 years-old), affected by AMI with ST segment elevation. The morphological and functional analysis (LV) with 3D ECHO (volumes, LVEF, 3D sphericity index) was carried out up to seven days and six months after the AMI. The LVR was considered for increase > 15% of the end diastolic volume of the LV (LVEDV) six months after the AMI, compared to the LVEDV up to seven days from the event. RESULTS Eight (38%) patients have presented LVR. Echocardiographic measurements (n = 21 patients): I- up to seven days after the AMI: 1- LVEDV: 92.3 ± 22.3 mL; 2- LVEF: 0.51 ± 0.01; 3- sphericity index: 0.38 ± 0.05; II- after six months: 1- LVEDV: 107.3 ± 26.8 mL; 2- LVEF: 0.59 ± 0.01; 3- sphericity index: 0.31 ± 0.05. Correlation coefficient (r) between the sphericity index up to seven days after the AMI and the LVEDV at six months (n = 8) after the AMI: r: 0.74, p = 0.0007; (r) between the sphericity index six months after the AMI and the LVEDV at six months after the AMI: r: 0.85, p < 0.0001. CONCLUSION In this series, LVR has been observed in 38% of the patients six months after the AMI. The three-dimensional sphericity index has been associated to the occurrence of LVR.
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Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease. J Thorac Cardiovasc Surg 2013; 145:1234-1241.e5. [DOI: 10.1016/j.jtcvs.2012.01.088] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 12/07/2011] [Accepted: 01/04/2012] [Indexed: 01/26/2023]
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Abstract
Real-time 3D echocardiography is one of the most important developments in the field of non-invasive cardiac imaging within the last years. To investigate whether this new technology can be considered as a standard method the current guidelines and recommendations were reviewed. In the field of left ventricular function assessment, evaluation of mitral valve pathologies and peri-interventional monitoring of percutaneous valve repair procedures 3D echocardiography plays a major role. For other clinical applications, such as right heart assessment, congenital heart disease and stress echocardiography, a high potential is seen but evidence is currently too weak for general recommendations. However, in the near future no echo laboratory will be working without 3D modalities.
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Desai RR, Vargas Abello LM, Klein AL, Marwick TH, Krasuski RA, Ye Y, Nowicki ER, Rajeswaran J, Blackstone EH, Pettersson GB. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg 2012; 146:1126-1132.e10. [PMID: 23010580 DOI: 10.1016/j.jtcvs.2012.08.061] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 07/30/2012] [Accepted: 08/23/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function. METHODS From 2001 to 2007, 1833 patients with degenerative mitral valve disease, a structurally normal tricuspid valve, and no coronary artery disease underwent mitral valve repair, and 67 underwent concomitant tricuspid valve repair. Right ventricular function (myocardial performance index and tricuspid annular plane systolic excursion) was measured before and after surgery using transthoracic echocardiography for randomly selected patients with tricuspid regurgitation grade 0, 1+, and 2+ (100 patients for each grade) and 93 with grade 3+/4+, 393 patients in total. RESULTS In patients with mild (<3+) preoperative tricuspid regurgitation, mitral valve repair alone was associated with reduced tricuspid regurgitation and mild worsening of right ventricular function. Tricuspid regurgitation of 2+ or greater developed in fewer than 20%, and right ventricular function had improved, but not to preoperative levels, at 3 years. In patients with severe (3+/4+) preoperative tricuspid regurgitation, mitral valve repair alone reduced tricuspid regurgitation and improved right ventricular function; however, tricuspid regurgitation of 2+ or greater returned and right ventricular function worsened toward preoperative levels within 3 years. Concomitant tricuspid valve repair effectively eliminated severe tricuspid regurgitation and improved right ventricular function. Also, over time, tricuspid regurgitation did not return and right ventricular function continued to improve to levels comparable to that of patients with lower grades of preoperative tricuspid regurgitation. CONCLUSIONS In patients with mitral valve disease and severe tricuspid regurgitation, mitral valve repair alone was associated with improved tricuspid regurgitation and right ventricular function. However, the improvements were incomplete and temporary. In contrast, concomitant tricuspid valve repair effectively and durably eliminated severe tricuspid regurgitation and improved right ventricular function toward normal, supporting an aggressive approach to important functional tricuspid regurgitation.
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Affiliation(s)
- Ravi R Desai
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Séguéla PE, Hascoët S, Brierre G, Bongard V, Acar P. Feasibility of Three-Dimensional Transthoracic Echocardiography to Evaluate Right Ventricular Volumes in Children and Comparison to Left Ventricular Values. Echocardiography 2011; 29:492-501. [PMID: 22150697 DOI: 10.1111/j.1540-8175.2011.01596.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23:685-713; quiz 786-8. [PMID: 20620859 DOI: 10.1016/j.echo.2010.05.010] [Citation(s) in RCA: 4901] [Impact Index Per Article: 350.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lawrence G Rudski
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Leibundgut G, Rohner A, Grize L, Bernheim A, Kessel-Schaefer A, Bremerich J, Zellweger M, Buser P, Handke M. Dynamic assessment of right ventricular volumes and function by real-time three-dimensional echocardiography: a comparison study with magnetic resonance imaging in 100 adult patients. J Am Soc Echocardiogr 2010; 23:116-26. [PMID: 20152692 DOI: 10.1016/j.echo.2009.11.016] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to validate a novel real-time three-dimensional echocardiographic (RT3DE) analysis tool for the determination of right ventricular volumes and function in unselected adult patients. METHODS A total of 100 consecutive adult patients with normal or pathologic right ventricles were enrolled in the study. A dynamic polyhedron model of the right ventricle was generated using dedicated RT3DE software. Volumes and ejection fractions were determined and compared with results obtained on magnetic resonance imaging (MRI) in 88 patients with adequate acquisitions. RESULTS End-diastolic, end-systolic, and stroke volumes were slightly lower on RT3DE imaging than on MRI (124.0 +/- 34.4 vs 134.2 +/- 39.2 mL, P < .001; 65.2 +/- 23.5 vs 69.7 +/- 25.5 mL, P = .02; and 58.8 +/- 18.4 vs 64.5 +/- 24.1 mL, P < .01, respectively), while no significant difference was observed for ejection fraction (47.8 +/- 8.5% vs 48.2 +/- 10.8%, P = .57). Correlation coefficients on Bland-Altman analysis were r = 0.84 (mean difference, 10.2 mL; 95% confidence interval [CI], -31.3 to 51.7 mL) for end-diastolic volume, r = 0.83 (mean difference, 4.5 mL; 95% CI, -23.8 to 32.9 mL) for end-systolic volume, r = 0.77 (mean difference, 5.7 mL; 95% CI, -24.6 to 36.0 mL) for stroke volume, and r = 0.72 (mean difference, 0.4%; 95% CI, -14.2% to 15.1%) for ejection fraction. CONCLUSION Right ventricular volumes and ejection fractions as assessed using RT3DE imaging compare well with MRI measurements. RT3DE imaging may become a time-saving and cost-saving alternative to MRI for the quantitative assessment of right ventricular size and function.
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Affiliation(s)
- Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
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Ding J, Ma G, Huang Y, Wang C, Zhang X, Zhu J, Lu F. Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect. Echocardiography 2009; 26:1146-52. [DOI: 10.1111/j.1540-8175.2009.00941.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Non-invasive investigations of the right heart: how and why? Arch Cardiovasc Dis 2009; 102:219-32. [PMID: 19375676 DOI: 10.1016/j.acvd.2008.12.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 12/29/2008] [Indexed: 11/20/2022]
Abstract
The importance of right ventricular (RV) function in the clinical management of patients with cardiopulmonary disorders is now well recognized. However, due to both its shape and location and to the load dependence of its ejection fraction, accurate evaluation of its function is still a challenge. Echocardiography allows morphological, hemodynamic and functional assessment of the right heart. Displacement and deformation parameters derived from new techniques are promising tools. 3D echocardiography also has a potential interest in the quantification of RV volumes and ejection fraction. Radionuclide technique allows an easy and accurate measurement of right ventricular ejection fraction. MRI remains nowadays the technique of choice for the quantification of volumes and function of the RV. All these techniques have proven their interest in various diseases affecting the right heart. RV function is an important prognostic factor in heart failure and is a major component of functional capacity in such patients. In pulmonary arterial hypertension, echocardiography is the best tool for the routine follow-up of patients. Finally, all these non-invasive techniques of investigation of the right heart enable the diagnosis of specific right ventricular damage such as myocardial infarction or arrhythmogenic right ventricular dysplasia.
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Domingo E, Aguilar R, López-Meseguer M, Teixidó G, Vazquez M, Roman A. New concepts in the invasive and non invasive evaluation of remodelling of the right ventricle and pulmonary vasculature in pulmonary arterial hypertension. Open Respir Med J 2009; 3:31-7. [PMID: 19452037 PMCID: PMC2682922 DOI: 10.2174/1874306400903010031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 01/17/2009] [Accepted: 01/19/2009] [Indexed: 11/22/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare fatal disease defined as a sustained elevation of pulmonary arterial pressure to more than 25 mmHg at rest, with a mean pulmonary-capillary wedge pressure and left ventricular enddiastolic pressure of less than 15 mmHg at rest. Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers. These changes, named as vascular remodelling, include vascular proliferation, fibrosis, and vessel obstruction. In clinical practice the diagnosis of PAH relies on measurements of pulmonary vascular pressure and cardiac output, and calculation of pulmonary vascular resistances. Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio and diminished pulsatility than in control patients. Optical Coherence Tomography, a new high resolution imaging modality that has proven its superiority over intravascular ultrasound (IVUS) for the detection and characterization of coronary atherosclerotic plaque composition, may potentially be a useful technique for the in vivo study of the pulmonary arterial wall. In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle. This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.
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Affiliation(s)
- Enric Domingo
- Cardiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain
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Arnould MA, Gougnot S, Lemoine S, Lemoine J, Aliot E, Juillière Y, Selton-Suty C. [Quantification of right ventricular function by 2D speckle imaging and three dimensional echography. Comparison with MRI]. Ann Cardiol Angeiol (Paris) 2008; 58:74-85. [PMID: 19345336 DOI: 10.1016/j.ancard.2008.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 11/04/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE The echocardiographic assessment of right ventricular (RV) function requires many different parameters. We studied and compared with magnetic resonance imaging (MRI) two markers of RV function derived from new imaging tools: 2D speckle imaging (2DSI) and three dimensional echography. METHODS AND RESULTS Thirty-two patients (19 with RV ejection fraction [RVEF]< or =45%) underwent both complete echocardiography--including standard parameters of RV function (fractional area change [FAC], Tei index, systolic velocity of tricuspid annulus by DTI), 3D full-volume acquisition on RV--and MRI for the evaluation of RV volumes and RVEF. 2DSI was applied to high frame rate cine loops centred on the RV free wall with measurement of peak systolic strain (%) in the basal, median and apical segments of this wall. Strain, especially in RV median and apical segments, is reduced in patients with RVEF less or equal to 45% (median strain: -16.39+/-5.27 vs. -24.74+/-8.00 [p=0.002]; apical strain -13.01+/-6.84 vs. 22.53+/-11.32 [p=0.03]) with a very good correlation with RVEF (r=-0.717, p=0.0001) but also with the usual echographic parameters of RV function, (FAC: r=0.019; Tei: r=0.01; peak systolic velocity: r=0.002). The 3D RVEF is also but poorly correlated with MRI RVEF, (r=0.447, p=0.017). Furthermore, 3D significantly underestimated RV volumes. By multivariate analysis, apical strain (p=0.004) and FAC (p=0.029) were predictive of a decreased RVEF. CONCLUSION Apical strain as measured from 2DSI seems a promising parameter in the estimation of RV function. 3D estimation of RVEF is more disappointing because of an important underestimation of RV volumes.
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Affiliation(s)
- M-A Arnould
- University Hospital of Nancy-Brabois, Allée du Morvan, 54500 Nancy, France.
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