Comprehensive Assessment of Right Ventricular Function in Patients with Pulmonary Hypertension with Global Longitudinal Peak Systolic Strain Derived from Multiple Right Ventricular Views

Rajagopal, Sudarshan; Forsha, Daniel; Risum, Niels; Hornik, Christoph P.; Poms, Abby; Fortin, Terry; Tapson, Victor F.; Velázquez, Eric J.; Kisslo, Joseph; Samad, Zainab

doi:10.1016/j.echo.2014.02.001

Cited by 78 publications

(68 citation statements)

References 30 publications

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“…A smaller apical cavity radius imparting less wall-stress, or that the apex shares less septum with the dysfunctional RV apex, 23, 24 might explain preserved LV apical mechanics. Rotational mechanics were also preserved, in contrast to findings in adult PH.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Myocardial Function in Children With Pulmonary Hypertension

Burkett

Slorach

Patel

et al. 2015

Circ: Cardiovascular Imaging

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Background Through ventricular interdependence, pulmonary hypertension (PH) induces left ventricular (LV) dysfunction. We hypothesized that LV strain/strain rate, surrogate measures of myocardial contractility, are reduced in pediatric PH and relate to invasive hemodynamics, right ventricular (RV) strain, and functional measures of PH. Methods and Results At two institutions, echocardiography was prospectively performed in 54 pediatric PH patients during cardiac catheterization, and in 54 matched controls. PH patients had reduced LV global longitudinal strain (LS) (-18.8 [-17.3 - -20.4]% vs. -20.2 [-19.0 - -20.9]%, P=0.0046) predominantly due to reduced basal (-12.9 [-10.8 - -16.3]% vs. -17.9 [-14.5 - -20.7]%, P<0.0001) and mid (-17.5 [-15.5 - -19.0]% vs. -21.1 [-19.1 - -23.0]%, P<0.0001) septal strain. Basal global circumferential strain (CS) was reduced (-18.7 [-15.7 - -22.1]% vs. -20.6 [-19.0 - -22.5]%, P=0.0098), as were septal and free-wall segments. Mid CS was reduced within the free-wall. Strain rates were reduced in similar patterns. “Basal septum” LS, the combined average LS of basal and mid interventricular septal segments, correlated strongly with degree of PH (r=0.66, P<0.0001), pulmonary vascular resistance (r=0.60, P<0.0001), and RV free-wall LS (r=0.64, P<0.0001). Brain natriuretic peptide levels correlated moderately with septal LS (r=0.48, P=0.0038). PH functional class correlated moderately with LV free-wall LS (r=-0.48, P=0.0051). The septum, shared between ventricles and affected by septal shift, was the most affected LV region in PH. Conclusions Pediatric PH patients demonstrate reduced LV strain/strain rate, predominantly within the septum, with relationships to invasive hemodynamics, RV strain, and functional PH measures.

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Myocardial Function in Children With Pulmonary Hypertension

Burkett

Slorach

Patel

et al. 2015

Circ: Cardiovascular Imaging

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“…RV strain analysis is another emerging modality to evaluate right heart function in PAH, and it has been shown to predict clinical outcome and response to therapy in this cohort. [23][24][25] Future work may incorporate RV strain analysis to further establish the role of RA function in PAH.…”

Section: Limitationsmentioning

confidence: 99%

Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension

2016

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Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSE RA ) and that occurring before RA contraction (TAPSE RV ). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA-FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSE RA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects. Pulmonary arterial hypertension (PAH) is characterized by marked increases in right ventricular (RV) afterload, which if left untreated leads to progressive RV dysfunction, exercise intolerance, and potentially death.1-3 As recently emphasized by the International Right Heart Foundation Working Group, the right ventricle (also RV) is only one part of the total right heart system, and the other components, including the right atrium (RA), contribute importantly to total right heart function. 4It has been recognized that in the setting of RV failure, preserved right atrial (also RA) function is essential to maintain adequate total right heart function. After RV infarction, for example, preserved RA function has been shown to improve RV filling and performance, whereas diminished RA function compromises cardiac output. 5,6 Loss of atrial function, in the form of supraventricular arrhythmias with resulting atrioventricular dyssynchrony, is also known to be poorly tolerated among patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH). 7,8 Moreover, animal models have shown that RA systolic function is, in fact, augmented in the setting of RV ischemia and that if there is a subsequent ischemic insult to the RA, RV function is significantly reduced. 7 Taken together, these studies suggest that RA function must not only be maintained but at times augmented, in order to optimize total right heart function in the setting of RV c...

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“…Speckle tracking is today widely accepted in the context of functional assessment of the left ventricle. In the last few years, there has been increasing interest in the use of this technique for RV analysis [31][32][33][34][35][36][37][38]. Compared to other markers of function, strain measurements have been reported to be angle-independent, less loadsensitive and able to accurately reflect regional deformation.…”

Section: Fig 4 Results Of Linear Regression (Top) and Bland-altman (mentioning

confidence: 97%

Semi-automated echocardiographic quantification of right ventricular size and function

Medvedofsky

Addetia

Hamilton

et al. 2015

Int J Cardiovasc Imaging

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Although parameters of right ventricular (RV) size and function are clinically important, echocardiographic assessment of this chamber is complex. Existing quantitative approaches rely on manual measurements performed on different images, and are thus time-consuming. Consequently, in clinical practice, qualitative assessment is usually used instead. We tested a new approach for automated measurements of RV size and function using speckle tracking by comparing them to the conventional manual methodology. Transthoracic images were obtained in 149 patients with a wide range of RV size and function, and were analyzed by an expert using conventional techniques to obtain RV end-diastolic and end-systolic areas, fractional area change, dimensions (basal and mid-cavity diameters and length), tricuspid annular plane systolic excursion and peak systolic velocity. Same parameters were obtained using the semi-automated software (Epsilon Imaging), which requires tracing of the RV endocardial boundary in a single frame in the RV focused view. Fifteen patients were excluded due to image quality (90% feasibility). Time required for the automated analysis was approximately 30 s per patient, compared to 4 min for conventional analysis. The parameters obtained with the semi-automated approach were in good agreement with manual measurements: r-values 0.79-0.95 for RV size and 0.70-0.74 for function indices and biases of 2-22% of the mean measured values, which were comparable to the intrinsic variability of the conventional technique. In conclusion, the semi-automated technique is feasible, fast and provides quantitative parameters of RV size and function, which are comparable to conventional measurements.

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Comprehensive Assessment of Right Ventricular Function in Patients with Pulmonary Hypertension with Global Longitudinal Peak Systolic Strain Derived from Multiple Right Ventricular Views

Cited by 78 publications

References 30 publications

Left Ventricular Myocardial Function in Children With Pulmonary Hypertension

Left Ventricular Myocardial Function in Children With Pulmonary Hypertension

Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension

Semi-automated echocardiographic quantification of right ventricular size and function

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