Comprehensive echocardiographic evaluation of the right heart in patients with pulmonary vascular diseases: the PVDOMICS experience

Abstract

Aims There is a wide spectrum of diseases associated with pulmonary hypertension, pulmonary vascular remodelling, and right ventricular dysfunction. The NIH-sponsored PVDOMICS network seeks to perform comprehensive clinical phenotyping and endophenotyping across these disorders to further evaluate and define pulmonary vascular disease. Methods and results Echocardiography represents the primary non-invasive method to phenotype cardiac anatomy, function, and haemodynamics in these complex patients. However, comprehensive right heart evaluation requires the use of multiple echocardiographic parameters and optimized techniques to ensure optimal image acquisition. The PVDOMICS echo protocol outlines the best practice approach to echo phenotypic assessment of the right heart/pulmonary artery unit. Conclusion Novel workflow processes, methods for quality control, data for feasibility of measurements, and reproducibility of right heart parameters derived from this study provide a benchmark frame of reference. Lessons learned from this protocol will serve as a best practice guide for echocardiographic image acquisition and analysis across the spectrum of right heart/pulmonary vascular disease.

Relationship of TAPSE Normalized by Right Ventricular Area With Pulmonary Compliance, Exercise Capacity, and Clinical Outcomes

“…5 While RV fractional area change can capture RV’s longitudinal and transverse contraction, its measurement using echocardiography is often limited by inconsistent windows, poor endocardial definition of RV walls, and trabeculations on the endocardial surface. 1,6,29 It also fails to account for the RV outflow tract and results in the underestimation of RV volumes. 30 The current study combines both of these metrics (TAPSE and RV areas) to reduce the limitations and improve the utility of 2-dimensional echocardiography in PH.…”

“…We further divided the entire cohort based on hemodynamic phenotype, leading to a dilution of sample size within each group with a small sample size, which may contribute to type II error. Using an echocardiogram to calculate the RV area is technically challenging given its limited windows, poor endocardial definition of RV walls, and trabeculations on the endocardial surface 1,6,29 ; however, we only included subjects with good windows and excluded subjects with poor endocardial definition of RV free wall. Lastly, the current study excluded patients with prior cardiothoracic surgery to reduce bias from postcardiotomy patients.…”

The heart of the matter: Right heart imaging indicators for treatment escalation in pulmonary arterial hypertension

“… 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 Of the at least 20 parameters studied, only RA area, the ratio of TAPSE with pulmonary artery systolic pressure (TAPSE/PASP), and pericardial effusion are cited in guidelines. 5 , 34 , 35 Additionally, significant gaps exist in the literature due to nonstandardized imaging variables and algorithms and a lack of large multicenter studies or systematic data collection across studies, 36 rendering evidence related to the use of RH imaging relatively weak and limited. There is little consensus on which RH imaging variables are appropriate, how objective imaging should be incorporated into the standard of care, whether imaging provides value beyond standard assessments of risk, and how imaging should be used in treatment decision‐making.…”

Pulmonary pulse transit time: A promising marker in assessing early cardiopulmonary hemodynamic changes in patients with chronic obstructive pulmonary disease

“…Low RV E' and RV E/A measures were associated with shorter pPTT values, suggesting a potential early vascular impact on RV ventricular diastolic function in patients with COPD 1 . This is important considering that while the comprehensive right heart assessment in pulmonary vascular disease was recently defined in an excellent summary, 8 there were not many options in this document available as markers of early RV diastolic abnormality. Interestingly, the authors could not find a correlation between the pPTT measurements and the RV diastolic function in healthy controls.…”