Differences in right ventricular morphology, not function, indicate the nature of increased afterload in pulmonary hypertensive subjects with normal left ventricular function

Abstract

Systolic RV base/apex ratio is a simple 2D index of RV shape that powerfully predicts a PVR > 3 WU and provides powerful discriminating ability between PVH and PH .

Right ventricular base/apex ratio in the assessment of pediatric pulmonary arterial hypertension: Results from the European Pediatric Pulmonary Vascular Disease Network

“…As such, a depressed RV function is a final common pathway of any insult to preload, afterload, and contractile function. Dilation of the RV apex (to a greater extent than the RV base so that the RVES b/a ratio is decreased) has been shown to represent a morphologic signature of high PA afterload . The RVES b/a ratio negatively correlated with invasive hemodynamics (eg, PVRi) in our pediatric PH patients, which suggests that RVES b/a ratio decreased with increasing disease severity in pediatric PAH, making it a valuable future diagnostic variable.…”

“…Dilation of the RV apex (to a greater extent than the RV base so that the RVES b/a ratio is decreased) has been shown to represent a morphologic signature of high PA afterload. 11 The RVES b/a ratio negatively correlated with invasive hemodynamics (eg, PVRi) in our pediatric PH patients, which suggests that RVES b/a ratio decreased with increasing disease severity in pediatric PAH, making it a valuable future diagnostic variable. But further clinical studies (ideally in a multicenter approach) are clearly needed to evaluate the power of this ratio in screening patients for PH.…”

“…In particular, echocardiographically determined RV end‐systolic and RV end‐diastolic diameters can easily be obtained and therefore may be used as noninvasive measures of RV size and geometry in children with PAH . A novel RV end‐systolic basal‐apical ratio (RVES b/a ratio) recently has been demonstrated to be a simple reproducible prognostic marker in adults with PAH . However, to date, neither normal RVES b/a ratio values for healthy children nor data for those with PAH are available.…”

“…10 A novel RV end-systolic basal-apical ratio (RVES b/a ratio) recently has been demonstrated to be a simple reproducible prognostic marker in adults with PAH. 11 However, to date, neither normal RVES b/a ratio values for healthy children nor data for those with PAH are available. A simple index that would incorporate the dilatation of the RV and estimating the RVES b/a will add relevant information on the typical features of an RV "under pressure" in pediatric PAH.…”

Current and Future Respiratory Medicine Challenges: Insights from a Barcelona Respiratory Network Foundation Retreat in Barcelona in 2017

“…Real-time MRIs allow pathophysiological assessment in pulmonary hypertension 38 . Three-dimensional ultra-sonographic computing has a great potential in the study of different kinds of respiratory diseases such as vascular pulmonary abnormalities, pulmonary hypertension as well as in the characterisation of pleural diseases 39 . Another alternative is three-dimensional CT with great potential in the study of different kinds of chronic respiratory diseases such as COPD, asthma, interstitial lung diseases and also lung cancer 40 .…”