Echocardiographic assessment of right ventricular contractile reserve in patients with pulmonary hypertension

Almeida, Ana Rita; Loureiro, María José; Lopes, Laura Cardia Gomes; Cotrim, Carlos; Lopes, Luís Rocha; Repolho, Débora; Pereira, Hélder

doi:10.1016/j.repc.2013.09.015

Cited by 25 publications

(24 citation statements)

References 11 publications

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“…The loss of this capacity to augment ventricular contractility at a given level of loading has been shown to be an early sign of RV dysfunction in PAH . Only limited studies have addressed RV contractile reserve . Our data demonstrated that cMRI‐FT can quantify changes in ventricular wall mechanics during both rest and submaximal exercise in healthy controls and PAH subjects and could potentially be useful in risk stratifying patients with PAH.…”

Section: Discussionmentioning

confidence: 71%

Quantification of biventricular strain and assessment of ventriculo–ventricular interaction in pulmonary arterial hypertension using exercise cardiac magnetic resonance imaging and myocardial feature tracking

Lin

Seale

Hamilton-Craig

et al. 2018

Magnetic Resonance Imaging

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Background Right ventricular (RV) failure is the main cause of mortality in pulmonary arterial hypertension (PAH). Exercise testing helps identify early RV maladaptation and systolic dysfunction and facilitates therapy. Myocardial strain has been shown to be more sensitive than ejection fraction (EF) in detecting subclinical ventricular contractile dysfunction. Chronic pressure overload in PAH had been associated with changes in left ventricular (LV) filling. Purpose To compare biventricular strains and ventriculo–ventricular interaction in PAH and controls using cardiac magnetic resonance feature tracking (cMRI‐FT) and to determine the reproducibility of strain analysis. Study Type Prospective. Population Nine PAH and nine control subjects. Field Strength/Sequence 1.5T MRI balanced steady state free precession. Assessment RV and LV longitudinal strain (EllRV and EllLV) were derived using the mid‐axial images. Radial (ErrLV) and circumferential strain (EccLV) were derived using the mid‐ventricular short‐axis images. Relationships between strain and volumetric parameters were assessed at rest and during submaximal in‐magnet exercise. Statistical Tests Comparison of rest‐to‐exercise data between PAH and controls was analyzed using two‐way repeated measures analysis of variance. The relationship between volumetric parameters and cMRI‐FT were assessed using Pearson's correlation. Reproducibility was assessed by using Bland–Altman plots. Results PAH had significantly lower EllRV at rest (−16.6 ± 2.7 vs. −20.1 ± 3.6, P = 0.03) despite normal RVEF. During exercise, RV systolic contractile reserve measured by EllRV was significantly reduced in PAH (PInteraction = 0.02). In PAH, indexed RV end‐systolic volume (ESVi) significantly correlated with EccLV and ErrLV at rest (r = −0.65 and r = −0.70, P < 0.05) and with ErrLV during exercise (r = −0.43, P < 0.05). High observer agreement was demonstrated. Data Conclusion Despite normal resting RVEF, RV systolic function and contractile reserve as measured by EllRV was significantly reduced in PAH. The close relation between RVESVi with EccLV and ErrLV provides evidence of systolic ventriculo–ventricular interaction in PAH. Exercise cMRI‐FT may provide a quantitative metric for detection of subclinical RV dysfunction in PAH. Level of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1427–1436.

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Section: Discussionmentioning

confidence: 71%

Quantification of biventricular strain and assessment of ventriculo–ventricular interaction in pulmonary arterial hypertension using exercise cardiac magnetic resonance imaging and myocardial feature tracking

Lin

Seale

Hamilton-Craig

et al. 2018

Magnetic Resonance Imaging

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“…RV contractile reserve reflects the ability of RV to accommodate the increased afterload during exercise and has crucial implications in revealing subclinical dysfunction in precapillary PH. In a study by Almeida et al, the magnitude of change in S′, TAPSE, and RVFAC in patients with precapillary PH was significantly lower than that in healthy subjects. Grunig et al assessed exercise‐induced increase in pulmonary arterial systolic pressure (PASP) as a measure of RV contractile reserve.…”

Section: Discussionmentioning

confidence: 85%

“…Second, the application of ESE in precapillary PH is still being studied; there is no established threshold of abnormal RV function as well as RV contractile reserve. Consequently, we used healthy subjects as controls, similar to previous studies . Third, certain limitations inherent to the technique of ESE also exist.…”

Section: Discussionmentioning

confidence: 99%

Influence of impaired right ventricular contractile reserve on exercise capacity in patients with precapillary pulmonary hypertension: A study with exercise stress echocardiography

Guo

Yang

et al. 2019

Echocardiography

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Objectives Right ventricular (RV) contractile reserve reflects the ability of RV to accommodate the increased afterload and may play an essential role in the evaluation of precapillary pulmonary hypertension (PH). This study aimed to assess RV contractile reserve based on exercise stress echocardiography (ESE) and to determine the echocardiographic determinants of exercise capacity in patients with precapillary PH. Methods A total of 31 patients with precapillary PH and 15 age‐ and sex‐matched healthy control subjects were prospectively recruited. All subjects underwent ESE to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. Patients with precapillary PH also underwent cardiopulmonary exercise test (CPET), and data pertaining to peak oxygen uptake (peak VO2) and minute ventilation/carbon dioxide production (VE/VCO2) were collected. Results Right ventricular contractile reserve including change in tricuspid annular plane systolic excursion (∆TAPSE), change in RV fractional area change (∆RVFAC), and change in Doppler‐derived tricuspid lateral annular peak systolic velocity (∆S′) was significantly depressed in precapillary PH patients compared with control subjects (P < 0.05). Parameters of RV function and RV contractile reserve were markedly associated with maximal exercise capacity (P < 0.05). ∆RVFAC was an independent predictor of peak VO2 (r2 = 0.601, P < 0.05). Conclusions Assessment of RV contractile reserve facilitates identification of subclinical dysfunction and evaluation of clinical status and severity of precapillary PH. ESE as a noninvasive method may provide a comprehensive clinical assessment and facilitate therapeutic decision‐making for these patients.

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“…One feasibility study looked at lateral tricuspid S’ wave velocity change in controls and PH patients who performed a treadmill stress test. 115 They demonstrated impaired change in value in the PH group (46% vs. 78% for controls). In the same study, TAPSE showed just 4% change in the PH group vs. 21% in the controls and RVFAC actually reduced by 2% in the PH group.…”

Section: Cardiac Function Under Stress By Echocardiography and Cmrimentioning

confidence: 92%

Non‐invasive imaging of global and regional cardiac function in pulmonary hypertension

2017

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Pulmonary hypertension (PH) is a progressive illness characterized by elevated pulmonary artery pressure; however, the main cause of mortality in PH patients is right ventricular (RV) failure. Historically, improving the hemodynamics of pulmonary circulation was the focus of treatment; however, it is now evident that cardiac response to a given level of pulmonary hemodynamic overload is variable but plays an important role in the subsequent prognosis. Non-invasive tests of RV function to determine prognosis and response to treatment in patients with PH is essential. Although the right ventricle is the focus of attention, it is clear that cardiac interaction can cause left ventricular dysfunction, thus biventricular assessment is paramount. There is also focus on the atrial chambers in their contribution to cardiac function in PH. Furthermore, there is evidence of regional dysfunction of the two ventricles in PH, so it would be useful to understand both global and regional components of dysfunction. In order to understand global and regional cardiac function in PH, the most obvious non-invasive imaging techniques are echocardiography and cardiac magnetic resonance imaging (CMRI). Both techniques have their advantages and disadvantages. Echocardiography is widely available, relatively inexpensive, provides information regarding RV function, and can be used to estimate RV pressures. CMRI, although expensive and less accessible, is the gold standard of biventricular functional measurements. The advent of 3D echocardiography and techniques including strain analysis and stress echocardiography have improved the usefulness of echocardiography while new CMRI technology allows the measurement of strain and measuring cardiac function during stress including exercise. In this review, we have analyzed the advantages and disadvantages of the two techniques and discuss pre-existing and novel forms of analysis where echocardiography and CMRI can be used to examine atrial, ventricular, and interventricular function in patients with PH at rest and under stress.

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Echocardiographic assessment of right ventricular contractile reserve in patients with pulmonary hypertension

Abstract: S-wave velocity, TAPSE and RVFAC increased significantly with exercise in controls. S-wave velocity was the only parameter that showed a significant increase in cases, although the magnitude of this increase was significantly less than in controls.

Cited by 25 publications

References 11 publications

Quantification of biventricular strain and assessment of ventriculo–ventricular interaction in pulmonary arterial hypertension using exercise cardiac magnetic resonance imaging and myocardial feature tracking

Quantification of biventricular strain and assessment of ventriculo–ventricular interaction in pulmonary arterial hypertension using exercise cardiac magnetic resonance imaging and myocardial feature tracking

Influence of impaired right ventricular contractile reserve on exercise capacity in patients with precapillary pulmonary hypertension: A study with exercise stress echocardiography

Non‐invasive imaging of global and regional cardiac function in pulmonary hypertension

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