Echocardiography in Pulmonary Arterial Hypertension

Forfia, Paul R.; Vachiéry, Jean‐Luc

doi:10.1016/j.amjcard.2012.06.012

Cited by 79 publications

(74 citation statements)

References 41 publications

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“…Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart. [2][3][4][5][6][7] PET is also offering novel insights into perfusion and blood flow, metabolism, neurohormonal activation, and other molecular processes in the right side of the heart but is used mainly for research at this time. Catheterization of the right side of the heart remains the gold standard for defining PH and assessing hemodynamics both at rest and with exercise.…”

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confidence: 99%

“…1,2 The second was the emergence of multimodality imaging with a complementary role for echocardiography, magnetic resonance (MRI), computed tomography, and positron emission tomography (PET). [2][3][4][5][6][7] These techniques not only help in the diagnosis of PH but also help identify factors that determine risk and prognosis and gauge therapeutic effects on right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart.…”

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Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

et al. 2015

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899N oninvasive imaging plays a key role in both the diagnosis and management of patients with pulmonary hypertension (PH). In recent years, there have been 2 major changes in perspective of imaging in PH. The first was the realization that imaging should focus on the evaluation of not only the pulmonary pressures but also the cardiopulmonary unit ( Figure 1). 1,2The second was the emergence of multimodality imaging with a complementary role for echocardiography, magnetic resonance (MRI), computed tomography, and positron emission tomography (PET).2-7 These techniques not only help in the diagnosis of PH but also help identify factors that determine risk and prognosis and gauge therapeutic effects on right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). Although echocardiography is the mainstay in the assessment of hemodynamic and ventricular function in PH, MRI has emerged as the gold standard for quantifying volumes, function, and flow in the right side of the heart. 2-7 PET is also offering novel insights into perfusion and blood flow, metabolism, neurohormonal activation, and other molecular processes in the right side of the heart but is used mainly for research at this time. Catheterization of the right side of the heart remains the gold standard for defining PH and assessing hemodynamics both at rest and with exercise. Invasive assessment of cardiac output (CO) may, however, have limited accuracy when assumed instead of measured oxygen consumption is used to derive CO (eg, using the Fick method) or when thermodilution is used in the setting of a low-CO state. [8][9][10] This review covers RV imaging studies performed in the field of PH and discusses recent advances in echocardiography and cardiac MRI and PET imaging for detailed assessment of RV function. The review starts with a discussion of important physiological considerations and unmet needs in imaging research of the right side of the heart in PH. Computed tomography angiography, which plays an important role in evaluating chronic thromboembolic PH, is not discussed extensively in this review. Physiological ConsiderationsAlthough PH is a syndrome affecting the pulmonary vasculature, survival of patients with PH is closely related to RV function. 1,[11][12][13][14] The RV initially adapts to the increased afterload by increasing its wall thickness and contractility. These mechanisms are, however, often insufficient, and RV dysfunction eventually occurs. After the recent Fifth World Symposium on Pulmonary Hypertension, a definition of failure of the right side of the heart secondary to PH was adopted: "Right heart failure in the setting of PH can be defined as a complex clinical syndrome due to a suboptimal delivery of blood or elevated systemic venous pressure at rest or exercise as a consequence of elevated RV afterload."2 The proposed definition takes into account both the systolic and diastolic characteristics of function of the right side of the heart, as well as physiological demands such as exercise.In underst...

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Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

et al. 2015

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“…There are numerous validated echocardiographic parameters of RV function and morphology that could have been considered and potentially applied in this study. 12 Understanding the relationship between the PAP and RV (PA-RV coupling) is not only critical to understanding pathogenesis, but also to defining effective therapeutic approaches.…”

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Pulmonary Hypertension in CKD

Sarnak

Roberts

2016

Journal of the American Society of Nephrology

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Pulmonary hypertension (PH), defined as a mean pulmonary artery pressure (mPAP) $25 mmHg, is described in numerous pathologic conditions and its presence is typically associated with worse outcomes. Experts in the field have established a clinical classification system which places patients with PH into five groups according to shared pathobiology, clinical presentation, and therapeutic approaches. 1 Although patients with CKD exhibit many symptoms and risk factors associated with PH, literature describing the epidemiology and impact of PH in CKD has been limited. Until recently, in fact, this literature was limited to CKD stages 4 and 5 with and without dialysis dependency. In these patients with advanced CKD, PH is prevalent (approximately 30%-40%) and associated with worse outcomes. 2,3 Reflective of poor insight into the nature of PH in this population, individuals with PH and ESRD are included in group 5 PH -that due to cryptic or multifactorial etiologies. The larger population with earlier stages of CKD bears a very high burden of cardiovascular morbidity and mortality; therefore, gaining additional knowledge related to PH in this population is of clinical relevance.The current study from Navaneethan et al. leverages the power of the Chronic Renal Insufficiency Cohort (CRIC), a large (n52959) longitudinal cohort study of subjects with eGFR 20-70 ml/min per 1.73 m 2 , providing the most comprehensive description to date of PH prevalence and significance in a nondialysis CKD population. 4 CRIC subjects underwent transthoracic Doppler echocardiography (TTE) interpreted centrally in a core laboratory, as well as detailed ascertainment of covariates and comorbid conditions, and thorough adjudication of cardiovascular and kidney outcomes. The authors used an accepted echocardiographic case definition of PH: pulmonary artery systolic pressure (ePASP) .35 mmHg and/or tricuspid regurgitant velocity .2.5 m/s.Concordant with recent studies from Italy and China, 5,6 PH was prevalent in the CRIC, present in roughly one in five subjects (21%), and was significantly and indirectly related to the eGFR, rising from 6% among CKD stage 1 to 33% in CKD stage 5. As has been described in other studies, PH was associated with older age, systemic hypertension, diabetes, and a history of heart failure (HF). 5,7 Multivariable analysis found that older age, lower hemoglobin, lower left ventricular ejection fraction, and the presence of left ventricular hypertrophy were independently associated with PH. The presence of PH was associated with a 38% increased risk of overall mortality and a 23% increased risk of cardiovascular events (HF, myocardial infarction, cerebrovascular accident, and peripheral vascular disease). In this cohort PH was not associated with progression of CKD.This study has value, not only for the relative novelty of the message that PH is prevalent in all stages of CKD, but additionally for its ability to assess predictors and mortality related to PH using a more systematized approach than prior studies. Despite ...

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“…The RV is principally composed of longitudinal muscle (17). Ejection is performed by longitudinal muscle, so the majority of RV function research has focused on longitudinal muscle (18)(19)(20).…”

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confidence: 99%

Evaluation of two-dimensional strain echocardiography for quantifying right ventricular function in patients with pulmonary arterial hypertension

Liu

Wang

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the current study was to evaluate the use of two-dimensional strain echocardiography (2DS) in quantifying right ventricular (RV) function in patients with pulmonary arterial hypertension (PAH). A total of 41 patients with PAH and 40 healthy control patients were recruited to the study. 2DS was used to determine the strain (ε) and strain rate (SR) of basal, middle and apical segments of the RV free wall. The aforementioned indicators were compared with measurements of RV function taken by conventional ultrasound and right heart catheterization. The ε and SR of all segments of the right ventricular free wall were significantly lower in the PAH group, as compared with the control group (P<0.05). In the PAH group, the ε and SR of the middle and apical segments were significantly lower compared with basal segments (P<0.01). The SR of the apical segments were positively correlated with the area and diameter of the right ventricular. The ε of the apical segments were positively correlated with RV area, diameter and systolic function. The ε and SR of apical segments were positively correlated with pulmonary artery pressure and pulmonary vascular resistance measured by right heart catheterization. These findings indicated that 2DS can accurately evaluate RV longitudinal systolic function.

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Echocardiography in Pulmonary Arterial Hypertension

Cited by 79 publications

References 41 publications

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Noninvasive Imaging in the Assessment of the Cardiopulmonary Vascular Unit

Pulmonary Hypertension in CKD

Evaluation of two-dimensional strain echocardiography for quantifying right ventricular function in patients with pulmonary arterial hypertension

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