Effect of electrical dyssynchrony on left and right ventricular mechanics in children with pulmonary arterial hypertension

Schäfer, Michal; Collins, Kathryn K.; Browne, Lorna P.; Ivy, D. Dunbar; Abman, Steven H.; Friesen, Richard M.; Frank, Benjamin S.; Fonseca, Brian; DiMaria, Michael V.; Hunter, Kendall S.; Truong, Uyen; Alvensleben, Johannes C. von

doi:10.1016/j.healun.2018.01.1308

Cited by 24 publications

(36 citation statements)

References 27 publications

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“…The improved strain values correlate with improvements in known prognostic markers of PAH such as 6-min walk test, pro-BNP, and mean pulmonary arterial pressure (MPAP) [ 21 ••]. Furthermore, an interventricular dyssynchronous contraction has been documented with a left-to-right delay assessed by strain in adult and paediatric patients with PAH [ 33 – 36 ].…”

Section: Regional Function and Strainmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Kjellström

Lindholm

Ostenfeld

2020

Curr Heart Fail Rep

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Purpose of Review Pulmonary arterial hypertension (PAH) is a progressive disease with high mortality. A greater understanding of the physiology and function of the cardiovascular system in PAH will help improve survival. This review covers the latest advances within cardiovascular magnetic resonance imaging (CMR) regarding diagnosis, evaluation of treatment, and prognostication of patients with PAH. Recent Findings New CMR measures that have been proven relevant in PAH include measures of ventricular and atrial volumes and function, tissue characterization, pulmonary artery velocities, and arterio-ventricular coupling. Summary CMR markers carry prognostic information relevant for clinical care such as treatment response and thereby can affect survival. Future research should investigate if CMR, as a non-invasive method, can improve existing measures or even provide new and better measures in the diagnosis, evaluation of treatment, and determination of prognosis of PAH.

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Section: Regional Function and Strainmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Kjellström

Lindholm

Ostenfeld

2020

Curr Heart Fail Rep

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“…However, subjects with RVD showed lower values of RVGLS than subjects without RVD, which was mainly attributed to the decline in RV strain at basal segments, suggesting that regional RV function was more affected by RVD. Similarly, it has been demonstrated that the presence of RVD was associated with reduced RVGLS in children with PAH as evaluated by CMR ( Schafer et al, 2018 ). Furthermore, we also found a significant increase in tricuspid IVA in all subjects and RVD- subjects but not in RVD + subjects after HA exposure, which indicated that RV IVA was blunted by RVD.…”

Section: Discussionmentioning

confidence: 86%

“…However, unlike portable echocardiography, CMR is not flexible and convenient for field studies at HA. In addition, the lower temporal resolution of CMR compared with echocardiography may affect the analysis of time-to-peak metrics (Schafer et al, 2018). On the other hand, compared to the conventional TDI method, STE analysis can provide some advantages of angle independence and improved signal-to-noise ratio.…”

Section: Rvd Measurements By Ste Analysismentioning

confidence: 99%

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

et al. 2020

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The aims of this study were to explore the effect of high-altitude (HA) exposure on the incidence, determinants, and impacts of right ventricular dyssynchrony (RVD). In our study, 108 healthy young men were enrolled, and physiological and echocardiographic variables were recorded at both sea level and 4,100 m. By using two-dimensional speckle-tracking echocardiography, RVD was evaluated by calculating the R-R intervalcorrected standard deviation of the time-to-peak systolic strain for the four mid-basal RV segments (RVSD4) and defined by RVSD4 > 18.7 ms. After HA exposure, RVSD4 was significantly increased, and the incidence of RVD was approximately 32.4%. Subjects with RVD showed lower oxygen saturation (SaO 2) and RV global longitudinal strain and higher systolic pulmonary artery pressure than those without RVD. Moreover, myocardial acceleration during isovolumic contraction was increased in all subjects and those without RVD, but not in those with RVD. Multivariate logistic regression revealed that SaO 2 is an independent determinant of RVD at HA (odds ratio: 0.72, 95% CI: 0.56-0.92; P = 0.009). However, the mean pulmonary artery pressure was linearly correlated with the magnitude of RVD in the presence of Notch. No changes were found in RV fractional area change, tricuspid annular motion, or tricuspid s' velocity between subjects with and without RVD. Collectively, we demonstrated for the first time that HA exposure could induce RVD in healthy subjects, which may be mainly attributed to the decline in SaO 2 as well as RV overload; the incidence of RVD was associated with reduced RV regional function and blunted myocardial acceleration.

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“…252 MRI-derived functional and volumetric indices predict morbidity and mortality in pediatric PH and may provide additional information with respect to inter-ventricular interactions. 120,275 In addition, phase-contrast MRI remains the state-of-the-art flow imaging technique enabling precise flow volume quantification and consequently provides valuable assessment of Q p /Q s ratios in children with PH associated with congenital heart disease and intracardiac shunts. Furthermore, parallel or sequential phase-contrast MRI and pressure evaluation in the catheterization lab has been proposed as a novel and potentially more reliable method for the calculation of PVR in comparison to standard Fick principle or thermodilution.…”

Section: Section 40: Imaging Children With Suspected Pulmonary Hypermentioning

confidence: 99%

Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

Kiely¹,

Levin²,

et al. 2019

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Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.

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Effect of electrical dyssynchrony on left and right ventricular mechanics in children with pulmonary arterial hypertension

Cited by 24 publications

References 27 publications

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Cardiac Magnetic Resonance Imaging in Pulmonary Arterial Hypertension: Ready for Clinical Practice and Guidelines?

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI)

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