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

Abstract

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.

When the Right Is Not Doing Right: The Role of Strain Imaging in Pulmonary Arterial Hypertension

“…1 Right ventricular (RV) failure is the most prominent cause of death in PAH. 2 The adaptation of the RV to the increased afterload in PAH and its response to therapy determine prognosis and are therefore in the focus of risk assessment. [2][3][4] Whereas for the diagnosis of PAH measurement of mean pulmonary artery pressure (PAP), mean pulmonary artery wedge pressure, and cardiac output by right heart catheterization as well as calculation of transpulmonary gradient and pulmonary vascular resistance are mandatory and central ( Fig.…”

Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

“…Mechanisms of ventricular interdependence and altered myocardial synchrony (mechanical dispersion; MD) contribute to ventricular dysfunction in these settings, and may also be important in CDH. Improved understanding of cardiac function in adult pulmonary hypertension has been possible due to advances in non-invasive imaging, including speckle tracking echocardiography (STE) [4]. STE has also been demonstrated to be feasible in newborn infants, allows assessment of regional and global myocardial function, and MD (synchrony) without the limitations of traditional geometric and velocity-based measures [5].…”

Clinical Features and Risk Factors of Pulmonary Hypertension in Chinese Patients With Systemic Lupus Erythematosus

“…However, as a non-invasive procedure, regular echocardiography provides information on not only the estimation of pulmonary hemodynamics but also the function of the right atrium. 31,32 Echocardiography can be used in preliminary screening, 10 and patients with SLE and with PASP ≥40 mmHg should undergo RHC for proper diagnosis. The combination of six-minute walk test, NT-proBNP, clinical findings, and monitoring of pulmonary pressure can aid in the early diagnosis and monitoring of treatment response to treatment.…”