Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension

Ghio, Stefano; Klersy, Catherine; Magrini, Giulia; D’Armini, Andrea Maria; Scelsi, Laura; Raineri, Claudia; Pasotti, Michele; Serio, Alessandra; Campana, Carlo; Viganò, Mario

doi:10.1016/j.ijcard.2008.11.051

Cited by 310 publications

(277 citation statements)

References 26 publications

(34 reference statements)

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“…Moreover, in a recent echocardiographic study, TAPSE less than 15 mm was associated with poor prognosis in patients with idiopathic pulmonary arterial hypertension [15]. The present study seems to validate the clinical relevance of these cut-off values.…”

Section: Discussionsupporting

confidence: 75%

Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

Sato

Tsujino

Oyama‐Manabe

et al. 2013

Int J Cardiovasc Imaging

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Purpose: The present study examined whether tricuspid annular plane systolic excursion (TAPSE) can simply predict right ventricular ejection fraction (RVEF) in patients with pulmonary hypertension (PH). The TAPSE cut-off value to predict reduced RV EF was also evaluated. Methods and results:The association between TAPSE and cardiac magnetic resonance imaging (CMRI)-derived RVEF was examined in 53 PH patients. The accuracy of the prediction equation to calculate RVEF using TAPSE was also evaluated. In PH patients, TAPSE was strongly correlated with CMRI-derived RVEF in PH patients (r=0.86, p<0.0001). We then examined the accuracy of the two equations: the original regression equation (RVEF = 2.01 x TAPSE + 0.6) and the simplified prediction equation (RV EF = 2 x TAPSE). Bland-Altman plot showed that the mean difference ± limits of agreement was 0.0 ± 10.6 for the original equation and −0.6 ± 10.6 for the simplified equation. Intraclass correlation coefficient was 0.84 for the original and 0.82 for the simplified equation. Normal RV EF was considered to be ≥ 40% based on the data from 53 matched controls, and the best TAPSE cut-off value to determine reduced RV EF (< 40%) was calculated to be 19.7 mm (sensitivity 88.9%, specificity 84.6%). Conclusion:A simple equation of RV EF = 2 x TAPSE enables easy prediction of RV 3 EF using TAPSE, an easily measurable M-mode index of echocardiography. TAPSE of 19.7 mm predicts reduced RV EF in PH patients with clinically acceptable sensitivity and specificity.4

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Section: Discussionsupporting

confidence: 75%

Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

Sato

Tsujino

Oyama‐Manabe

et al. 2013

Int J Cardiovasc Imaging

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“…These findings are consistent with those of the present study, in which an independent association between LV eccentricity and transverse motion has been identified, and with those of previous studies showing the prognostic significance of LV eccentricity. 10,22 Limitations This was a single-center study. Technical limitations include difficulties defining the endocardium of the RV, and due to complex trabeculations of the free wall inaccuracies may occur in the measurement of SFD.…”

Section: Discussionmentioning

confidence: 97%

Longitudinal and Transverse Right Ventricular Function in Pulmonary Hypertension: Cardiovascular Magnetic Resonance Imaging Study from the ASPIRE Registry

et al. 2015

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Right ventricular (RV) function is a strong predictor of outcome in cardiovascular diseases. Two components of RV function, longitudinal and transverse motion, have been investigated in pulmonary hypertension (PH). However, their individual clinical significance remains uncertain. The aim of this study was to determine the factors associated with transverse and longitudinal RV motion in patients with PH. In 149 treatment-naive patients with PH and 16 patients with suspected PH found to have mean pulmonary arterial pressure of <20 mmHg, cardiovascular magnetic resonance imaging was performed within 24 hours of right heart catheterization. In patients with PH, fractional longitudinal motion (fractional tricuspid annulus to apex distance [f-TAAD]) was significantly greater than fractional transverse motion (fractional septum to free wall distance [f-SFD]; P = 0.002). In patients without PH, no significant difference between f-SFD and f-TAAD was identified (P = 0.442). Longitudinal RV motion was singularly associated with RV ejection fraction independent of age, invasive hemodynamics, and cardiac magnetic resonance measurements (P = 0.024). In contrast, transverse RV motion was independently associated with left ventricular eccentricity (P = 0.036) in addition to RV ejection fraction (P = 0.014). In conclusion, RV motion is significantly greater in the longitudinal direction in patients with PH, whereas patients without PH have equal contributions of transverse and longitudinal motion. Longitudinal RV motion is primarily associated with global RV pump function in PH. Transverse RV motion not only reflects global pump function but is independently influenced by ventricular interaction in patients with PH.Keywords: pulmonary hypertension, magnetic resonance imaging, right ventricle. Right ventricular (RV) dysfunction is considered a key determinant of adverse outcomes in several cardiopulmonary disease states. RV dilatation 1-3 and progressive reduction in RV ejection fraction (RVEF) predicts mortality in patients with pulmonary arterial hypertension (PAH). 1,3 In addition, RV dysfunction predicts mortality in patients following myocardial infarction 4,5 and in nonischemic cardiomyopathy. 6 The transverse and longitudinal components of RV function have been studied previously in patients with pulmonary hypertension (PH). 7,8 However, there are conflicting data regarding the importance of transverse and longitudinal shortening in relation to global RV function in PH. Longitudinal shortening measured using tricuspid annular plane systolic excursion (TAPSE) has been shown to be a strong predictor of adverse outcomes in patients with PH, 9,10 and it has been postulated that longitudinal motion, rather than transverse motion, is the main determinant of RVEF in both healthy subjects and patients with PH. 8 In direct contrast, Kind et al. 7 demonstrated a stronger association between transverse RV motion and RVEF than between longitudinal RV motion and RVEF in patients with PH. Moreover, Mauritz et al. 11 identi...

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“…An increased diastolic LV EI > 1, together with diastolic septal flattening, has been shown to predict adverse outcomes in adult idiopathic PAH (IPAH) patients, and this index is likely to be useful for stratification of prognosis in pediatric PH as well. 98,99 Figure 9 shows a significantly increased RV/LV ratio in a 13-year-old patient with PH-CHD. Limitations of this index are that slightly off-axis images may result in an artificially flattened septum, which may falsely increase the index, and that an inaccurate identification of the end-systole may influence the index.…”

Section: Eccentricity Indexmentioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

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Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension

Cited by 310 publications

References 26 publications

Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

Longitudinal and Transverse Right Ventricular Function in Pulmonary Hypertension: Cardiovascular Magnetic Resonance Imaging Study from the ASPIRE Registry

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

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