Progressive Changes in Right Ventricular Geometric Shortening and Long-term Survival in Pulmonary Arterial Hypertension

Mauritz, Gert-Jan; Kind, Taco; Marcus, J. Tim; Bogaard, Harm Jan; Veerdonk, Mariëlle van de; Postmus, Pieter E.; Boonstra, Anco; Westerhof, Nico; Vonk‐Noordegraaf, Anton

doi:10.1378/chest.10-3277

Cited by 124 publications

(114 citation statements)

References 27 publications

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“…Where the septum is convex in the healthy subjects, it is flattened or even concave into the lV in the PH patients, giving the rV a more spherical appearance, resembling a left ventricle [21,23]. These studies by Swift et al and grapsa et al [21,23] as well as the study by Mauritz et al [24] have reported that changes in regional diameter, sphericity index from diameter or other two-dimensional regional measurements carry prognostic information of poor outcome. They suggest that the contributions to transverse and longitudinal motion using three-dimensional imaging may improve accuracy.…”

Section: Relation To Earlier Studiesmentioning

confidence: 99%

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Ostenfeld

Stephensen

Steding‐Ehrenborg

et al. 2016

Int J Cardiovasc Imaging

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59 ± 9 %, p < 0.0001 and p < 0.01, respectively). This decrease did not differ in patient with ejection fraction (eF) >50 % and <50 % (p = 0.5) and was compensated for by increased lV lateral contribution to lVSV in patients (49 ± 13 % vs. 37 ± 7 %, p = 0.001). Septal motion contributed less to lVSV in patients (5 ± 8 %) compared to controls (8 ± 4 %, p = 0.05). rV aVPD was lower in patients (12.0 ± 3.6 mm vs. 21.8 ± 2.2 mm, p < 0.0001) but longitudinal and lateral contribution to rVSV did not differ between patients (78 ± 17 % and 29 ± 16 %) and controls (79 ± 9 % and 31 ± 6 % p = 0.7 for both) explained by increased rV cross sectional area in patients. lV function is affected in patients with PH despite preserved global lV function. The decreased longitudinal contribution and increased lateral contribution to lVSV was not seen in the rV, contrary to previous findings in patients with volume loaded RVs. Abstract To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (rV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMr). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (rHC) and CMr. CMr from 33 healthy adults (13 females) were used as controls. left ventricular (lV) atrioventricular plane displacement (aVPD) and corresponding longitudinal contribution to lVSV was lower in patients (10.8 ± 3.2 mm and 51 ± 12 %) compared to controls (16.6 ± 1.9 mm and 1 3 1244 int J Cardiovasc imaging (2016) 32:1243-1253 trols. The control group has been described in a previous study [11]. The regional ethical review board approved the study and written informed consent was obtained from all patients and healthy volunteers prior to CMr examination. Keywords Right heart catheterizationinvasive measurements were obtained during rHC with a triple-lumen Swan-ganz catheter in supine position and in local anesthesia. Pressures of pulmonary artery (PaP), right atrium, right ventricle and pulmonary artery wedge as well as cardiac output using thermodilution were measured. Precapillary PH was characterized by elevated mean pulmonary arterial pressure (mPaP) ≥25 mmHg and pulmonary artery wedge pressure ≤15 mmHg at normal or reduced cardiac output. Systemic pressure was available using a cuff and sphygmomanometer. Cardiac magnetic resonance imagingImage acquisition all subjects underwent CMr imaging in the supine position and images were acquired during end-expiratory breath-hold covering the entire heart, including both ventricles and atria. a 1.5 Tesla magnetic resonance imaging scanner was used for all studies (Philips achieva, Best, The netherlands). Steady state free precession cine images were ...

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Section: Relation To Earlier Studiesmentioning

confidence: 99%

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Ostenfeld

Stephensen

Steding‐Ehrenborg

et al. 2016

Int J Cardiovasc Imaging

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“…Here, we report our clinical experience with compassionate use of low-dose FK506 in three patients with endstage PAH who did not qualify for our trial because of the severity of their illness (patient details are provided in the online supplement). We assessed traditional clinical parameters, New York Heart Association (NYHA) functional class, 6-minute-walk distance, serologic biomarkers, and hospital admissions, as well as protocolized cardiac magnetic resonance imaging assessed by blinded readers (13,14). All patients continued receiving stable doses of PAH medication and diuretics throughout the 12-month period.…”

mentioning

confidence: 99%

Low-Dose FK506 (Tacrolimus) in End-Stage Pulmonary Arterial Hypertension

Spiekerkoetter

Sung

Sudheendra

et al. 2015

Am J Respir Crit Care Med

108

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“…[36][37][38][39] RV longitudinal shortening (tricuspid annular plane excursion [TAPSE]) and transverse shortening provide clinical relevant measures that are correlated with global RV function. 22,40,41 Although the determination of global measures of RV function is relative time consuming, these measures are simpler to obtain. Mauritz et al 22 showed that both transverse and longitudinal shortening were valuable parameters and that, in particular, a progressive decrease in RV transverse wall motion is associated with end-stage RV disease.…”

Section: Regional Rv Function and Strainmentioning

confidence: 99%

“…An increased RV end-diastolic volume and progressive dilatation during follow-up assessed by CMR were among the strongest predictors of mortality in PAH. 21,22 Although readily available in clinical practice, volumetric assessment can be less reliably performed by twodimensional echocardiography because of the difficulty in visualizing the RV anterior wall and infundibulum. This explains the variable correlations between volumetric echocardiographic and CMR measures.…”

Section: Introductionmentioning

confidence: 99%

State of the Art: Advanced Imaging of the Right Ventricle and Pulmonary Circulation in Humans (2013 Grover Conference Series)

et al. 2014

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Pulmonary arterial hypertension (PAH) is a progressive disease characterized by remodeling and vasoconstriction of the pulmonary vasculature, ultimately leading to right ventricular (RV) failure and death. Recent developments in echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and positron emission tomography allow advanced, noninvasive, in vivo assessment of the RV and have contributed to the identification of risk factors, prognostic factors, and monitoring of therapeutic responses in patients with PAH. Although far from reaching its future potential, these techniques have not only provided global RV assessment but also allowed evaluation of changes in cellular and molecular tissue processes, such as metabolism, oxygen balance and ischemia, angiogenesis, and apoptosis. Integrated application of these techniques could provide full insights into the different pathophysiological aspects of a failing RV in the setting of PAH. Recent advances in hybrid imaging have implemented simultaneous measurements of myocardial and vascular interactions and will be one of the most important potential future developments.

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Progressive Changes in Right Ventricular Geometric Shortening and Long-term Survival in Pulmonary Arterial Hypertension

Cited by 124 publications

References 27 publications

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Low-Dose FK506 (Tacrolimus) in End-Stage Pulmonary Arterial Hypertension

State of the Art: Advanced Imaging of the Right Ventricle and Pulmonary Circulation in Humans (2013 Grover Conference Series)

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