Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension

Li, Yidan; Wang, Yidan; Zhai, Zhenguo; Guo, Xiaojuan; Yang, Yuanhua; Lu, Xiuzhang

doi:10.1371/journal.pone.0129557

Cited by 19 publications

(17 citation statements)

References 18 publications

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“…In patients with pulmonary hypertension, RIMP, RVFAC, and S′ correlated with EF by cMRI as compared with TAPSE. However, 3D RVEF showed the best correlation with cMRI …”

Section: Echocardiographic Assessment Of the Rvmentioning

confidence: 88%

Echocardiographic evaluation of the right ventricle: Clinical implications

Dutta

Aronow

2017

Clinical Cardiology

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Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S 0 , and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV. | ANATOMY OF THE RVThe RV is composed of 3 different segments: the inlet area, the trabecular portion, and the outflow area. The inlet extends from the papillary muscles to the tricuspid annulus. The trabecular portion extends from the papillary muscles to the right ventricular (RV) apex.The outflow portion is a smooth area leading to the pulmonic valve. 1Because the RV does not follow a traditional symmetrical shape, the RV volume does not lend itself to estimation. Wall-motion abnormalities are also more difficult to evaluate, as there are 3 different subsections. Wall motion is also difficult to evaluate due to a combination of radial, longitudinal, and circumferential shortening; these independent movements are not clearly visible on an echocardiogram. 2Normal values for the RV were significantly limited due to the lack of standardization across echocardiographic protocols. cMRI, which measures the RV in planes that are not visualized on echocardiography, was able to provide a series of normal valves. As a result, we know that although RV mass and volumes are larger among males vs females, there is no significant difference in systolic function. | FUNCTION OF THE RVThe LV is often described as a pump whose function is based on its inherent contractility. In contrast, the RV is profoundly affected by loading conditions. The RV function is dependent on preload and afterload.2 It provides the same stroke volume as the LV with

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“…In patients with pulmonary hypertension, RIMP, RVFAC, and S′ correlated with EF by cMRI as compared with TAPSE. However, 3D RVEF showed the best correlation with cMRI …”

Section: Echocardiographic Assessment Of the Rvmentioning

confidence: 88%

Echocardiographic evaluation of the right ventricle: Clinical implications

Dutta

Aronow

2017

Clinical Cardiology

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“…23,41 The correlation reported here between depressed RV-PA coupling and exercise-induced RV dilation suggests a potentially new method to estimate coupling. With recent advances in three-dimensional echocardiography or CMR during exercise, 12,42,43 one could assess RV dilatation with stress and use this as a surrogate for RV-PA coupling. Further work is needed to validate these findings in a range of healthy and diseased subjects and correlate them with clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension

et al. 2016

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Background Right ventricular (RV) functional reserve affects functional capacity and prognosis in patients with pulmonary arterial hypertension (PAH). PAH associated with systemic sclerosis (SSc-PAH) has a substantially worse prognosis as compared to idiopathic PAH (IPAH), even though many measures of resting RV function and pulmonary vascular load are similar. We therefore tested the hypothesis that RV functional reserve is depressed in SSc-PAH patients. Methods and Results RV pressure-volume relations were prospectively measured in IPAH (n=9) and SSc-PAH (n=15) patients at rest and during incremental atrial pacing or supine bicycle ergometry. Systolic and lusitropic function increased at faster heart rates in IPAH patients, but were markedly blunted in SSc-PAH. The recirculation fraction, which indexes intracellular calcium recycling, was also depressed in SSc-PAH (0.32±0.05 versus 0.50±0.05; p=0.039). At matched exercise (25 Watts), SSc-PAH patients failed to augment contractility (end-systolic elastance) whereas IPAH did (p<0.001). RV afterload assessed by effective arterial elastance rose similarly in both groups; thus, ventricular-vascular coupling declined in SSc-PAH. Both end-systolic and end-diastolic RV volumes increased in SSc-PAH patients to offset contractile deficits, whereas chamber dilation was absent in IPAH (+37±10% versus +1±8%, p=0.004, and +19±4% versus −1±6%, p<0.001, respectively). Exercise-associated RV dilation also strongly correlated with resting ventricular-vascular coupling in a larger cohort. Conclusions RV contractile reserve is depressed in SSc-PAH versus IPAH subjects, associated with reduced calcium recycling. During exercise, this results in ventricular-pulmonary vascular uncoupling and acute RV dilation. RV dilation during exercise can predict adverse ventricular-vascular coupling in PAH patients.

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“…Moreover the LV is thicker and has more mass than the RV and therefore is better appropriate to manage pressure overload, while the more compliant RV is better equipped to manage volume overload. Therefore, given their inherent differences, specific renal abnormalities affect each ventricle differently [4,6]. Among the several echo-Doppler measures of RV function, TAPSE index, is the one that has been more extensively studied and together with ePAPs have been associated with adverse outcomes [11].…”

Section: Discussionmentioning

confidence: 99%

“…Atherosclerotic disease in CKD patients is characterized by increase in intima-media thickness, atheromatous plaques, and diffuse vascular calcifications, determined by traditional and non traditional risk factors such as anemia, endothelial dysfunction, hypertension, haemodynamic alteration, hyperhomocysteinemia, hyperuricemia, mineral bone disorders (MBD) with deficiency of vitamin D, hyperparathyroidism and abnormal calcium-phosphate metabolism, inflammation, uremic toxins, neurohormonal activation, oxidative stress, etc. These vascular changes result in cardiomyopathy with left ventricular hypertrophy (LVH) or dilatation and decreased coronary reserve or perfusion [4,5]. Left ventricle abnormality have been widely studied in CKD, but little is known about the early changes of the right ventricle (RV), indeed few studies in literature aimed to evaluate the parameters of right ventricular function in CKD [6,7].…”

Section: Introductionmentioning

confidence: 99%

Cardio-Renal Syndrome Type 4: The Correlation Between Cardiorenal Ultrasound Parameters

Lai

Ciccariello

Dimko

et al. 2016

Kidney Blood Press Res

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Bakground/Aims: Cardiovascular diseases represent the leading causes of morbidity and mortality in patients with cronich kidney disease (CKD). The pathogenesis includes a complex, bidirectional interaction between heart and kidney termed cardiorenal syndrome type 4. The aim of study was to evaluate the association between renal and cardiovascular ultrasonographic parameters and identify early markers of cardiovascular risk. Methods: A total of 35 patients with CKD and 25 healthy controls, were enrolled and we have evaluated inflammatory indexes, mineral metabolism, renal function, renal and cardiovascular ultrasonographic parameters. Results: Tricuspid anular plane systolic excursion (TAPSE) and estimated pulmonary artery systolic pressure (ePAPs) showed a statistically significant difference between CKD patients and healthy controls (p<0.001, p=0.05). Also 25 hydroxyvitaminD (25-OH-VitD), parathyroid hormone (iPTH), posphorus, serum uric acid, renal resistive index (RRI) and C-reactive protein (CRP) showed a significant difference between the two groups (p=0.002, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). Moreover the TAPSE correlated positively with estimated glomerula filtration rate (eGFR) and negatively with RRI (p=0.05, p=0.008), while ePAPs correlated negatively with eGFR and positively with RRI (p=0.029, p<0.001). Conclusion: CKD can contribute to the development and progression of right ventricle dysfunction with endothelial dysfunction, inflammation and mineral metabolism disorders. Accurate assessment of right ventricular function is recommended in patients with CKD. RRI and echocardiographic parameters can be an important instrument for the diagnosis, prognosis and therapeutic assessment of cardio-renal syndrome in these patients.

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Real-Time Three-Dimensional Echocardiography to Assess Right Ventricle Function in Patients with Pulmonary Hypertension

Cited by 19 publications

References 18 publications

Echocardiographic evaluation of the right ventricle: Clinical implications

Echocardiographic evaluation of the right ventricle: Clinical implications

Right Ventricular Functional Reserve in Pulmonary Arterial Hypertension

Cardio-Renal Syndrome Type 4: The Correlation Between Cardiorenal Ultrasound Parameters

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