Right ventricular function in patients with pulmonary hypertension; the value of myocardial performance index measured by tissue Doppler imaging

Cabrita, Inês Zimbarra; Ruisánchez, Cristina; Dawson, David M.; Grapsa, Julia; North, Bernard; Howard, Luke; Pinto, Fausto J.; Nihoyannopoulos, Petros; Gibbs, J. Simon R.

doi:10.1093/ejechocard/jeq051

Cited by 30 publications

(14 citation statements)

References 30 publications

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“…More interestingly, our echocardiographic data also captured RVMPI, which is used to assess right ventricular systolic function in the setting of pulmonary hypertension . Normal RVMPI is less than 0.30.…”

Section: Discussionmentioning

confidence: 99%

Operative and Functional Outcome After Pulmonary Endarterectomy for Advanced Thromboembolic Pulmonary Hypertension

2015

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Aim: To evaluate the midterm hemodynamic and functional outcome of pulmonary endarterectomy (PEA) for patients with advanced chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Thirty-eight consecutive patients underwent PEA for CTEPH from May 2004 to March 2012. All patients were followed prospectively at six months postoperatively and annually thereafter. Each patient underwent serial cardiopulmonary exercise testing (CPET) and transthoracic echocardiography, and were followed for up to four years. Results: Overall, 31.5% (12/38) of patients had Jamieson class II disease while 65.8% (25/38) had class III disease. There were three in-hospital mortalities (7.9%), all of which had baseline pulmonary vasculature resistance (PVR) greater than 1400 dynes-sec-cm S5 . Preoperative PVR and mean pulmonary artery pressure were 1209 W 723 dynes-sec-cm S5 and 50 W 14 mmHg, respectively, signifying a high-risk operative group. Ninety-seven percent of patients were in NYHA class III or IV preoperatively. At median follow-up of 29 months 89.5% (17/19) of patients were in NYHA class I or II. CPET revealed a progressive increase in peak oxygen consumption from 16.5 W 4.1 ml/kg/min at first follow-up, to a plateau of 20.2 W 5.6 ml/kg/min (p = 0.032) at two years. Conclusions: CPET can be used to quantify progress in functional capacity post-CTEPH, although improvements in peak oxygen consumption plateau at two years.

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Section: Discussionmentioning

confidence: 99%

Operative and Functional Outcome After Pulmonary Endarterectomy for Advanced Thromboembolic Pulmonary Hypertension

2015

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“…[9], [23] However, in the work of Wang and his colleagues, significant correlation between RVMPI and RVEF by CMRI was not found in patients with ARVD and controls. [24] In the present study, we also failed to find a significant association between the two parameters.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Parameters in Patients with Pulmonary Arterial Hypertension: Correlations with Right Ventricular Ejection Fraction Derived from Cardiac Magnetic Resonance and Hemodynamics

Yang

Zhang

et al. 2013

PLoS ONE

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BackgroundEchocardiography is the most convenient method used to evaluate right ventricular function, and several echocardiographic parameters were studied in previous studies. But the value of these parameters to assess the right ventricular function in patients with pulmonary arterial hypertension (PAH) has not been well defined.MethodsPatients with PAH were observed prospectively. Right heart catheterization, echocardiography and cardiac magnetic resonance (CMR) were performed within 1 week interval. The correlations between echocardiographic parameters and right ventricular ejection fraction (RVEF) derived from CMR as well as hemodynamics were analyzed.ResultsThirty patients were enrolled including 24 with idiopathic PAH, 5 with PAH associated with connective tissue diseases and 1 with hereditary PAH. All echocardiographic parameters except right ventricular myocardial performance index (RVMPI) correlated significantly with RVEF (tricuspid annual plane systolic excursion [TAPSE], r = 0.440, P = 0.015; tricuspid annular systolic excursion velocity [S’], r = 0.444, P = 0.016; isovolumic acceleration [IVA], r = 0.600, P = 0.001; right ventricular fraction area change [RVFAC], r = 0.416, P = 0.022; ratio of right ventricular transverse diameter to left ventricular transverse diameter [RVETD/LVETD], r = −0.649, P<0.001; RVMPI, r = −0.027, P = 0.888). After adjusted for mean right atrial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance (PVR), only IVA and RVETD/LVETD could independently predict RVEF. Four echocardiographic parameters displayed significant correlations with PVR (TAPSE, r = −0.615, P<0.001; S’, r = −0.557, P = 0.002; RVFAC, r = −0.454, P = 0.012; RVETD/LVETD, r = 0.543, P = 0.002).ConclusionsThe echocardiographic parameters IVA and RVETD/LVETD can reflect RVEF independently regardless of hemodynamics in patients with PAH. In addition, TAPSE, S’, RVFAC and RVETD/LVETD can also reflect PVR in PAH patients.

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“…Concerning MPI, this variable has been shown a good correlation both with RV function and pulmonary hypertension [5]. However, MPI may be increased in patients with pulmonary hypertension independently of the presence of RV dysfunction [19].…”

Section: Discussionmentioning

confidence: 97%

“…isovolumic relaxation time (IRT) divided by RV ejection time (ET), as follows: RV MPI = (ICT ? IRT)/ET [5]. Patients were divided into 2 groups according to the presence of RV dysfunction by FAC, with RV dysfunction present when FAC \ 40 % [6].…”

Section: Echocardiographymentioning

confidence: 99%

Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism

Rodrigues

Guimarães

et al. 2014

Int J Cardiovasc Imaging

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The impact of pulmonary embolism on right ventricular (RV) performance can be evaluated by echocardiography, however, the relationship between pulmonary vascular involvement and RV burden is controversial. To assess the effect of clot burden on RV performance we studied 85 patients (aged 53 ± 17 years, 39 female) with confirmed PE by multislice computed tomography (CT) and echocardiography within 24 h of diagnosis. A CT score ranging from 1 to 20 points according to the pulmonary arteries involved was used. RV function was evaluated with fractional area change (FAC), with dysfunction present when FAC < 40%. Tissue Doppler RV systolic (s') velocities and myocardial performance index (MPI) were obtained, as well as pulmonary artery pressure (PAP). Mean CT score was 9.4 ± 6.7. Only 31 out of 85 patients (37%) presented with RV dysfunction, with FAC measuring 27.8 ± 7.2% in patients with dysfunction compared to 47.8 ± 4.4 for those with preserved RV function (p < 0.05). RV dysfunction was associated to older age, higher CT scores, increased pulmonary pressures and MPI and decreased s' (p < 0.001). An inverse correlation with CT clot burden was found for FAC (r = -0.57), whereas a direct correlation was seen for PAP (r = 0.51) and MPI (0.32). No correlation was observed for tissue Doppler velocities. In patients with acute PE, the effect of clot burden on RV performance is better expressed FAC than tissue Doppler indexes; the increase in pulmonary pressure is proportional to the magnitude of obstruction.

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Right ventricular function in patients with pulmonary hypertension; the value of myocardial performance index measured by tissue Doppler imaging

Cited by 30 publications

References 30 publications

Operative and Functional Outcome After Pulmonary Endarterectomy for Advanced Thromboembolic Pulmonary Hypertension

Operative and Functional Outcome After Pulmonary Endarterectomy for Advanced Thromboembolic Pulmonary Hypertension

Echocardiographic Parameters in Patients with Pulmonary Arterial Hypertension: Correlations with Right Ventricular Ejection Fraction Derived from Cardiac Magnetic Resonance and Hemodynamics

Relationship of clot burden and echocardiographic severity of right ventricular dysfunction after acute pulmonary embolism

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