Right Ventricular Strain for Prediction of Survival in Patients With Pulmonary Arterial Hypertension

Sachdev, Arun; Villarraga, Hector R.; Frantz, Robert P.; McGoon, Michael D.; Hsiao, Ju Feng; Maalouf, Joseph F.; Ammash, Naser M.; McCully, Robert B.; Miller, Fletcher A.; Pellikka, Patricia A.; Oh, Jae K.; Kane, Garvan C.

doi:10.1378/chest.10-2015

Cited by 298 publications

(235 citation statements)

References 50 publications

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“…An increase in PAPs does not necessarily reflect disease progression and a decrease in PAPs does not necessarily signal improvement. A comprehensive echocardiographic assessment includes a description of chamber sizes, particularly of the RA and RV area, the magnitude of tricuspid regurgitation, the LV eccentricity index and RV contractility, which can be determined by several variables, including RV longitudinal systolic strain/strain rate and RV fractional area change, Tei index and tricuspid annular plane systolic excursion (TAPSE) [101][102][103][104][105][106][107][108].…”

Section: The World Health Organization Functional Class (Who-fc) (Webmentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

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Section: The World Health Organization Functional Class (Who-fc) (Webmentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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“…47,48 Importantly, RV function as estimated by echocardiography and pulmonary hemodynamics as measured by RHC (MPAP, CO, PVR) may independently characterize survival in PAH. 46,49 Our data suggest that the IPVD patients had better RV function (lower median RIMP) than non-IPVD patients at the time of diagnosis of POPH, despite similar hemodynamics. However, survival was worse in the setting of IPVD.…”

Section: Discussionmentioning

confidence: 70%

Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival

et al. 2015

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MinnesotaHepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary vascular complications of portal hypertension with divergent clinicopathologic features and management. The presence of intrapulmonary vascular dilatations (IPVDs), detected by agitated saline contrast-enhanced transthoracic echocardiography (cTTE), is an essential feature of HPS but is not typically characteristic of POPH. Although IPVDs have been reported rarely in POPH, the prevalence and significance of this finding have not been systematically studied. We conducted a retrospective chart review of 80 consecutive patients diagnosed with POPH from January 1, 2002 to June 30, 2014 with documentation of cTTE findings, pulmonary hemodynamics, oxygenation, and survival. A total of 34 of the 80 patients (42%) underwent cTTE during initial diagnosis of POPH. IPVDs were detected in 20/34 patients (59%); intracardiac shunting was detected in 9/34 patients (26%; 4 also had IPVDs); and 9 patients (26%) had negative cTTE with no evidence of IPVD or intracardiac shunting. Patients with IPVD had decreased survival as compared to those without IPVD (P 5 0.003), a trend that persisted after exclusion of liver transplant recipients (P 5 0.07). The IPVD group had a trend toward higher Model for End-Stage Liver Disease score with and without incorporating sodium (MELD or MELD-Na; P 5 0.05 for both). The right ventricular index of myocardial performance (RIMP) was lower in the IPVD group (median, 0.4 versus 0.6; P 5 0.006). Patients with moderate or large IPVDs (n 5 6) had worse oxygenation parameters (partial pressure of arterial oxygen, diffusing capacity of the lung for carbon monoxide, and alveolar-arterial oxygen gradient) as compared to the rest of the cohort. Unexpectedly, IPVDs were frequently documented in POPH and associated with decreased survival. To further understand this observation, we recommend screening for IVPD in all patients with POPH. Liver Transpl 21:1355-1364, 2015. V C 2015 AASLD.Received March 25, 2015; accepted June 11, 2015. Abbreviations: A1AT, alpha-1-antitrypsin; A-a, alveolar-arterial; AIH, autoimmune hepatitis; ALD, alcoholic liver disease; ARDS, acute respiratory distress syndrome; ATN, acute tubular necrosis; CO, cardiac output; cTTE, contrast-enhanced transthoracic echocardiography; DLCO, diffusing capacity of the lung for carbon monoxide; DPG, diastolic pulmonary pressure gradient; ESLD, end-stage liver disease; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HPS, hepatopulmonary syndrome; INR, international normalized ratio; IPVD, intrapulmonary vascular dilatation; IQR, interquartile range; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; MELD-Na, Model for End-Stage Liver Disease incorporating sodium; MPAP, mean pulmonary artery pressure; N/A, not available; Na, sodium; NASH, nonalcoholic steatohepatitis; PA, pulmonary artery; PAH, pulmonary arterial hypertension; PaO 2 , partial pressure of arterial oxygen; PCWP, pulmonary capillary wedge pressure; PEA, pulseless elect...

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“…in relatives of patients with idiopathic PAH [51], but as yet no clear clinical cut-off values have been accepted. Strain and strain rate examine the deformation and rate of deformation, respectively, of the myocardial segment and, in PH, RV systolic strain and strain rate has been shown to predict morbidity and mortality [52], but at present is still considered outside the standard echocardiography protocol.…”

Section: New Techniquesmentioning

confidence: 99%

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Howard¹,

Grapsa²,

Dawson³

et al. 2012

European Respiratory Review

158

157

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Patients with suspected pulmonary hypertension (PH) should be evaluated using a multimodality approach to ensure that they receive a correct diagnosis. The series of investigations required includes clinical evaluation, noninvasive imaging techniques and right heart catheterisation (considered to be the ''gold standard'' for the diagnosis of PH). Current guidelines recommend that a detailed echocardiographic assessment is performed in all patients with suspected PH.In this review we summarise a protocol adopted by the National Pulmonary Hypertension Centres of UK and Ireland and approved by the British Society of Echocardiography for the evaluation of these patients. The views and measurements described are recommended for diagnosis, assisting in prognosis and providing a noninvasive means of following disease progression or response to therapy.

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Right Ventricular Strain for Prediction of Survival in Patients With Pulmonary Arterial Hypertension

Cited by 298 publications

References 50 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

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