Usefulness of Adding Echocardiography of the Right Heart to Risk-Assessment Scores in Prostanoid-Treated Pulmonary Arterial Hypertension

Badagliacca, Roberto; Papa, Silvia; Manzi, Giovanna; Miotti, Cristiano; Luongo, Federico; Sciomer, Susanna; Cedrone, Nadia; Fedele, Francesco; Naeije, Robert; Vizza, Carmine Dario

doi:10.1016/j.jcmg.2020.04.005

Cited by 31 publications

(37 citation statements)

References 3 publications

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“…Telemedical visits allow patients' clinical assessment but don't provide information neither on RV structure, function and remodeling nor on hemodynamic. The echocardiographic evaluation of the RV is essential in the management of PAH patients, helping clinicians with the difficult task of predicting morbidity and mortality in clinical practice [ 51 , 52 ]. Thus, a tele-echocardiography program with the use of handheld ultrasounds could represent an important breakthrough in the management of PAH patients limiting the number of in clinic echocardiograms at accredited PH centers.…”

Section: Telemedicine In Pah: Current Available Tools and Future Chal...mentioning

confidence: 99%

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

Manzi

Papa

Mariani

et al. 2022

Vascular Pharmacology

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Section: Telemedicine In Pah: Current Available Tools and Future Chal...mentioning

confidence: 99%

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

Manzi

Papa

Mariani

et al. 2022

Vascular Pharmacology

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“…A sigmoid function of PVR reduction represents this relation. Indeed, it was observed that >50% of RHRR was obtained with >50% reduction in PVR [57].…”

Section: Impact Of Therapeutic Strategies On Echocardiographic-derivementioning

confidence: 99%

“…The evaluation of right heart reverse remodeling (RHRR) defined in two-dimensional echocardiography by combining decreased right-sided atrial and ventricle areas and left ventricle eccentricity index, has recently emerged as a key parameter in evaluating patients' response to therapy. Indeed, a dramatic reduction in PVR in response to therapy has been shown to be associated with RHRR, which in turn is strongly associated with improved outcomes [56,57].…”

Section: Echocardiographic Parameters With Prognostic Impact (Echocarmentioning

confidence: 99%

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece

Miotti

Papa

Manzi

et al. 2021

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Pulmonary arterial hypertension (PAH) is a rare, progressive disease with a poor prognosis. The pathophysiologic model is mainly characterized by an afterload mismatch in which an increased right ventricle afterload, driven by increased pulmonary vascular resistance (PVR), leads to right heart failure. International guidelines recommend optimization of treatment based on regular risk assessments to achieve or maintain a low-risk status. Current risk scores are based on a multi-modality approach, including demographic, clinical, functional, exercise, laboratory, and hemodynamic parameters, which lack significant echocardiographic parameters. The originality of echocardiography relies on the opportunity to assess in a non-invasive way a physiologically meaningful combination of easy to measure variables tightly related to right ventricle adaptation/maladaptation to increased afterload, the main determinant of a patient’s prognosis. Echo-derived morphological and functional parameters have been investigated in PAH, proving to have prognostic relevance. Different therapeutic strategies proved to have different effects in reducing PVR. An upfront combination of drugs, including a parenteral prostacyclin, has shown to be associated with right heart reverse remodeling in a greater proportion of patients than other treatment strategies as a function of PVR reduction. Adding echocardiographic data to current risk scores would allow better identification of right ventricle (RV) adaptation in PAH patients’ follow-up. This additional information would allow better stratification of the patient, leading to optimized and personalized therapeutic management.

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“…Approved therapies largely rely on RV afterload reduction to allow right-heart reverse remodeling (RHRR), defined by the combination of decreased right-sided atrial and RV areas and LV eccentricity. According to the pathophysiological model of afterload mismatch, the likelihood of RHRR after institution of targeted therapies is strongly correlated with a reduction in PVR > 50%, a result that can be achieved through aggressive therapeutic strategies, including parenteral prostacyclins [ 12 , 13 ]. RHRR, which emerged as an independent predictor of prognosis and risk status [ 14 ], should therefore be included in the routine imaging assessment of PAH patients.…”

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Comment on Topyła-Putowska et al. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations. J. Clin. Med. 2021, 10, 3229

Manzi

Vizza

Badagliacca

2022

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A comprehensive PAH echocardiographic examination of patients with pulmonary arterial hypertension (PAH) should include a set of parameters resembling the pathophysiological changes occurring in the course of the disease. This approach could help clinicians build a complete picture of the patient, test the effects of targeted therapies and identify patients who need a more aggressive therapeutic approach to achieve a low risk-status.

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Usefulness of Adding Echocardiography of the Right Heart to Risk-Assessment Scores in Prostanoid-Treated Pulmonary Arterial Hypertension

Cited by 31 publications

References 3 publications

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece

Comment on Topyła-Putowska et al. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations. J. Clin. Med. 2021, 10, 3229

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