Usefulness of Two-Dimensional Echocardiography in the Assessment of Right Heart in Chronic Obstructive Lung Disease

L, Bertoli; Mantero, Antonio; Cicero, Salvatore Lo; Alpago, Raffaella; Rizzato, G; Belli, C

doi:10.1159/000410429

Cited by 10 publications

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“…The remarkable clinical diffusion of 2D-ECHO and the increased instrumental experience made it possible to detect tho racic windows -as the subcostal one -fit for visualizing the right heart in COLD patients by overcoming the technical diffi culties represented by the thoracopulmonary alterations typical of such patients [14,16,18], Our percentage of success in detecting and measuring the structures of the RV, both at TV and RVOT level (85%), is nearly equal to that achieved by Zenker et al (18] and Danchin et al [15]. Moreover, we were able to get sharp and reproducible images of the SPA, of the RPA and of the PV in 76% of the cases; these results are decidedly better than those obtained by Morpurgo et al [23], and Oswald-Mammosser et al [10] by M-mode echocardiog raphy, above all as concerns the latter structure.…”

Section: Discussionmentioning

confidence: 99%

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Value of Two-Dimensional Echocardiography in the Identification of Pulmonary Hypertension in Chronic Obstructive Lung Disease

Mantero²,

Alpago³

et al. 1989

Respiration

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Thirty-three patients suffering from chronic obstructive lung disease (COLD) were submitted to right heart two-dimensional echocardiographic (2D-ECHO) and hemodynamic study. By the subcostal approach, the right ventricle outflow tract including the pulmonary vessels was visualized in 85% of the patients. Most parameters measured on the right ventricle and pulmonary vessels were significantly higher than those recorded in the healthy control group. Very significant correlations were observed between the mean pulmonary artery pressure (PAP) and the following 2D-ECHO parameters: diameter of the pulmonary artery at valve level (r = 0.62; p < 0.001); supravalvular diameter of the pulmonary artery (r = 0.44; p < 0.03); diameter of the left branch of the pulmonary artery (r = 0.48; p < 0.05); diameter of the right branch of the pulmonary artery (r = 0.39; p < 0.05), and between the PAP and PaO₂ (r = -0.66; p < 0.001). Furthermore, the sensitivity, specificity, and accuracy of 2D-ECHO measurements were calculated to assess the presence of pulmonary hypertension. Overall sensitivity was 65%, specificity 75%, and accuracy 67%. However, by combining the value of PaO₂ with that of the pulmonary valve by means of the multiple regression analysis, sensitivity increased to 84% in identifying pulmonary hypertension. Such data demonstrate that the 2D-ECHO study of the right heart in COLD patients has to carefully measure the dimensions of the pulmonary valve and the great pulmonary vessels, as their modification are mainly linked with the presence of pulmonary hypertension. Hence, it can be concluded that 2D-ECHO if associated with PaO₂ measurement allows the physician to diagnose pulmonary hypertension in COLD with a good degree of probability.

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Section: Discussionmentioning

confidence: 99%

“…Indeed, their diaphragm is low and the heart medially and inferiorly shifted toward the subxiphoid region. So, the cardiac structures are closer to the transducer positioned in this location, and the image quality of the right heart and the largest pulmonary ves sels is enhanced [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Value of Two-Dimensional Echocardiography in the Identification of Pulmonary Hypertension in Chronic Obstructive Lung Disease

Mantero²,

Alpago³

et al. 1989

Respiration

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“…Megítélésüket azonban több tényező is nehezíti általánosságban, de különösen COPD-ben, ugyanis a jobb kamra komplex geometriá-ja miatt "valódi", volumenbecsléseken alapuló ejekciós frakció nem meghatározható 2D echokardiográfi ával, ezért különböző helyettesítő módszerek alkalmazását javasolják (4). Szintén nehezíti a jobb kamra megítélé-sét a COPD-s betegek mellkasának fi zikális tulajdonsá-gai a gyakran társuló emphysema miatt (5). A szív MR-vizsgálat az egyik legpontosabb módszer a jobb kamra megítélésére, amellyel direkt módon meghatározható a jobb kamrai ejekciós frakció (6).…”

Section: Bevezetésunclassified

A jobbkamra-funkció echokardiográfiás és szív MR-paramétereinek összehasonlítása COPD-ben

Hajdu¹,

Vértes²,

Meiszterics³

et al. 2017

Cardiologia Hungarica

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Bevezetés: A COPD-s betegek prognózisát rontja a jobbkamra-diszfunkció (JK). Rutinszerűen echokardiográfi át használunk a JK-méret és -funkció megítélésére, ám ennek klinikai értéke COPD-ben nem tisztázott. A szív MR számít referenciamód-szernek, de nincs konszenzus arról, hogy a jobb kamrai volumenhez számítandó-e a trabekulák és a papilláris izmok tér-fogata. Így kutatásunk célja a JK-t jellemző echokardiográfi ás és szív MR-paraméterek közti összefüggések vizsgálata volt COPD-s betegekben. A trabekulák és papilláris izmok beszámításának hatását is tanulmányoztuk a JK-i méret és funkció szív MR-rel mért paramétereire. Betegek és módszerek: 22 fő, GOLD II. és III. stádiumú COPD-s beteget (62±9 év) vizsgáltunk. Echokardiográfi ával határoztuk meg a JK-i végszisztolés (ES) és végdiasztolés (ED) areát és a falvastagságot. A JK-funkciót TAPSE és RVFAC mérésével, valamint a tricuspidalis anuluszon mért szisztolés (S) sebességgel jellemeztük. Szív MR-rel JK-térfogat (MR-tér-fogat), ejekciós frakció (MR-EF) és izomtömeg-index (MR-tömeg-index) meghatározás történt. A manuális kontúrozás során a trabekulák és a papilláris izmok a kamrai volumen részét képezték, majd egy pixelintenzitáson alapuló programmal hozzászámítottuk a kamrai izomtömeghez. Eredmények: A JK-i átmérő és area értékek szignifi kánsan korreláltak az MR-térfogattal, a falvastagság pedig az MR-tömeg-indexszel. Az MR-EF szignifi kánsan korrelált a JK hosszanti átmérőjére normalizált TAPSE és tricuspidalis S-értékekkel, míg az RVFAC-cal nem. A trabekulák és papilláris izmok beszámítása szignifi kánsan csökkentette az MR-térfogatot (ED: -26,5±9,6; ES: -17,3±6,9 ml). Az MR-EF (+3,6±2,6%) és az MR-tömeg-index (ED:+27,8±10,0; ES:+18,1±7,2 g/m 2 ) szignifi kánsan nőtt. Következtetések: Az echokardiográfi a rutinszerűen alkalmazható a JK méretének és funkciójának meghatározására COPD-s betegeknél. A TAPSE és a tricuspidalis S a preferálandó módszerek a JK-funkció megítélésére. A trabekulák és papilláris izmok beszámítása a szív MR-mérések során szignifi kánsan befolyásolja az MR-rel nyert térfogat, tömeg és EF-értékeket.Correlations between echocardiographic and CMR-derived parameters of right ventricular function in COPD Background: In COPD right ventricular (RV) failure is linked to worse outcome. Though echocardiography is the common method for the assessment of RV size and function, its clinical value in COPD is not well defi ned. CMR is the reference technique, but it is not known, if trabeculae and papillary muscles should be included or excluded from the muscles during analysis. Thus we aimed to investigate the correlations between echocardiographic and CMR-derived parameters of the RV size and function in COPD patients. In addition, our aim was to determine the impact of including trabeculae and papillary muscles on RV volumes and function as assessed by CMR. Patients and methods: 22 COPD patients (62±9 years) in stages GOLD II. and III. were involved. RV end-systolic (ES) and end-diastolic (ED) area and RV wall thickness were measured by echocardiograph...

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“…The major shortcoming of the used procedures was that they were performed from the parasternal position, from where only a limited number of patients suffering from chronic obstructive airway disease and emphysema can be sufficiently examined [3]. Howev er, echocardiography is easier in this patient group when using the apical or the subcostal view [3,4]. Introduction of Doppler echocardiography opened the way for new possibilities in the diagnosis of pulmonary hypertension [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Two-Dimensional Echocardiographic Assessment of Right Cardiac Pressure Overload in Patients with Chronic Obstructive Airway Disease

Machraoui

Dryander²,

Hinrichsen³

et al. 1993

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Two-dimensional echocardiography was used to estimate right cardiac pressure overload in patients with chronic obstructive airway disease. Area measurements of the four heart chambers were carried out from the apical four-chamber view. Additionally, the respiratory behaviour of the inferior vena cava was examined from the subcostal view. A good apical imaging of the four-chamber view for area measurement was obtained in 44 out of 48 patients with chronic obstructive airway disease. The respiratory behaviour of the inferior vena cava was investigated from the subcostal view in 38 patients. Within 8 days after echocardiography, right cardiac catheterization was carried out in order to measure pulmonary artery and right atrial mean pressures and to determine pulmonary vascular resistance. A good correlation was found between pulmonary artery mean pressure and the following echocardiographic parameters: area index (area/body surface) of the two right heart cavities (r = 0.83), right-to-left ventricular area ratio (r = 0.82) and right-to-left cardiac area ratio (ratio between the added areas of both right heart cavities on the one side and the added areas of both left heart cavities on the other; r = 0.82). Correlation between these parameters and pulmonary vascular resistance (r = 0.71, 0.66 and 0.71, respectively) and between the right atrial mean pressure and the right atrial area index was less close (r = 0.64). On the other hand, the respiratory behaviour of the inferior vena cava proved to be highly specific but not very sensitive in predicting a pathological right atrial pressure. The combination of area measurements with investigation of the respiratory behaviour of the inferior vena cava is a useful method for evaluating the long-term effect of right cardiac pressure overload in patients with chronic obstructive airway disease, who can otherwise only be investigated with difficulty.

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Usefulness of Two-Dimensional Echocardiography in the Assessment of Right Heart in Chronic Obstructive Lung Disease

Cited by 10 publications

References 0 publications

Value of Two-Dimensional Echocardiography in the Identification of Pulmonary Hypertension in Chronic Obstructive Lung Disease

Value of Two-Dimensional Echocardiography in the Identification of Pulmonary Hypertension in Chronic Obstructive Lung Disease

A jobbkamra-funkció echokardiográfiás és szív MR-paramétereinek összehasonlítása COPD-ben

Two-Dimensional Echocardiographic Assessment of Right Cardiac Pressure Overload in Patients with Chronic Obstructive Airway Disease

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