Ventricular Geometry, Strain, and Rotational Mechanics in Pulmonary Hypertension

Puwanant, Sarinya; Park, Margaret; Popović, Zoran B.; Tang, W.H. Wilson; Farha, Samar; George, Deepa; Sharp, Jacqueline; Puntawangkoon, Jirapa; Loyd, James E.; Erzurum, Serpil C.; Thomas, James D.

doi:10.1161/circulationaha.108.844340

Cited by 219 publications

(200 citation statements)

References 33 publications

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“…Interestingly, an inverse relationship between LV end-diastolic EI and LV torsion has similarly been reported recently in adult patients with pulmonary hypertension. 18 The predominant effect of RV dilation and LV compression on apical rotation, and hence LV torsion, is intriguing. While the exact mechanism remains to be elucidated, the recent report of differential response of the three RV components to volume overload in the setting of TOF mighty shed some light on a possible explanation.…”

Section: Discussionmentioning

confidence: 99%

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Cheung

Wong

Liang

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp hile right ventricular (RV) dysfunction has been the main concern in patients after repair of tetralogy of Fallot (TOF), 1-3 the importance of left ventricular (LV) dysfunction as a risk factor of long-term adverse outcomes is increasingly acknowledged. 1,4,5 Dysfunction of the left ventricle is characterized by reduced ejection fraction, 1,4 altered systolic myocardial deformation, 6,7 and systolic mechanical dyssynchrony. 1,7,8 These LV functional abnormalities have been attributed to suboptimal ventricular-ventricular interaction, 1,4 although the nature of this interaction remains to be defined.Assessment of cardiac mechanics has extended from evaluation of linear to torsional deformation, which might provide new mechanistic insights. Twisting motion of the left ventricle during the ejection phase is important in the Frank-Starling mechanism, 9 while untwisting contributes to LV diastolic relaxation and early diastolic filling. 10 Interaction between LV subendocardial and subepicardial helical myocardial fibres has been proposed to explain the phenomenon of torsional deformation. 11 Alteration of septal geometry and changes in LV shape due to volume overloading of the right ventricle might potentially distort this interaction and impair torsional deformation. In the present study, we tested the hypothesis that alteration of LV torsional mechanics occurs in postoperative TOF patients and is associated with RV volume overload and changes in LV configuration. Methods SubjectsFifty-five patients who had undergone surgical repair of TOF with transannular patch enlargement of the RV outflow were recruited consecutively from the cardiac clinic of Queen Mary Hospital. From the case records, the following data were retrieved: age at operation, types of surgical procedure, and duration of follow up since total repair. Twenty-seven healthy subjects, including those followed up for non-specific chest pain and palpitation but without documented cardiac arrhythmias and healthy siblings, were recruited as controls. The weight and height of all subjects were measured and the body surface area was calculated accordingly. The Institutional Review Board approved the study and all of the subjects gave

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Section: Discussionmentioning

confidence: 99%

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Cheung

Wong

Liang

et al. 2011

Circ J

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“…59 It has been shown in adults that the more severe the PH, the more impaired the end-systolic longitudinal strain in the RV free wall. 60 While RV strain reflects myocardial performance, it is influenced by increased afterload and will decrease with increasing RV afterload. 61 RV global longitudinal peak systolic strain and strain rate were significantly impaired in adults with PH, compared to controls, 62 with RV systolic strain most altered in patients with severe PH, when compared with patients with mild PH.…”

Section: Rv Fractional Area Changementioning

confidence: 99%

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

et al. 2016

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Transthoracic echocardiography (TTE) is the most accessible noninvasive diagnostic procedure for the initial assessment of pediatric pulmonary hypertension (PH). This review focuses on principles and use of TTE to determine morphologic and functional parameters that are also useful for follow-up investigations in pediatric PH patients. A basic echocardiographic study of a patient with PH commonly includes the hemodynamic calculation of the systolic pulmonary artery pressure (PAP), the mean and diastolic PAP, the pulmonary artery acceleration time, and the presence of a pericardial effusion. A more detailed TTE investigation of the right ventricle (RV) includes assessment of its size and function. RV function can be evaluated by RV longitudinal systolic performance (e.g., tricuspid annular plane systolic excursion), the tricuspid regurgitation velocity/right ventricular outflow tract velocity time integral ratio, the fractional area change, tissue Doppler imaging-derived parameters, strain measurements, the systolic-to-diastolic duration ratio, the myocardial performance (Tei) index, the RV/left ventricle (LV) diameter ratio, the LV eccentricity index, determination of an enlarged right atrium and RV size, and RV volume determination by 3-dimensional echocardiography. Here, we discuss the potential use and limitations of TTE techniques in children with PH and/or ventricular dysfunction. We suggest a protocol for TTE assessment of PH and myocardial function that helps to identify PH patients and their response to pharmacotherapy. The outlined protocol focuses on the detailed assessment of the hypertensive RV; RV-LV crosstalk must be analyzed separately in the evaluation of different pathologies that account for pediatric PH.

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“…pressure gradient, 15,16 leading to decrease in LV compliance. 1,2,14,[17][18][19] Other causes include an increase in RV tension that leads to prolonged RV myocardial shortening with abnormal relaxation of the interventricular septum that impairs RV systole and LV diastole, 1,20 decrease in LV torsion, 21 delay in early diastolic LV untwisting, 22 reduction in the preload, 4,5,21 diastolic asynchrony in the anterior-lateral or apical regions, 23,24 and intrinsic disease of the left ventricle. [25][26][27] In our study, as well as others, 2,14 septal displacement (measured as eccentricity index) was predominantly observed in systole and early diastole, possible decreasing LV compliance and explaining impaired LV relaxation.…”

Section: Acknowledgmentsmentioning

confidence: 99%

Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension

Tonelli¹,

Plana

Heresi³

et al. 2012

Chest

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Background:Little is known about the association between left ventricular (LV) diastolic dysfunction and outcomes in patients with idiopathic or heritable pulmonary arterial hypertension (PAH). Our rationale was to investigate the prevalence of LV diastolic dysfunction, and its association with disease severity and outcomes, in patients with idiopathic or heritable PAH. Methods: Using the Cleveland Clinic Pulmonary Hypertension Registry, we identifi ed subjects with heritable or idiopathic PAH who underwent Doppler echocardiography and right-sided heart catheterization. Echocardiographic diastolic parameters were assessed in each patient. Results: A total of 61 patients met the inclusion criteria (idiopathic 85%, heritable 15%). The age at the time of echocardiography was 48.3 Ϯ 18 years, 84% of the subjects were women, and 48% were on PAH-targeted therapies. Normal LV diastolic function, impaired relaxation, and pseudonormalization were seen in 10%, 88%, and 2% of the patients, respectively. Peak early diastolic (peak E) velocity was directly associated with LV end-diastolic volume and cardiac index and inversely associated with the degree of right ventricular dilation, right atrial pressure, and pulmonary vascular resistance. Peak E velocity was associated with mortality adjusted for age and sex (hazard ratio [HR], 1.5; 95% CI, 1.1-2 per 10 cm/s decrease; P 5 .015) and age, sex, 6-min walk distance, and cardiac output (HR, 1.8; 95% CI, 1.2-2.9 per 10 cm/s decrease; P 5 .01). Conclusions: LV diastolic dysfunction of the impaired relaxation type is observed in the majority of patients with advanced idiopathic or heritable PAH. A decrease in transmitral fl ow peak E velocity is associated with worse hemodynamics and outcome. CHEST 2012; 141(6):1457-1465Abbreviations: A 5 late diastolic; D 5 anterograde diastolic; E 5 early diastolic; HR 5 hazard ratio; LA 5 left atrial; LV 5 left ventricular; NYHA 5 New York Heart Association; PAH 5 pulmonary arterial hypertension; PAOP 5 pulmonary artery occlusion pressure; PAP 5 pulmonary artery pressure; PVR 5 pulmonary vascular resistance; RA 5 right atrial; RHC 5 right-sided heart catheterization; RV 5 right ventricular; S 5 systolic

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Ventricular Geometry, Strain, and Rotational Mechanics in Pulmonary Hypertension

Abstract: Background-We tested the hypothesis that right ventricular (RV) pressure overload affects RV function and further influences left ventricular (LV) geometry, which adversely affects LV twist mechanics and segmental function. Methods and Results-Echocardiographic

Cited by 219 publications

References 33 publications

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Torsional Mechanics of the Left Ventricle in Patients After Surgical Repair of Tetralogy of Fallot

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension

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