Pulmonary hypertension and the right ventricle

ESC CardioMed ◽  
2018 ◽  
pp. 485-490
Author(s):  
Petros Nihoyannopoulos ◽  
Julia Grapsa
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Imaging Modality ◽  
Three Dimensional ◽  
Quantitative Information ◽  
Ventricular Size ◽  
Right Ventricular Size ◽  
Group 2 ◽  
Line Imaging ◽  
Dimensional Echocardiography

Due to its widespread availability, echocardiography is used as the first-line imaging modality for the assessment of right ventricular size, function, and pressures. Two-dimensional echocardiography can easily obtain valuable quantitative information about right ventricular size and function. Measurements such as the tricuspid annular plane systolic excursion, right ventricular myocardial performance index, fractional area change, tissue Doppler-derived tricuspid lateral annular systolic velocity, global longitudinal strain and strain rate, and eccentricity index are the recommended parameters to be used for the routine evaluation of right ventricular function. Three-dimensional echocardiography and three-dimensional strain have now entered the clinical arena for a more precise right ventricular assessment. Echocardiography is also important to establish the causes of secondary pulmonary hypertension (group 2) by evaluating the various left heart conditions leading to the rise of right ventricular systolic pressures. Finally, echocardiography is probably the most accurate non-invasive imaging modality for the assessment of right ventricular pressure and is therefore an ideal tool for the evaluation and screening of pulmonary hypertension.

Abstract 15413: Comparison of Right Ventricular Functional Indices Using Two-dimensional and Three-dimensional Echocardiography to Predict Outcomes in Pediatric Pulmonary Hypertension

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Pei-Ni Jone ◽  
SuHong Tong ◽  
D. Dunbar Ivy
Keyword(s):  
Pulmonary Hypertension ◽  
Adverse Events ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Three Dimensional ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography ◽  
Serial Evaluation ◽  
Rv Function

Background: Right ventricular (RV) function is an important determinant of outcomes in pulmonary hypertension (PH) patients. Conventional indices of fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and RV tissue Doppler imaging myocardial performance index (RV TDI MPI) have been used as surrogates of RV function. RV ejection fraction (EF) from real time three-dimensional echocardiography (RT-3DE) has emerged as a quantitative evaluation of global RV function and has correlated well with cardiac magnetic resonance imaging. In this study, 3D RV EF was compared with conventional indices in the serial evaluation of RV function in pediatric PH patients to predict adverse events. Methods: Forty-eight pediatric PH patients (median age = 10 years (4 months - 27 years)) were evaluated serially (138 visits with median interval visit = 116 days (4 -368 days)) with RT-3DE to follow their ejection fraction (EF) and conventional indices from April, 2014 to May, 2015. Echocardiographic variables include measures of RV function: 3D RV EF, FAC, TAPSE, and RV TDI MPI. Adverse events included: initiation or intensification of intravenous vasodilator therapy, atrial septostomy, Pott’s shunt, or death. Receiver Operating Characteristics (ROC) analyses were performed to identify the best cut-offs in predicting adverse events in serial follow up of pediatric PH patients. Results: Patients were classified based on their World Health Classification (I = 16, II=16, III=11, IV=3). Two patients were not classified as they were too young. There were 13 adverse events. 3D RV EF was a good predictor of adverse events with highest area under curve (AUC) = 0.79, p<0.001(cut-off value of 38% = sensitivity 69%; specificity of 78%) compared to FAC has an AUC = 0.77, p<0.05 (cut-off value of 33% = sensitivity 63%; specificity of 78%). TAPSE and TV TDI MPI were not statistically significant (AUC = 0.54, p = 0.65; AUC 0.63, p = 0.09 respectively). Conclusion: 3D RV EF is a good index in predicting adverse events and was better than FAC, TAPSE, and RV TDI MPI in predicting adverse events in serial follow up of pediatric PH patients. 3D RV EF can be used as a noninvasive tool in the serial evaluation of RV function in pediatric PH patients as it is easily obtained clinically.

Right ventricular size and contractile reserve significantly correlate in patients with pulmonary hypertension

2018 ◽  
Author(s):  
Lukas Fischer ◽  
Nicola Benjamin ◽  
Benjamin Egenlauf ◽  
Satenik Harutyunova ◽  
Hanns-Martin Lorenz ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Contractile Reserve ◽  
Ventricular Size ◽  
Right Ventricular Size
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