Echocardiographic Parameters in Patients with Pulmonary Arterial Hypertension: Correlations with Right Ventricular Ejection Fraction Derived from Cardiac Magnetic Resonance and Hemodynamics
Background Echocardiography is the most convenient method used to evaluate right ventricular function, and several echocardiographic parameters were studied in previous studies. But the value of these parameters to assess the right ventricular function in patients with pulmonary arterial hypertension (PAH) has not been well defined. Methods Patients with PAH were observed prospectively. Right heart catheterization, echocardiography and cardiac magnetic resonance (CMR) were performed within 1 week interval. The correlations between echocardiographic parameters and right ventricular ejection fraction (RVEF) derived from CMR as well as hemodynamics were analyzed. Results Thirty patients were enrolled including 24 with idiopathic PAH, 5 with PAH associated with connective tissue diseases and 1 with hereditary PAH. All echocardiographic parameters except right ventricular myocardial performance index (RVMPI) correlated significantly with RVEF (tricuspid annual plane systolic excursion [TAPSE], r = 0.440, P = 0.015; tricuspid annular systolic excursion velocity [S’], r = 0.444, P = 0.016; isovolumic acceleration [IVA], r = 0.600, P = 0.001; right ventricular fraction area change [RVFAC], r = 0.416, P = 0.022; ratio of right ventricular transverse diameter to left ventricular transverse diameter [RVETD/LVETD], r = ？0.649, P<0.001; RVMPI, r = ？0.027, P = 0.888). After adjusted for mean right atrial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance (PVR), only IVA and RVETD/LVETD could independently predict RVEF. Four echocardiographic parameters displayed significant correlations with PVR (TAPSE, r = ？0.615, P<0.001; S’, r = ？0.557, P = 0.002; RVFAC, r = ？0.454, P = 0.012; RVETD/LVETD, r = 0.543, P = 0.002). Conclusions The echocardiographic parameters IVA and RVETD/LVETD can reflect RVEF independently regardless of hemodynamics in patients with PAH. In addition, TAPSE, S’, RVFAC and RVETD/LVETD can also reflect PVR in PAH patients.
References
[1]
Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, et al. (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30: 2493–2537.
[2]
van Wolferen SA, Marcus JT, Boonstra A, Marques KM, Bronzwaer JG, et al. (2007) Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 28: 1250–1257.
[3]
van de Veerdonk MC, Kind T, Marcus JT, Mauritz GJ, Heymans MW, et al. (2011) Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol 58: 2511–2519.
[4]
Mooij CF, de Wit CJ, Graham DA, Powell AJ, Geva T (2008) Reproducibility of MRI measurements of right ventricular size and function in patients with normal and dilated ventricles. J Magn Reson Imaging 28: 67–73.
[5]
Bradlow WM, Hughes ML, Keenan NG, Bucciarelli-Ducci C, Assomull R, et al. (2010) Measuring the heart in pulmonary arterial hypertension (PAH): implications for trial study size. J Magn Reson Imaging 31: 117–124.
[6]
Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, et al. (1996) Doppler echocardiographic index for assessment of global right ventricular function.”. J Am Soc Echocardiogr 9(6): 838–847.
[7]
Grignola JC, Ginés F, Guzzo D (2006) Comparison of the Tei index with invasive measurements of right ventricular function. Int J Cardiol 113: 25–33.
[8]
Schiller NB, Kwan DM (2009) The Tei index as an expression of right ventricular impairment and recovery: investment grade or subprime? JACC Cardiovasc Imaging 2: 150–152.
[9]
Sato T, Tsujino I, Ohira H, Oyama-Manabe N, Yamada A, et al. (2012) Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension. J Am Soc Echocardiogr 25: 280–286.
[10]
Zeng WJ, Sun YJ, Xiong CM, Gu Q, He JG, et al. (2011) Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in idiopathic pulmonary arterial hypertension. Chin Med J (Engl) 124: 1672–1677.
[11]
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166: 111–117.
[12]
De Castro S, Cavarretta E, Milan A, Caselli S, Di Angelantonio E, et al. (2008) Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension: a comparison with 3D echo-derived right ventricular ejection fraction. Echocardiography 25: 289–293.
[13]
Sade LE, Gülmez O, Ozyer U, Ozgül E, A？ildere M (2009) Tissue Doppler Study of the Right Ventricle with a Multisegmental Approach: Comparison with Cardiac Magnetic Resonance. J Am Soc Echocardiogr 22: 361–368.
[14]
Wahl A, Praz F, Schwerzmann M, Bonel H, Koestner SC, et al. (2011) Assessment of right ventricular systolic function: comparison between cardiac magnetic resonance derived ejection fraction and pulsed-wave tissue Doppler imaging of the tricuspid annulus. Int J Cardiol 151: 58–62.
[15]
Grapsa J, Gibbs JS, Dawson D, Watson G, Patni R, et al. (2012) Morphologic and functional remodeling of the right ventricle in pulmonary hypertension by real time three dimensional echocardiography. Am J Cardiol 109: 906–913.
[16]
Vogel M, Schmidt MR, Kristiansen SB, Cheung M, White PA, et al. (2002) Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure-volume relations in an animal model. Circulation 105: 1693–1699.
[17]
Schattke S, Knebel F, Grohmann A, Dreger H, Kmezik F, et al. (2010) Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study. Cardiovasc Ultrasound 8: 3 doi:10.1186/1476-7120-8-3.
[18]
Tugcu A, Yildirimtürk O, Tayyareci Y, Demiroglu C, Aytekin S, et al. (2010) Evaluation of subclinical right ventricular dysfunction in obstructive sleep apnea patients using velocity vector imaging. Circ J 74: 312–319.
[19]
Frémont B, Pacouret G, Jacobi D, Puglisi R, Charbonnier B, et al. (2008) Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients. Chest 133: 358–362.
[20]
Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107: 526–531.
[21]
Ueti OM, Camargo EE, Ueti Ade A, de Lima-Filho EC, Nogueira EA, et al. (2002) Assessment of right ventricular function with Doppler echocardiographic indices derived from tricuspid annular motion: comparison with radionuclide angiography. Heart 88: 244–248.
[22]
Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westerhof N, et al. (2010) Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson 12: 35 doi:10.1186/1532-429X-12-35.
[23]
Zimbarra Cabrita I, Ruisanchez C, Dawson D, Grapsa J, North B, et al. (2010) Right ventricular function in patients with pulmonary hypertension; the value of myocardial performance index measured by tissue Doppler imaging, Eur J Echocardiogr. 11: 719–24.
[24]
Wang J, Prakasa K, Bomma C, Tandri H, Dalal D, et al. (2007) Comparison of novel echocardiographic parameters of right ventricular function with ejection fraction by cardiac magnetic resonance. J Am Soc Echocardiogr 20: 1058–1064.
[25]
Vonk MC, Sander MH, van den Hoogen FH, van Riel PL, Verheugt FW, et al. (2007) Right ventricle Tei-index: A tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. Eur J Echocardiography 8: 317–321.
[26]
Dalsgaard M, Snyder EM, Kjaergaard J, Johnson BD, Hassager C, et al. (2007) Isovolumic acceleration measured by tissue Doppler echocardiography is preload independent in healthy subjects. Echocardiography 24: 572–579.
