Int J Cardiovasc Imaging DOI 10.1007/s10554-015-0598-x

ORIGINAL PAPER

Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension Yoshiki Motoji • Hidekazu Tanaka • Yuko Fukuda • Hiroyuki Sano • Keiko Ryo • Junichi Imanishi • Tatsuya Miyoshi • Takuma Sawa • Yasuhide Mochizuki • Kensuke Matsumoto • Noriaki Emoto • Ken-ichi Hirata

Received: 24 September 2014 / Accepted: 17 January 2015 Ó Springer Science+Business Media Dordrecht 2015

Abstract Although impaired right ventricular (RV) performance has been associated with adverse outcomes for pulmonary hypertension (PH) patients, the relationship between bi-ventricular interdependence and outcomes is not yet fully understood. We studied 96 PH patients. RV systolic function was assessed by means of RV free-wall longitudinal speckle-tracking strain (RV-free), and left ventricular (LV) filling as early diastolic transmitral flow velocity (TMF-E). RV-free B19 % and TMF-E \60 cm/s were adopted as pre-defined cut-offs for RV systolic dysfunction and LV under-filling, respectively, associated with worse outcomes. Long-term outcome was tracked over 2.2 years. RV-free correlated significantly with TMF-E (r = 0.57, p \ 0.001).TMF-E and RV-free were significantly lower in patients with than in those without cardiac events. RV systolic dysfunction and LV under-filling was observed in 35 patients. These features were associated with worse long-term survival compared to other subgroups (log-rank p = 0.012). A sequential Cox model based on clinical variables including world health organization functional class IV and brain natriuretic peptide [150 pg/dl (v2 = 1.2) was improved by the addition of RV-free (v2 = 5.5, p = 0.04) as well as of TMF-E (v2 = 11.5, p = 0.01). In conclusions, RV systolic function was shown to correlate significantly with LV filling in PH patients. In addition, not only assessment of RV systolic function, but also of a combined bi-ventricular

Y. Motoji  H. Tanaka (&)  Y. Fukuda  H. Sano  K. Ryo  J. Imanishi  T. Miyoshi  T. Sawa  Y. Mochizuki  K. Matsumoto  N. Emoto  K. Hirata Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan e-mail: [email protected]

parameter comprising RV systolic function and LV filling may well have clinical implications for more successful management of PH patients. Keywords Pulmonary hypertension  Bi-ventricular function  Echocardiography

Introduction Pulmonary hypertension (PH) leads to marked increases in pulmonary artery pressure (PAP) and exercise intolerance, is associated with poor outcomes [1–3]. Since impaired right ventricular (RV) performance has been associated with adverse outcomes for PH patients [4, 5], the assessment of RV performance by means of right heart catheterization, echocardiography or cardiac magnetic resonance imaging has become increasingly important in the management of such patients. In addition, reduced left ventricular (LV) diastolic filling has been also identified in PH patients [6–8]. As a consequence of RV dysfunction, LV performance, especially LV diastolic function, is further impaired by reduced LV distensibility resulting from leftward ventricular septal bowing [9], both of which are related to the extent of RV dilatation and LV underfilling. However, a previous study reported that LV underfilling in PH patients improved after treatment [10, 11]. While bi-ventricular interdependence in PH patients has therefore been established by previous studies, the relationship between RV systolic function and LV filling is not yet fully understood. Accordingly, the objectives of this study were to characterize this association in PH patients. We also tested the hypothesis that the addition of an assessment of LV filling to that of RV systolic function can enhance the prediction of long-term outcomes for patients after PH-specific therapy.

123

Int J Cardiovasc Imaging

Methods

BTO8; GE Vingmed Ultrasound AS) for subsequent offline speckle-tracking analysis.

Study subjects RV systolic function assessed by speckle-tracking strain

Data for a total of 100 consecutive patients with PH classified as Dana Point group 1 or 4 [12] who visited or were admitted to Kobe University Hospital between June 2006 and March 2014 were analyzed retrospectively. PH was defined as mean pulmonary arterial pressure (PAP) [ 25 mmHg at rest determined by means of right heart catheterization (RHC) [12]. We excluded PH patients with (1) coronary artery disease, defined as a single coronary artery stenosis of [50 % of the diameter of a major epicardial vessel or a previous history of myocardial infarction; (2) any known cause of cardiomyopathy or a history of familial cardiomyopathy; (3) pulmonary capillary wedge pressure [15 mmHg determined by means of RHC; (4) more than mild aortic and/or mitral valvular heart disease; (5) atrial fibrillation and (6) patients with port hypertension and/or liver cirrhosis. At the time of enrollment, all patients were in clinically stable condition. All patients were stable at echocardiography, and 50 patients (42 %) took PH-specific drugs at baseline.

The assessment of RV systolic function by means of twodimensional longitudinal speckle-tracking strain from the RV free wall (RV-free) was previously described in detail [18–22]. Briefly, a region of interest was traced on the RV endocardium with a point-and-click approach at end-diastole from the RV-focused apical four-chamber view. A second, larger region of interest was then generated and manually adjusted near the epicardium. Special care was taken to fine-tune the region of interest, using visual assessment during cine loop playback, to ensure that segments were tracked appropriately. The RV was then divided into six standard segments, and six corresponding time-strain curves were generated. RV-free was calculated by averaging three regional peak systolic strains along the entire RV free wall (Fig. 1). On the basis of previous findings, the predefined cutoff for RV systolic dysfunction in PH patients was set at RV-free B19 % [18, 22].

Echocardiographic examination

Hemodynamic measurement

All echocardiographs were obtained with a commercially available system with a 3.5-MHz transducer (Vivid 7 and E9; GE Vingmed Ultrasound, Horten, Norway). Digital routine cine loops were obtained from the standard parasternal, apical and RV–focused apical four-chamber views from three consecutive beats at the end of expiratory apnea [13, 14]. For speckle tracking analysis, frame rates were 65 ± 9 Hz and depth was 13 ± 2 cm. Sector width and gain were optimized to allow for complete myocardial and endocardium visualization. Tricuspid annular plane systolic excursion and right atrial area were measured according to the guideline of the American Society of Echocardiography [13]. In addition, end-systolic LV eccentricity index was also measured [15]. Standard LV measurements were obtained from the parasternal longaxis view, and LV volumes and ejection fraction (LVEF) were calculated with the biplane Simpson’s method [14]. The pulsed-wave Doppler-derived early diastolic (TMF-E) and atrial transmitral flow velocity, and spectral tissue Doppler-derived septal mitral annular velocity (e0 ) were obtained from the apical four-chamber view and used for the assessment of LV diastolic function [16]. The predefined cutoff of LV filling responsible for worse outcome or PH patients was set at TMF-E \ 60 cm/s in accordance with a previously reported finding [17]. Digital data were transferred to dedicated offline software (EchoPAC version

All patients underwent RHC for the assessment of mean PAP (mPAP) and pulmonary vascular resistance (PVR). An investigator blinded to the echocardiographic data performed the pressure measurements.

123

Definitions of long-term outcomes The clinical endpoints were pre-specified as admission for deteriorating right-sided heart failure and cardiac death after treatment with PH-specific drugs. Deteriorating rightsided heart failure was defined as dyspnea with co-occurrence of ascites and/or pitting peripheral edema, or of ascites and/or hepatomegaly. Long-term follow-up lasted 2.2 years after PH-specific treatment including the addition of PH-specific drugs for idiopathic pulmonary arterial hypertension and PH associated connective tissue disease, and balloon pulmonary angiography or pulmonary endarterectomy for chronic thromboembolic PH. Statistical analysis Continuous variables were expressed as mean values ± standard deviation or percentages, while categorical data were summarized as frequencies and percentages. The parameters of the two subgroups were compared by means of the unpaired t test, while the paired t test was used for

Int J Cardiovasc Imaging

Fig. 1 a Assessment of right ventricular (RV) free wall longitudinal speckle-tracking strain (RV-free) by means of two-dimensional speckle-tracking longitudinal strain using the RV-focused apical four-chamber view. RV-free was calculated by averaging three

regional peak systolic strains. b The pulsed-wave Doppler-derived early diastolic transmitral flow velocity (TMF-E) was obtained from the apical four-chamber view and used for the assessment of left ventricular (LV) filling

comparison of continuous variables. Proportional differences were assessed with Fisher’s exact test or v2 test as appropriate. Event-free survival curves were determined with the Kaplan–Meier method and comparisons of cumulative event rates with the log-rank test. Linear regression was used for correlation analysis and findings were expressed as Pearson correlation coefficients. Sequential Cox models were used to determine the prognostic advantages of the LV diastolic parameter over hemodynamic parameters of RV performance, brain natriuretic peptide (BNP), World Health Organization (WHO) functional class (FC) and RV systolic function. In accordance with various guidelines and previous findings, WHO-FC [12] IV and BNP [ 150 pg/dl [23] were predefined as the cutoff values for predicting unfavorable outcomes for PH patients. A statistically significant increase in the global log-likelihood v2 of the model was defined as an improvement in the prognostic value. The intraclass correlation coefficient was used to determine

inter- and intra-observer reproducibility from 20 randomly selected subjects. For all tests, a p value of \0.05 was considered statistically significant. All the analyses were performed with commercially available software (MedCalc software version 10.4.0.0; MedCalc Software, Inc., Mariakerke, Belgium).

Results Baseline clinical characteristics After exclusion of four patients (4 %) whose images were suboptimal due to poor echocardiographic windows, the 96 remaining PH patients for whom both baseline echocardiographic and long-term outcome data were available formed the final study group. The baseline clinical, hemodynamic and echocardiographic characteristics of the PH patients are summarized in Table 1. Their mean age

123

Int J Cardiovasc Imaging Table 1 Baseline characteristics of patients Variable

All (n = 96)

Patients with event (n = 19)

Patients without event (n = 77)

p value 0.61

Age, n (%)

61 ± 16

63 ± 16

61 ± 16

Female, n (%)

64 (67 %)

15 (79 %)

49 (64 %)

0.21

Body surface area (m2)

1.55 ± 0.21

1.47 ± 0.20

1.57 ± 0.20

0.08

Systolic blood pressure (mmHg)

116 ± 19

105 ± 13

119 ± 19

0.004

Diastolic blood pressure (mmHg)

70 ± 12

62 ± 10

73 ± 12

0.004

Heart rate (beats/min)

72 ± 13

73 ± 11

72 ± 14

0.82

WHO functional class, n (%) I

8 (8 %)

1 (5 %)

7 (9 %)

0.59

II

42 (44 %)

7 (37 %)

35 (45 %)

0.50

III

40 (42 %)

9 (47 %)

31 (40 %)

0.58

6 (6 %)

2 (11 %)

4 (5 %)

0.40

IPAH

15 (16 %)

2 (11 %)

13 (17 %)

0.50

PH associated CTD

30 (31 %)

10 (53 %)

20 (26 %)

0.02

CTEPH

51 (53 %)

7 (37 %)

44 (57 %)

0.11

157 ± 236

285 ± 454

134 ± 180

0.02

Bosentan

28 (29 %)

7 (37 %)

21 (27 %)

0.42

Ambrisentan

2 (2 %)

2 (11 %)

0 (0 %)

1.0

Sildenafil

8 (8 %)

2 (11 %)

6 (8 %)

0.70

Beraprost

19 (20 %)

7 (37 %)

12 (16 %)

0.04

Epoprostenol

0 (0 %)

0 (%)

0 (0 %)

1.0

IV Etiology of PH, n (%)

Brain natriuretic peptide (pg/ml) Medications at baseline

Echocardiographic measurements LV end-diastolic diameter (mm)

40.9 ± 6.6

40.1 ± 5.7

41.1 ± 6.8

0.58

LV end-systolic diameter (mm)

24.3 ± 5.6

23.9 ± 4.2

24.4 ± 5.9

0.72

Left atrial diameter (mm)

34.5 ± 6.1

35.5 ± 6.0

34.3 ± 6.1

0.45

Intra ventricle septal thickness (mm) Posterior wall thickness (mm)

9.3 ± 1.8 9.2 ± 1.6

9.1 ± 1.7 8.9 ± 1.7

9.4 ± 1.9 9.3 ± 1.6

0.53 0.33

LV end-diastolic volume (ml)

57.6 ± 22.4

51.3 ± 17.5

59.3 ± 23.2

0.16

LV end-systolic volume (ml)

19.5 ± 10.9

18.4 ± 13.2

19.9 ± 10.3

0.60 0.29

LV ejection fraction (%)

67.3 ± 5.8

68.5 ± 5.2

67.0 ± 5.9

TMF-E (cm/s)

58.2 ± 16.2

51.7 ± 19.0

59.9 ± 15.3

0.049

TMF-A (cm/s)

70.3 ± 17.8

76.1 ± 20.0

68.9 ± 17.2

0.12

TMF-E/A

0.89 ± 0.41

0.74 ± 0.46

0.93 ± 0.39

0.07

e0 (cm/s)

5.8 ± 2.4

6.6 ± 3.7

5.6 ± 2.0

0.12

TMF-E/e

0

11.1 ± 4.2

8.8 ± 2.9

11.7 ± 4.2

0.006

RV-free (%)

19.7 ± 5.5

17.5 ± 5.9

20.3 ± 5.3

0.047 0.05

TAPSE (mm)

19.2 ± 4.2

17.5 ± 4.5

19.6 ± 4.0

Right atrial area (cm2)

16.6 ± 5.5

16.7 ± 6.0

16.6 ± 5.4

0.98

Eccentricity index

1.39 ± 0.26

1.46 ± 0.30

1.37 ± 0.24

0.16

Pericardial effusion

21 (20 %)

3 (16 %)

18 (23 %)

0.48 0.36

Hemodynamic measurements Mean PAP (mmHg)

36.8 ± 11.1

39.1 ± 13.9

36.3 ± 10.5

PVR (dyne sec cm-5)

694 ± 390

856 ± 573

661 ± 340

0.08

PCWP (mmHg)

7.1 ± 3.4

7.4 ± 3.7

7.1 ± 3.4

0.86

Transpulmonary pressure gradient (mmHg)

31 ± 9

30 ± 11

32 ± 9

0.43

Right atrial pressure (mmHg)

4.9 ± 3.7

4.9 ± 3.7

4.9 ± 3.7

0.30

123

Int J Cardiovasc Imaging Table 1 continued Variable Cardiac index (l/min/m2)

All (n = 96)

Patients with event (n = 19)

Patients without event (n = 77)

p value

3.40 ± 1.22

3.08 ± 0.41

3.40 ± 1.22

0.58

WHO world health organization, PH pulmonary hypertension, IPAH idiopathic pulmonary arterial hypertension, CTD connective tissue disease, CTEPH chronic thromboembolic pulmonary hypertension, LV left ventricular, TMF-E early diastolic mitral flow velocity, TMF-A late diastolic mitral flow velocity, e0 early diastolic mitral annulus velocity at septum RV-free averaged three regional peak systolic longitudinal strain in RV free wall, TAPSE tricuspid annular plane systolic excursion, PAP pulmonary arterial pressure, PVR pulmonary vascular resistance, PCWP pulmonary capillary wedge pressure

Fig. 2 Dot plots of right ventricular (RV) systolic function determined by RV-free versus left ventricular (LV) filling in PH patients determined by TMF-E shows a linear relationship

was 61 ± 16 years old, 64 (67 %) were female, and LV ejection fraction was 67.3 ± 5.8 %. Eight patients (8 %) were classified as WHO FC I, 42 (44 %) as FC II, 40 (42 %) as FC III, and 6 (6 %) as FC IV. The intraclass correlation coefficients for intra-observer reproducibility of RV-free was 0.9513 (95 % CI 0.8021–0.9887), and that for inter-observer reproducibility was 0.9083 (95 % CI 0.6510–0.9784). Correlation of RV systolic function and LV filling RV systolic function determined by means of RV-free correlated significantly with LV filling determined by means of TMF-E (r = 0.57, p \ 0.001; Fig. 2). Associations of long-term outcomes The primary endpoint of one of the pre-specified clinical events occurred in 19 of the 96 patients (20 %): Two (2 %) deaths from deteriorating right-sided heart failure and 17 (18 %) hospitalizations for deteriorating right-sided heart failure (Table 1). Patients with cardiac events were more

likely than those without cardiac events to show lower systolic and diastolic blood pressure (105 ± 13 vs. 119 ± 19 mmHg, p = 0.004; 62 ± 10 vs. 73 ± 12 mmHg, p = 0.004, respectively), higher usage of beraprost at baseline (37 vs. 16 %, p = 0.04), and higher BNP (285 ± 454 vs. 134 ± 180 pg/ml, p = 0.02). Of the echocardiographic parameters, TMF-E, TMF-E/e0 ratio and RV-free were significantly lower for patients with than those without cardiac events (TMF-E: 51.7 ± 19.0 vs. 59.9 ± 15.3 cm/s, p = 0.049; TMF-E/e0 : 8.8 ± 2.9 vs. 11.7 ± 4.2 cm/s, p = 0.006; RV-free: 17.5 ± 5.9 % vs. 20.3 ± 5.3 %, p = 0.047, respectively) (Table 1). Kaplan–Meier analysis showed that long-term outcomes were worse for patients with RV-free B 19 % than for those with RV-free [ 19 % (log-rank p = 0.005) as expected. Similarly, long-term outcomes for patients with TMF-E \ 60 cm/s were worse than for those with TMFE C 60 cm/s (log-rank p = 0.002). In addition, there were 35 patients with RV systolic dysfunction and LV underfilling (RV-free B 19 % and TMF-E \ 60 cm/s), features which were associated with worse long-term survival compared to other sub-groups (log-rank p = 0.012, Fig. 3). The incremental benefits of the addition of RV systolic function and LV filling for the prediction of cardiac events is shown in Fig. 4. A sequential Cox model based on clinical variables including WHO-FC and BNP (v2 = 1.2) was improved by the addition of RV systolic functional parameter (RV-free: v2 = 5.5, p = 0.04) and further improved by the addition of LV filling parameter (TMF-E: v2 = 11.5, p = 0.01).

Discussion The findings of our study demonstrated that RV systolic function determined by means of RV-free significantly correlated with LV filling determined by means of TMF-E, and that both RV systolic dysfunction and LV under-filling were associated with worse outcomes for PH patients. It was noteworthy that the presence of both RV systolic dysfunction and LV under-filling (RV-free B 19 % and

123

Int J Cardiovasc Imaging Fig. 3 There were 35 patients with right ventricular (RV) systolic dysfunction and left ventricular (LV) under-filling (RV-free B 19 % and TMFE \ 60 cm/s). These features were associated with worse long-term survival compared to other sub-groups

Bi-ventricular interdependence in PH patients

Fig. 4 Greater advantage of left ventricular (LV) filling parameter (TMF-E) for prediction of cardiac events. For sequential Cox models, a model based on clinical variables including world health organization functional class (WHO-FC) IV and brain natriuretic peptide (BNP) [ 150 pg/dl (v2 = 1.2), was improved by addition of right ventricular systolic functional parameter (RV-free) (v2 = 5.5, p = 0.04) and further enhanced by addition of TMF-E (v2 = 11.5, p = 0.01)

TMF-E \ 60 cm/s) was associated with the worst longterm survival. These observations may prove to be useful for more successful management of PH patients.

123

In this study, RV-free significantly correlated with TMF-E, and lower TMF-E was associated with cardiac events in PH patients. These results suggested that impaired RV systolic dysfunction causes lower forward blood flow from RV to LA. Thus, lower TMF-E might express lower LA pressure due to under filling. While, previous reports have dealt with Bi-ventricular interdependence in PH patients, especially the association of RV systolic function with LV filling. LV filling is additionally impaired by leftward ventricular septal bowing and intraventricular pressure gradient due to RV pressure overload [24] and delayed systolic peak in RV [25], as well as to lower LV preload resulting from a reduction in RV output [26, 27] which is expressed as lower TMF-E. The phenomenon of lower TMF-E has been fully elucidated in previous reports [11]. RV systole is prolonged and this is observed even after closure of the pulmonary valve [28] and continues into the early LV diastole, so that the septum is compressed by the bi-ventricular pressure gradient even in early diastole [25]. This phenomenon causes septal overstretching or LV septal bowing, and leads to both a reduction in RV stroke volume due to loss of energy and LV under-filling due to reduced RV output [27], while both of these in turn lead to a reduction in LV stroke volume [25, 26, 29]. These reports support our results. In addition, LV filling is associated

Int J Cardiovasc Imaging

with prognosis for PH patients [17, 29] and increased after PH-specific therapy in patients with pulmonary arterial hypertension and chronic thromboembolic PH [10, 24]. Tonelli et al. also found that LV relaxation was impaired in 88 % of PH patients with mPAP of 54 ± 14 mmHg and that TMF-E was directly associated with LV end-diastolic volume and cardiac index and inversely associated with the degree of RV dilation, right atrial pressure, and PVR [17]. Interestingly, they were able to demonstrate that TMFE \ 60 cm/s was associated with poor long-term outcomes for PH patients. In addition, according to our results from sequential Cox model showed that predictive value with WHO-FC IV, BNP and RV-free was significantly improved by adding TMF-E. This finding suggested that RV longitudinal systolic function may be affected by preload. According to the previous papers, TMF-E was affected by age, however, it might expresses LA preload or ‘‘effective forward blood flow from RV to LA’’. Thus, to evaluate both of RV systolic function and LV filling parameter would be better for management of PH patients than RV systolic function alone. Clinical implications The development of RV dysfunction in PH patients has been associated with adverse outcomes regardless of the underlying clinical entity. For the assessment of RV systolic function, RV free-wall longitudinal speckle-tracking strain has recently become increasingly important among the various parameters for such assessment, including tricuspid annular plane systolic excursion, tissue Dopplerderived tricuspid lateral annular systolic velocity, RV fractional area change and RV index of myocardial performance [18–22]. However, responses by PH patients to PH-specific therapy can be expected to be heterogeneous, and may be associated not only with RV systolic function but with a multiplicity of other factors. We further found that the presence of both RV-free B 19 % and TMFE \ 60 cm/s was associated with the worst long-term survival for patients with PH. Thus, the assessment of both RV systolic dysfunction and LV under-filling proved to be effective for more accurate prognostic risk stratification of PH patients. Study limitations This study covered only a small number of patients with various etiologies of PH enrolled in a single-center retrospective study, so that future studies of larger patient populations are necessary to validate our findings. Next, not all patients underwent the vasoreactivity test or exercise capacity tests such as 6-min walking test and cardiopulmonary exercise test. Finally, the cutoff values of RV-

free and TMF-E were assessed on the basis of previous reports in other subsets of patients. Then, the cutoff values in this study population were determined with receiveroperator characteristics curve analysis, and these cutoff values were similar (RV-free: 17.3 vs. 19 %, TMF-E: 57 vs. 60 cm/s). Furthermore, even if we reanalyzed using these new cutoff values, overall results were also similar.

Conclusions RV systolic function was shown to correlate significantly with LV filling in PH patients. This indicates that not only assessment of RV systolic function, but also of RV systolic function and LV filling as a bi-ventricular combined parameter will result in more accurate prediction of longterm outcome, and may well have clinical implications for more successful management of PH patients. Conflict of interest

None.

References 1. Thenappan T, Shah SJ, Rich S, Tian L, Archer SL, GombergMaitland M (2010) Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation. Eur Respir J 35(5):1079–1087 2. Galie N, Palazzini M, Manes A (2010) Pulmonary arterial hypertension: from the kingdom of the near-dead to multiple clinical trial meta-analyses. Eur Heart J 31(17):2080–2086 3. Mathai SC, Hummers LK, Champion HC, Wigley FM, Zaiman A, Hassoun PM, Girgis RE (2009) Survival in pulmonary hypertension associated with the scleroderma spectrum of diseases: impact of interstitial lung disease. Arthritis Rheum 60(2):569–577 4. Ghio S, Klersy C, Magrini G, D’Armini AM, Scelsi L, Raineri C, Pasotti M, Serio A, Campana C, Vigano M (2010) Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol 140(3):272–278 5. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, Chamera E, Corretti MC, Champion HC, Abraham TP, Girgis RE, Hassoun PM (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174(9):1034–1041 6. Yilmaz R, Gencer M, Ceylan E, Demirbag R (2005) Impact of chronic obstructive pulmonary disease with pulmonary hypertension on both left ventricular systolic and diastolic performance. J Am Soc Echocardiogr 18(8):873–881 7. Chang SM, Lin CC, Hsiao SH, Lee CY, Yang SH, Lin SK, Huang WC (2007) Pulmonary hypertension and left heart function: insights from tissue Doppler imaging and myocardial performance index. Echocardiography 24(4):366–373 8. Galie N, Ghofrani HA, Torbicki A, Barst RJ, Rubin LJ, Badesch D, Fleming T, Parpia T, Burgess G, Branzi A, Grimminger F, Kurzyna M, Simonneau G (2005) Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med 353(20): 2148–2157 9. Marcus JT et al (2008) Interventricular mechanical asynchrony in pulmonary arterial hypertension left-to-right delay in peak

123

Int J Cardiovasc Imaging

10.

11.

12.

13.

14.

15.

16.

17.

18.

shortening is related to right ventricular overload and left ventricular underfilling. JACC 51(7):750–757 Galie N, Hinderliter AL, Torbicki A, Fourme T, Simonneau G, Pulido T, Espinola-Zavaleta N, Rocchi G, Manes A, Frantz R, Kurzyna M, Nagueh SF, Barst R, Channick R, Dujardin K, Kronenberg A, Leconte I, Rainisio M, Rubin L (2003) Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and Doppler measures in patients with pulmonary arterial hypertension. J Am Coll Cardiol 41(8):1380–1386 Gurudevan SV, Malouf PJ, Auger WR, Waltman TJ, Madani M, Raisinghani AB, DeMaria AN, Blanchard DG (2007) Abnormal left ventricular diastolic filling in chronic thromboembolic pulmonary hypertension: true diastolic dysfunction or left ventricular underfilling? J Am Coll Cardiol 49(12):1334–1339 Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, GomezSanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (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(20):2493–2537 Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713 quiz 786-688 Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463 Ryan T, Petrovic O, Dillon JC, Feigenbaum H, Conley MJ, Armstrong WF (1985) An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol 5(4):918–927 Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133 Tonelli AR, Plana JC, Heresi GA, Dweik RA (2012) Prevalence and prognostic value of left ventricular diastolic dysfunction in idiopathic and heritable pulmonary arterial hypertension. Chest 141(6):1457–1465 Motoji Y, Tanaka H, Fukuda Y, Ryo K, Emoto N, Kawai H, Hirata K (2013) Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 77(3):756–763

123

19. Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, Kane GC (2013) Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging 6(5):711–721 20. Fukuda Y, Tanaka H, Motoji Y, Ryo K, Sawa T, Imanishi J, Miyoshi T, Mochizuki Y, Tatsumi K, Matsumoto K, Shinke T, Emoto N, Hirata KI (2014) Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension. Int J Cardiovasc Imaging 30(7):1269–1277 21. Fukuda Y, Tanaka H, Sugiyama D, Ryo K, Onishi T, Fukuya H, Nogami M, Ohno Y, Emoto N, Kawai H, Hirata K (2011) Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 24(10):1101–1108 22. Haeck ML, Scherptong RW, Marsan NA, Holman ER, Schalij MJ, Bax JJ, Vliegen HW, Delgado V (2012) Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging 5(5):628–636 23. Nagaya N, Nishikimi T, Uematsu M, Satoh T, Kyotani S, Sakamaki F, Kakishita M, Fukushima K, Okano Y, Nakanishi N, Miyatake K, Kangawa K (2000) Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 102(8):865–870 24. Mahmud E, Raisinghani A, Hassankhani A, Sadeghi HM, Strachan GM, Auger W, DeMaria AN, Blanchard DG (2002) Correlation of left ventricular diastolic filling characteristics with right ventricular overload and pulmonary artery pressure in chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol 40(2):318–324 25. Marcus JT, Gan CT, Zwanenburg JJ, Boonstra A, Allaart CP, Gotte MJ, Vonk-Noordegraaf A (2008) Interventricular mechanical asynchrony in pulmonary arterial hypertension: leftto-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol 51(7):750–757 26. Gan C, Lankhaar JW, Marcus JT, Westerhof N, Marques KM, Bronzwaer JG, Boonstra A, Postmus PE, Vonk-Noordegraaf A (2006) Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 290(4):H1528–H1533 27. Vonk-Noordegraaf A, Marcus JT, Gan CT, Boonstra A, Postmus PE (2005) Interventricular mechanical asynchrony due to right ventricular pressure overload in pulmonary hypertension plays an important role in impaired left ventricular filling. Chest 128(6 Suppl):628S–630S 28. Lopez-Candales A, Dohi K, Rajagopalan N, Suffoletto M, Murali S, Gorcsan J, Edelman K (2005) Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class. Cardiovasc Ultrasound 3:23 29. van Wolferen SA, Marcus JT, Boonstra A, Marques KM, Bronzwaer JG, Spreeuwenberg MD, Postmus PE, Vonk-Noordegraaf A (2007) Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 28(10):1250–1257

Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension.

Although impaired right ventricular (RV) performance has been associated with adverse outcomes for pulmonary hypertension (PH) patients, the relations...
792KB Sizes 1 Downloads 7 Views