Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Skip to main content
Springer Nature Link
Log in

RV Fractional Area Change and TAPSE as Predictors of Severe Right Ventricular Dysfunction in Pulmonary Hypertension: A CMR Study

  • Pulmonary Hypertension
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Background

The right ventricular ejection fraction (RVEF) is a surrogate marker of right ventricular function in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The tricuspid annular plane systolic excursion (TAPSE) measures only the longitudinal component of RV contraction while the right ventricular fractional area change (RVFAC) takes into account both the longitudinal and the transversal components. The aim of our study was to evaluate the relationship between RVEF, RVFAC, and TAPSE according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and Results

Fifty-four patients with PAH (n = 15) and CTEPH (n = 39) underwent right heart catheterization and cardiac magnetic resonance (CMR). The ventricular volumes and areas, TAPSE, and eccentricity index were measured. The RVFAC was more strongly correlated with the RVEF (r = 0.81, p < 0.0001) than the TAPSE (r = 0.63, p < 0.0001). RVEF < 35% was better predicted by the RVFAC than the TAPSE (TAPSE: AUC = 0.77 and RVFAC: AUC = 0.91; p = 0.042). In the group with the worse hemodynamic status, the RVFAC correlated much better with the RVEF than the TAPSE. There were no significant differences in the CMR data analyzed between the groups of PAH and CETPH patients.

Conclusions

The RVFAC is a good index to estimate RVEF in PH patients; even better than the TAPSE in patients with more severe hemodynamic profile, possibly for including the transversal component of right ventricular function in its measurement. Furthermore, RVFAC performance was similar in the two PH groups (PAH and CTEPH).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Woods J, Monteiro P, Rhodes A (2007) Right ventricular dysfunction. Curr Opin Crit Care 13:532–540

    PubMed  Google Scholar 

  2. McLaughlin VV, McGoon MD (2006) Pulmonary arterial hypertension. Circulation 114:1417–1431

    Article  PubMed  Google Scholar 

  3. van Wolfereng SA, Marcus JT, Boonstra A, Marques KMJ, Bronwaer JGF, Spreeuwenberg MD et al (2007) Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 28:1250–1257

    Article  Google Scholar 

  4. Vonk-Noordegraaf A, Souza R (2012) Cardiac magnetic resonance imaging: what can it add to our knowledge of the right ventricle in pulmonary arterial hypertension? Am J Cardiol 110:25S–31S

    Article  Google Scholar 

  5. van de Veerdonk M, Kind T, Marcus T, Mauritz GJ. Heymans MW, Bogaard HJ et al (2011) Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol 58:2511–2519

    Article  PubMed  Google Scholar 

  6. Nijveldt R, Germans T, McCann G, Beek AM, van Rossum AC (2008) Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetric approach: a cardiovascular magnetic resonance study. Eur Radiol 18:2399–2405

    Article  PubMed  Google Scholar 

  7. Kosiborod M, Wackers FJT (2003) Assessment of right ventricular morphology and function. Semin Respir Crit Care Med 24:245–261

    Article  PubMed  Google Scholar 

  8. Germing A, Gotzmann M, Rausse R, Brodherr T, Holt S, Lindstaedt M, Dietrich J et al (2010) Normal values for longitudinal function of the right ventricle in healthy women > 70 years of age. Eur J Echocardiogr 11:725–728

    Article  PubMed  Google Scholar 

  9. Ueti OM, Camargo EE, Ueti AA, Lima-Filho EC, Nogueira EA (2002) Assessment of right ventricular function with Doppler echocardiographic indices derived from tricuspid annular motion: comparison with radionuclide angiography. Heart 88:244–248

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Lamia B, Teboul J, Monnet X, Richard C, Chemla D (2007) Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients. Intensive Care Med 33:2143–2149

    Article  PubMed  Google Scholar 

  11. Forfia PR, Fisher MR, Mathai SC, Hausten-Harris T, Hemnes AR, Borlaug AB, Chamera E et al (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174:1034–1041

    Article  PubMed  Google Scholar 

  12. Anavekar NS, Skali H, Bourgoun M, Ghali JK, Kober L, Maggioni AP, McMurray JJ et al (2008) Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from de VALIANT ECHO Study). Am J Cardiol 101:607–612

    Article  PubMed  Google Scholar 

  13. Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westhof N, Vonk-Noordegraaf A (2010) Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson 12:35

    Article  PubMed  PubMed Central  Google Scholar 

  14. Leary PJ, Kurtz CE, Hough CL, Waiss M-P, Ralph DD, Sheehan FH (2012) Three-dimensional analysis of right ventricular shape and function in pulmonary hypertension. Pulm Circ 2:34–40

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mauritz G, Kind T, Marcus JT, Bogaard H, van de Veerdonk M, Postmus PE, Boonstra A et al (2012) Progressive changes in right ventricular geometric shortening and long-term survival in pulmonary arterial hypertension. Chest 141:935–943

    Article  PubMed  Google Scholar 

  16. Provencher S, Herve P, Sitbon O, Humbert M, Simonneau G, Chemla D (2008) Changes in exercise haemodynamics during treatment in pulmonary arterial hypertension. Eur Respir J 32:393–398

    Article  CAS  PubMed  Google Scholar 

  17. Ahmad H, Mor-Avi V, Lang RM, Nesser HJ, Weinert L, Tsang W et al (2012) Assessment of right ventricular function using echocardiographic speckled tracking of the tricuspid annular motion: coparison with cardiac magnetic resonance. Echocardiography 29:19–24

    Article  PubMed  Google Scholar 

  18. Jurcut R, Giusca S, La Gerche A, Vasile S, Ginghina C, Voigt JU (2010) The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Ecocardiogr 11:81–96

    Article  Google Scholar 

  19. Badano LP, Ginghina C, Easaw J, Muraru D, Grillo MT, Lancellotti P et al (2010) Right ventricle in pulmonary arterial hypertension. Haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodeling and treatment effects. Eur J Echocardiogr 11:27–37

    Article  PubMed  Google Scholar 

  20. Brown SB, Raina A, Katz D, Szerlip M, Wiegers S, Forfia P (2011) Longitudinal shortening accounts for the majority of right ventricular contraction and improves after pulmonary vasodilator therapy in normal subjects and in pulmonary arterial hypertension. Chest 140:27–33

    Article  PubMed  Google Scholar 

  21. Dellegrottaglie S, Sanz J, Poon M, Viles-Gonzalez JF, Sulica R, Goyenechea M, Macaluso F et al (2007) Pulmonary hypertension: accuracy of detection with left ventricular septal-to-free wall curvature ratio measured at cardiac MRI. Radiology 243:63–69

    Article  PubMed  Google Scholar 

  22. Roeleveld RJ, Marcus JT, Faes TJ, Gan TJ, Boonstra A, Postmus PE et al (2005) Interventricular septal configuration at MR imaging and pulmonary arterial pressure in pulmonary hypertension. Radiology 234:710–717

    Article  PubMed  Google Scholar 

  23. Alluni JP, Degano B, Arnaud C, Tétu L, Blot-Soulétie N, Didier A et al (2010) Cardiac MRI in pulmonary artery hypertension: correlations between morphological and function parameters and invasive measurements. Eur Radiol 20:1149–1159

    Article  Google Scholar 

  24. Marcus JT, Vonk-Noordegraaf A, Roeleveld RJ, Pieter E, Postmus PE, Heethaar RM et al (2001) Impaired left ventricular filling due to right ventricular pressure overload in primary pulmonary hypertension: noninvasive monitoring using MRI. Chest 119:1761–1765

    Article  CAS  PubMed  Google Scholar 

  25. Hoette S, Creuze N, Musset D, Jaïs X, Savale L, Natali D et al (2011) Comparing cardiac magnetic resonance imaging in group 1 and group 4 pulmonary hypertension. European Respiratory Society Annual Meeting in Amsterdam, NR 2309

  26. Souza R, Bogossian HB, Humbert M, Jardim C, Rabelo R, Amato MB et al (2005) N-terminal-pro-brain natriuretic peptide as a haemodynamic marker in idiopathic pulmonary arterial hypertension. Eur Respir J 25:509–513

    Article  CAS  PubMed  Google Scholar 

  27. Naeije R, Ghio S (2015) More on the right ventricle in pulmonary hypertension. Eur Respir J 45:33–35

    Article  CAS  PubMed  Google Scholar 

  28. Humbert M, Sitbon O, Simonneau G (2004) Treatment of pulmonary arterial hypertension. N Engl J Med 351:1425–1436

    Article  CAS  PubMed  Google Scholar 

  29. Gnanappa GK, Rashid I, Celermajer D, Ayer J, Puranik R (2017) Reproducibility of cardiac magnetic resonance imaging (CMRI)-derived right ventricular parameters in repaired tetralogy of fallot (ToF). Heart Lung Circ. https://doi.org/10.1016/j.hlc.2017.04.017

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pulmonary Department, Heart Institute, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil

    Susana Hoette & Rogerio Souza

  2. Physiology and Radiology-EA4533, Faculté de Médecine Paris 11-APHP, Le Kremlin Bicêtre, France

    Nicolas Creuzé & Denis Chemla

  3. Pneumology-APHP-Paris11 University-Inserm UMR_S999, Le Kremlin Bicêtre, France

    Sven Günther, David Montani, Laurent Savale, Xavier Jaïs, Florence Parent, Olivier Sitbon, Gerald Simonneau & Marc Humbert

  4. Cardiovascular Imaging, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Carlos Eduardo Rochitte

Authors
  1. Susana Hoette
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicolas Creuzé
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sven Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Montani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laurent Savale
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xavier Jaïs
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Florence Parent
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Olivier Sitbon
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carlos Eduardo Rochitte
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gerald Simonneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marc Humbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rogerio Souza
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Denis Chemla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rogerio Souza.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoette, S., Creuzé, N., Günther, S. et al. RV Fractional Area Change and TAPSE as Predictors of Severe Right Ventricular Dysfunction in Pulmonary Hypertension: A CMR Study. Lung 196, 157–164 (2018). https://doi.org/10.1007/s00408-018-0089-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-018-0089-7

Keywords

Search

Navigation