Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension

Background Right ventricular (RV) dysfunction is a prognostic factor for cardiovascular disease. However, its mechanism and pathophysiology remain unknown. We investigated RV function using RV‐specific 3‐dimensional (3D)‐speckle‐tracking echocardiography (STE) in patients with chronic thromboembolic...

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Main Authors: Hidenori Moriyama, Takashi Kawakami, Masaharu Kataoka, Takahiro Hiraide, Mai Kimura, Jin Endo, Takashi Kohno, Yuji Itabashi, Yoshihiro Seo, Keiichi Fukuda, Mitsushige Murata
Format: Article
Language:English
Published: Wiley 2020-11-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
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Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.120.018096
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author Hidenori Moriyama
Takashi Kawakami
Masaharu Kataoka
Takahiro Hiraide
Mai Kimura
Jin Endo
Takashi Kohno
Yuji Itabashi
Yoshihiro Seo
Keiichi Fukuda
Mitsushige Murata
author_facet Hidenori Moriyama
Takashi Kawakami
Masaharu Kataoka
Takahiro Hiraide
Mai Kimura
Jin Endo
Takashi Kohno
Yuji Itabashi
Yoshihiro Seo
Keiichi Fukuda
Mitsushige Murata
author_sort Hidenori Moriyama
collection DOAJ
description Background Right ventricular (RV) dysfunction is a prognostic factor for cardiovascular disease. However, its mechanism and pathophysiology remain unknown. We investigated RV function using RV‐specific 3‐dimensional (3D)‐speckle‐tracking echocardiography (STE) in patients with chronic thromboembolic pulmonary hypertension. We also assessed regional wall motion abnormalities in the RV and chronological changes during balloon pulmonary angioplasty (BPA). Methods and Results Twenty‐nine patients with chronic thromboembolic pulmonary hypertension who underwent BPA were enrolled and underwent right heart catheterization and echocardiography before, immediately after, and 6 months after BPA. Echocardiographic assessment of RV function included both 2‐dimensional‐STE and RV‐specific 3D‐STE. Before BPA, global area change ratio measured by 3D‐STE was significantly associated with invasively measured mean pulmonary artery pressure and pulmonary vascular resistance (r=0.671 and r=0.700, respectively). Dividing the RV into the inlet, apex, and outlet, inlet area change ratio showed strong correlation with mean pulmonary artery pressure and pulmonary vascular resistance before BPA (r=0.573 and r=0.666, respectively). Only outlet area change ratio was significantly correlated with troponin T values at 6 months after BPA (r=0.470), and its improvement after BPA was delayed compared with the inlet and apex regions. Patients with poor outlet area change ratio were associated with a delay in RV reverse remodeling after treatment. Conclusions RV‐specific 3D‐STE analysis revealed that 3D RV parameters were novel useful indicators for assessing RV function and hemodynamics in pulmonary hypertension and that each regional RV portion presents a unique response to hemodynamic changes during treatment, implicating that evaluation of RV regional functions might lead to a new guide for treatment strategies.
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spelling doaj.art-a1f5321070b64d8db69bda2ee042721c2022-12-21T23:56:00ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-11-0192110.1161/JAHA.120.018096Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary HypertensionHidenori Moriyama0Takashi Kawakami1Masaharu Kataoka2Takahiro Hiraide3Mai Kimura4Jin Endo5Takashi Kohno6Yuji Itabashi7Yoshihiro Seo8Keiichi Fukuda9Mitsushige Murata10Department of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Cardiology Kyorin University School of Medicine Tokyo JapanDepartment of Laboratory Medicine Keio University School of Medicine Tokyo JapanDepartment of Cardiology Nagoya City University Graduate School of Medical Sciences Nagoya JapanDepartment of Cardiology Keio University School of Medicine Tokyo JapanDepartment of Laboratory Medicine, Tokai University School of Medicine Tokai University Hachioji Hospital Tokyo JapanBackground Right ventricular (RV) dysfunction is a prognostic factor for cardiovascular disease. However, its mechanism and pathophysiology remain unknown. We investigated RV function using RV‐specific 3‐dimensional (3D)‐speckle‐tracking echocardiography (STE) in patients with chronic thromboembolic pulmonary hypertension. We also assessed regional wall motion abnormalities in the RV and chronological changes during balloon pulmonary angioplasty (BPA). Methods and Results Twenty‐nine patients with chronic thromboembolic pulmonary hypertension who underwent BPA were enrolled and underwent right heart catheterization and echocardiography before, immediately after, and 6 months after BPA. Echocardiographic assessment of RV function included both 2‐dimensional‐STE and RV‐specific 3D‐STE. Before BPA, global area change ratio measured by 3D‐STE was significantly associated with invasively measured mean pulmonary artery pressure and pulmonary vascular resistance (r=0.671 and r=0.700, respectively). Dividing the RV into the inlet, apex, and outlet, inlet area change ratio showed strong correlation with mean pulmonary artery pressure and pulmonary vascular resistance before BPA (r=0.573 and r=0.666, respectively). Only outlet area change ratio was significantly correlated with troponin T values at 6 months after BPA (r=0.470), and its improvement after BPA was delayed compared with the inlet and apex regions. Patients with poor outlet area change ratio were associated with a delay in RV reverse remodeling after treatment. Conclusions RV‐specific 3D‐STE analysis revealed that 3D RV parameters were novel useful indicators for assessing RV function and hemodynamics in pulmonary hypertension and that each regional RV portion presents a unique response to hemodynamic changes during treatment, implicating that evaluation of RV regional functions might lead to a new guide for treatment strategies.https://www.ahajournals.org/doi/10.1161/JAHA.120.018096chronic thromboembolic pulmonary hypertensionregional wall motion abnormalityright ventricular functionthree‐dimensional speckle‐tracking echocardiography
spellingShingle Hidenori Moriyama
Takashi Kawakami
Masaharu Kataoka
Takahiro Hiraide
Mai Kimura
Jin Endo
Takashi Kohno
Yuji Itabashi
Yoshihiro Seo
Keiichi Fukuda
Mitsushige Murata
Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
chronic thromboembolic pulmonary hypertension
regional wall motion abnormality
right ventricular function
three‐dimensional speckle‐tracking echocardiography
title Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension
title_full Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension
title_fullStr Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension
title_full_unstemmed Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension
title_short Regional Right Ventricular Abnormalities Implicate Distinct Pathophysiological Conditions in Patients With Chronic Thromboembolic Pulmonary Hypertension
title_sort regional right ventricular abnormalities implicate distinct pathophysiological conditions in patients with chronic thromboembolic pulmonary hypertension
topic chronic thromboembolic pulmonary hypertension
regional wall motion abnormality
right ventricular function
three‐dimensional speckle‐tracking echocardiography
url https://www.ahajournals.org/doi/10.1161/JAHA.120.018096
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