Regional right ventricular abnormalities implicate distinct pathophysiological conditions in patients with chronic thromboembolic pulmonary hypertension

Hidenori Moriyama, Takashi Kawakami, Masaharu Kataoka, Takahiro Hiraide, Mai Kimura, Jin Endo, Takashi Kohno, Yuji Itabashi, Yoshihiro Seo, Keiichi Fukuda, Mitsushige Murata

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article numbere018096
JournalJournal of the American Heart Association
Volume9
Issue number21
DOIs
Publication statusPublished - 2020 Nov 3

Keywords

  • Chronic thromboembolic pulmonary hypertension
  • Regional wall motion abnormality
  • Right ventricular function
  • Threedimensional speckle-tracking echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Regional right ventricular abnormalities implicate distinct pathophysiological conditions in patients with chronic thromboembolic pulmonary hypertension'. Together they form a unique fingerprint.

Cite this