Right ventricular free wall motion abnormalities as a simple method of assessment in patients with pulmonary hypertension (RCD code: II‐1A.O)

Emilia Sawicka, Katarzyna Ptaszyńska‑Kopczyńska, Anna Krentowska, Anna Skoneczny, Włodzimierz Jerzy Musiał, Bożena Sobkowicz, Karol Adam Kamiński

Full Text:

PDF

Abstract


Background: Pulmonary hypertension (PH) is a cardiovascular pathology leading to right-sided heart failure. A qualitative assessment
of right ventricular (RV) function in echocardiography provides valuable information on a patient’s condition. The standard echocar-
diographic parameter, assessed in PH patients, is RV free wall motion.
Aim
: To verify the utility of RV free wall motion assessment via echocardiography in PH patients.
Methods: Data from 30 PH patients, regardless of aetiology (except for left heart disease), was retrospectively analyzed. Based on the RV free wall motion visual echocardiographic assessment the population was divided into: group 1- normokinetic; group 2- hypokinetic RV. All patients underwent a medical interview, physical examination, basic laboratory work-up, echocardiography, and right heart catheterization (RHC). Twenty-one patients underwent a cardiopulmonary exercise test (CPET).
Results: The analysis revealed, that patients with RV free wall hypokinesis were characterized by impaired gas exchange parameters (higher values of ventilatory equivalents for oxygen and carbon dioxide, higher end-tidal oxygen pressures, lower end-tidal carbon dioxide pres-
sures and higher minute ventilation – carbon dioxide production relation slope) and cardiovascular response to exercise (lower increase
in O2 pulse during exercise) obtained in the CPET. RHC showed that patients with hypokinetic RV had higher diastolic and mean pul-
monary artery pressures (dPAP, mPAP), lower cardiac index, and higher pulmonary vascular resistance.
Conclusions
: RV free wall motion abnormalities, assessed using echocardiography in PH patients, are found in those with more advanced disease. They are characterized by impaired ventilation in the CPET and more advanced haemodynamic abnormalities in RHC. The association between this parameter and prognosis requires validation in a larger population of patients. JRCD 2017; 3 (5): 161–167


Keywords


pulmonary hypertension; right heart catheterization; cardiopulmonary exercise test; right ventricular failure; rare disease

References


Moreira EM, Gall H, Leening MJ, et al. Prevalence of pulmonary hypertension in the general population: The Rotterdam Study. PLoS On 2015; 10: e0130072.

Galie` N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Respir J 2015; 46: 1855–1856.

Kurzyna M, Araszkiewicz A, Błaszczak P, et al. Summary of recommendations for the haemodynamic and angiographic assessment of the pulmonary circulation. Joint statement of the Polish Cardiac Society’s Working Group on Pulmonary Circulation and Association of Cardiovascular Interventions. Kardiologia Polska 2015; 73: 63–68.

Bergstra A, van Dijk RB, Hillege HL, et al. Assumed oxygen consumption based on calculation from dye dilution cardiac output: an improved formula. Eur Heart J. 1995; 16: 698–703.

Rudski LG, Lai WW, Afilalo J, et al. 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 2010; 23: 685–713.

Nagaya N, Nishikimi T, Okano Y, et al. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 1998; 31: 202–208.

Mauritz GJ, Rizopoulos D, Groepenhoff H, et al. Usefulness of serial N-terminal pro-B-type natriuretic peptide measurements for determining prognosis in patients with pulmonary arterial hypertension. Am J Cardiol 2011; 108: 1645–1650.

Soon E, Doughty NJ, Treacy CM, et al. Log-transformation improves the prognostic value of serial NT-proBNP levels in apparently stable pulmonary arterial hypertension. Pulm Circ 2011; 1: 244–249.

Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 2006; 174: 1034–1041.

Ghio S, Klersy C, Magrini G, et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. M. Int J Cardiol 2010; 140: 272–278.

Kleber F, Vietzke G, Wernecke K, et al. Impairment of ventilatory efficiency in heart failure: prognostic impact. Circulation 2000; 101: 2803–2809.

Gitt A, Wasserman K, Kilkowski C, et al. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation 2002; 106: 3079–3084.

Guazzi M, de Vita S, Cardano P, et al. Normalization for peak oxygen uptake increases the prognostic power of the ventilatory response to exercise in patients with chronic heart failure. Am Heart J 2003; 146: 542–548.

Nanas S, Nanas J, Sakellariou D, et al. Ve/VCO2 slope is associated with abnormal resting haemodynamics and is a predictor of long-term survival in chronic heart failure. Eur J Heart Fail 2006; 8: 420–427.

Schwaiblmair M, Faul C, von Scheidt W, et al. Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension. BMC Pulm Med 2012; 12: 23.

Vicenzi M, Deboeck G, Faoro V, et al. Exercise oscillatory ventilation in heart failure and in pulmonary arterial hypertension. Int J Cardiol 2016; 202: 736–740.

Arena R, Lavie CJ, Milani RV, et al. Cardiopulmonary exercise testing in patients with pulmonary arterial hypertension: an evidence-based review. J Heart Lung Transplant 2010; 29: 159–173.

Liu WH, Luo Q, Liu ZH, et al. Pulmonary function differences in patients with chronic right heart failure secondary to pulmonary arterial hypertension and chronic left heart failure. Med Sci Monit 2014; 20: 960–966.

Yuan P, Chen TX, Pudasaini B, et al. Sex-specific cardiopulmonary exercise testing indices related to hemodynamics in idiopathic pulmonary arterial hypertension. Ther Adv Respir Dis 2017; 11: 135–145.

Deboeck G, Niset G, Lamotte M, et al. Exercise testing in pulmonary arterial hypertension and in chronic heart failure. Eur Respir J 2004; 23: 747–751.

Riley MS, Pórszász J, Engelen MP, et al. Gas exchange responses to continuous incremental cycle ergometry exercise in primary pulmonary hypertension in humans. Eur J Appl Physiol 2000; 83: 63–70.

Valli G, Vizza CD, Onorati P, et al. Pathophysiological adaptations to walking and cycling in primary pulmonary hypertension. Eur J Appl Physiol 2008; 102: 417–424.

Paolillo S, Farina S, Bussotti M, et al. Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol 2012; 19: 960–971.

Badagliacca R, Papa S, Valli G, et al. Echocardiography combined with cardiopulmonary exercise testing for the prediction of outcome in idiopathic pulmonary arterial hypertension. Chest 2016; 150: 1313–1322.




DOI: http://dx.doi.org/10.20418%2Fjrcd.vol3no5.312

Refbacks

  • There are currently no refbacks.
Journal of Rare Cardiovascular Diseases (JRCD)
John Paul II Hospital in Kraków, 80 Prądnicka Str., 31-202 Kraków, Poland
Phone: +48 (12) 614 33 99, +48 (12) 614 34 88 Fax: +48 (12) 614 34 88
e-mail: rarediseases@szpitaljp2.krakow.pl
Published by SoftQ sp. z o.o.
ul. Oleandry 2, 30-063 Kraków, Poland
Phone: +48 (12) 444 1650 Fax: +48 (12) 444 1659
e-mail: softq@softq.pl