Investigating the value of right heart echocardiographic metrics for detection of pulmonary hypertension in patients with advanced lung disease
Tóm tắt
This study determined whether novel right heart echocardiography metrics help to detect pulmonary hypertension (PH) in patients with advanced lung disease (ALD). We reviewed echocardiography and catheterization data of 192 patients from the Stanford ALD registry and echocardiograms of 50 healthy controls. Accuracy of echocardiographic right heart metrics to detect PH was assessed using logistic regression and area under the ROC curves (AUC) analysis. Patients were divided into a derivation (n = 92) and validation cohort (n = 100). Experimental validation was assessed in a piglet model of mild PH followed longitudinally. Tricuspid regurgitation (TR) was not interpretable in 52% of patients. In the derivation cohort, right atrial maximal volume index (RAVI), ventricular end-systolic area index (RVESAI), free-wall longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) differentiated patients with and without PH; 20% of patients without PH had moderate to severe RV enlargement by RVESAI. On multivariate analysis, RAVI and TAPSE were independently associated with PH (AUC = 0.77, p < 0.001), which was confirmed in the validation cohort (0.78, p < 0.001). Presence of right heart metrics abnormalities did not improve detection of PH in patients with interpretable TR (p > 0.05) and provided moderate detection value in patients without TR. Only two patients with more severe PH (mean pulmonary pressure 35 and 36 mmHg) were missed. The animal model confirmed that right heart enlargement discriminated best pigs with PH from shams. This study highlights the frequency of right heart enlargement and dysfunction in ALD irrespectively from presence of PH, therefore limiting their use for detection of PH.
Tài liệu tham khảo
Galiè N, Humbert M, Vachiery J-L, Gibbs S, 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): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J 46:903–975.
Fisher MR, Criner GJ, Fishman AP et al (2007) Estimating pulmonary artery pressures by echocardiography in patients with emphysema. Eur Respir J 30:914–921
Nathan SD, Shlobin OA, Barnett SD et al (2008) Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis. Respir Med 102:1305–1310
Amsallem M, Sternbach JM, Adigopula S et al (2015) Addressing the controversy of estimating pulmonary arterial pressure by echocardiography. J Am Soc Echocardiogr 29:93–102
Raymond RJ, Hinderliter AL, Willis PW et al (2002) Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 39:1214–1219
Ghio S, Klersy C, Magrini G et al (2010) Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol 140:272–278
Vonk Noordegraaf A, Galiè N (2011) The role of the right ventricle in pulmonary arterial hypertension. Eur Respir Rev 20:243–253
Zimbarra Cabrita I, Ruísanchez C, Grapsa J et al (2013) Validation of the isovolumetric relaxation time for the estimation of pulmonary systolic arterial blood pressure in chronic pulmonary hypertension. Eur Heart J Cardiovasc Imaging 14:51–55
Hilde JM, Skjørten I, Grøtta OJ et al (2013) Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol 62:1103–1111
McLaughlin VV, Archer SL, Badesch DB et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119:2250–2294
Rudski LG, Lai WW, Afilalo J et al (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 23:685–788
Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39
Mercier O, Fadel E (2013) Chronic thromboembolic pulmonary hypertension: animal models. Eur Respir J 41:1200–1206
Guihaire J, Haddad F, Boulate D et al (2014) Right ventricular plasticity in a porcine model of chronic pressure overload. J Heart Lung Transplant 33:194–202
Jurcut R, Giusca S, La Gerche A et al (2010) The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Echocardiogr 11:81–96
Hilde JM, Skjørten I, Hansteen V et al (2016) Assessment of right ventricular afterload in COPD. COPD 13:176–185
Bréchot N, Gambotti L, Lafitte S et al (2008) Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure. Eur J Echocardiogr 9:547–554
Dambrauskaite V, Delcroix M, Claus P et al (2005) The evaluation of pulmonary hypertension using right ventricular myocardial isovolumic relaxation time. J Am Soc Echocardiogr 18:1113–1120
Fukuda Y, Tanaka H, Sugiyama D et al (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 24:1101–1108
Utsunomiya H, Nakatani S, Okada T et al (2011) A simple method to predict impaired right ventricular performance and disease severity in chronic pulmonary hypertension using strain rate imaging. Int J Cardiol 147:88–94
Rice JL, Stream AR, Fox DL et al (2016) Speckle tracking echocardiography to evaluate for pulmonary hypertension in chronic obstructive pulmonary disease. COPD 13:1–6
Greiner S, Jud A, Aurich M, et al. (2014) Reliability of noninvasive assessment of systolic pulmonary artery pressure by Doppler echocardiography compared to right heart catheterization: analysis in a large patient population. J Am Heart Assoc 3(4):e001103.
Haddad F, Fadel E (2014) RV dysfunction after lung transplantation: a new prognostic marker or mainly a correlate of lung allograft function? JACC Cardiovasc Imaging 7:1095–1097