Serkan Unlu1, Konstantinos Farsalinos2, Koen Ameloot2, Ana M Daraban2, Agnieszka Ciarka2, Marion Delcroix3, Jens-Uwe Voigt4. 1. Department of Cardiovascular Diseases, Medical Imaging Research Center, Catholic University Leuven and University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Cardiology, Gazi University School of Medicine and Gazi Hospital, Ankara, Turkey. 2. Department of Cardiovascular Diseases, Medical Imaging Research Center, Catholic University Leuven and University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium. 3. Department of Pulmonology, University Hospital Leuven, Leuven, Belgium. 4. Department of Cardiovascular Diseases, Medical Imaging Research Center, Catholic University Leuven and University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium jens.uwe.voigt@gmx.net.
Abstract
AIMS: In some pulmonary hypertension (PH) patients, we noted a motion pattern where the right ventricular (RV) apex is pulled towards to left ventricle (LV) during systole, caused by traction from the LV ('apical traction', AT). Herein, we characterize patients with AT to investigate its prognostic significance. METHODS AND RESULTS: Echocardiograms of 62 pre-capillary PH patients (42 females, age 61 ± 15 years) were retrospectively analysed. The presence of AT was assessed visually and confirmed by speckle-tracking analysis. Fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV free-wall longitudinal strain (LS) as well as LV function were measured. A primary end point of death or heart/lung transplantation was set. AT was observed in 31 patients. They had worse functional capacity, lower TAPSE (1.3 ± 0.2 vs. 1.9 ± 0.4, P ≤ 0.001) and FAC (20.3 ± 6.1 vs. 33 ± 7.1%, P ≤ 0.001), worse RV free-wall LS (-12.4 ± 3.4 vs. -20.8 ± 4.9%, P < 0.001), and higher systolic pulmonary arterial pressure (92 ± 15 vs. 75 ± 23, P < 0.001). LV function was similar in both groups. The primary end point occurred in 16 patients with and 8 without AT. AT was an independent predictor of the outcome (HR: 14.826, 95% CI: 1.696-129.642, P = 0.015). CONCLUSION: AT occurs in RVs with impaired systolic function in PH patients. It may serve as a new, easily to assess visual parameter to predict the outcome in these patients. Its prognostic importance needs to be validated by prospective studies. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: In some pulmonary hypertension (PH) patients, we noted a motion pattern where the right ventricular (RV) apex is pulled towards to left ventricle (LV) during systole, caused by traction from the LV ('apical traction', AT). Herein, we characterize patients with AT to investigate its prognostic significance. METHODS AND RESULTS: Echocardiograms of 62 pre-capillary PH patients (42 females, age 61 ± 15 years) were retrospectively analysed. The presence of AT was assessed visually and confirmed by speckle-tracking analysis. Fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV free-wall longitudinal strain (LS) as well as LV function were measured. A primary end point of death or heart/lung transplantation was set. AT was observed in 31 patients. They had worse functional capacity, lower TAPSE (1.3 ± 0.2 vs. 1.9 ± 0.4, P ≤ 0.001) and FAC (20.3 ± 6.1 vs. 33 ± 7.1%, P ≤ 0.001), worse RV free-wall LS (-12.4 ± 3.4 vs. -20.8 ± 4.9%, P < 0.001), and higher systolic pulmonary arterial pressure (92 ± 15 vs. 75 ± 23, P < 0.001). LV function was similar in both groups. The primary end point occurred in 16 patients with and 8 without AT. AT was an independent predictor of the outcome (HR: 14.826, 95% CI: 1.696-129.642, P = 0.015). CONCLUSION: AT occurs in RVs with impaired systolic function in PH patients. It may serve as a new, easily to assess visual parameter to predict the outcome in these patients. Its prognostic importance needs to be validated by prospective studies. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Lawrence G Rudski; Wyman W Lai; Jonathan Afilalo; Lanqi Hua; Mark D Handschumacher; Krishnaswamy Chandrasekaran; Scott D Solomon; Eric K Louie; Nelson B Schiller Journal: J Am Soc Echocardiogr Date: 2010-07 Impact factor: 5.251
Authors: Paul R Forfia; Micah R Fisher; Stephen C Mathai; Traci Housten-Harris; Anna R Hemnes; Barry A Borlaug; Elzbieta Chamera; Mary C Corretti; Hunter C Champion; Theodore P Abraham; Reda E Girgis; Paul M Hassoun Journal: Am J Respir Crit Care Med Date: 2006-08-03 Impact factor: 21.405
Authors: Marlieke L A Haeck; Roderick W C Scherptong; Nina Ajmone Marsan; Eduard R Holman; Martin J Schalij; Jeroen J Bax; Hubert W Vliegen; Victoria Delgado Journal: Circ Cardiovasc Imaging Date: 2012-08-08 Impact factor: 7.792
Authors: Arun Sachdev; Hector R Villarraga; Robert P Frantz; Michael D McGoon; Ju-Feng Hsiao; Joseph F Maalouf; Naser M Ammash; Robert B McCully; Fletcher A Miller; Patricia A Pellikka; Jae K Oh; Garvan C Kane Journal: Chest Date: 2010-12-09 Impact factor: 9.410
Authors: Ronald J Raymond; Alan L Hinderliter; Park W Willis; David Ralph; Edgar J Caldwell; William Williams; Neil A Ettinger; Nicholas S Hill; Warren R Summer; Bennett de Boisblanc; Todd Schwartz; Gary Koch; Linda M Clayton; Maria M Jöbsis; James W Crow; Walker Long Journal: J Am Coll Cardiol Date: 2002-04-03 Impact factor: 24.094
Authors: Nazzareno Galiè; Marius M Hoeper; Marc Humbert; Adam Torbicki; Jean-Luc Vachiery; Joan Albert Barbera; Maurice Beghetti; Paul Corris; Sean Gaine; J Simon Gibbs; Miguel Angel Gomez-Sanchez; Guillaume Jondeau; Walter Klepetko; Christian Opitz; Andrew Peacock; Lewis Rubin; Michael Zellweger; Gerald Simonneau Journal: Eur Heart J Date: 2009-08-27 Impact factor: 29.983