Chest
Original ResearchPulmonary Vascular DiseaseLongitudinal Shortening Accounts for the Majority of Right Ventricular Contraction and Improves After Pulmonary Vasodilator Therapy in Normal Subjects and Patients With Pulmonary Arterial Hypertension
Section snippets
Normal Subjects
All clinically indicated echocardiograms obtained at the Hospital of the University of Pennsylvania over a 2-month period in 2006 were screened. Those deemed normal by the clinical reviewer were selected and analyzed retrospectively by the research investigator. Inclusion criteria were designed to capture normal adult echocardiograms and included the following: (1) age 18 years or older; (2) normal left atrial and ventricular size using standard criteria; (3) normal left ventricular (LV)
Results
We identified 90 subjects with normal echocardiograms and 36 subjects with PAH with baseline echocardiograms who met the criteria for inclusion in this study. The causes of PAH included connective tissue disease (systemic sclerosis in 15 patients, systemic lupus erythematosus in two patients), idiopathic PAH (in 14 patients), portopulmonary hypertension (in two patients), and chronic thromboembolic disease (in three patients). The two groups were similar with regard to gender (normal subjects:
Discussion
To the best of our knowledge, our study is the first to quantify the degree to which longitudinal contraction contributes to overall RV function. We found that, in the presence of increased RV afterload in PAH, longitudinal contraction is selectively impaired and the improvement in RV function after pulmonary vasodilating therapy is due to a recovery in longitudinal contraction. There was no improvement in transverse contraction with pulmonary vasodilators, suggesting that longitudinal
Conclusions
Longitudinal motion accounts for the majority of overall RV function in normal subjects and in patients with PAH. The RV dysfunction seen in PAH is characterized by more prominent impairment of longitudinal, than of transverse, motion. Treatment with PH-specific therapy leads to selective recovery of longitudinal RV motion. These findings provide further rationale for the use of longitudinal measures of RV function and suggest that serial monitoring of such measures may play an important role
Acknowledgments
Author contributions: The authors all assume responsibility for the integrity of the data.
Dr Brown: contributed to the original design and conception of the study, data acquisition, data analysis, and preparation and critical review of the manuscript.
Dr Raina: contributed to the study design, data acquisition, data analysis, and preparation and critical review of the manuscript.
Dr Katz: contributed to the design and conception of the study, data acquisition, data analysis, and preparation of
References (35)
- et al.
Variable spectrum and prognostic implications of left and right ventricular ejection fractions in patients with and without clinical heart failure after acute myocardial infarction
Am J Cardiol
(1986) - et al.
Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease
J Am Coll Cardiol
(1983) - et al.
Discordance in degree of right and left ventricular dilation in patients with dilated cardiomyopathy: recognition and clinical implications
J Am Coll Cardiol
(1993) - et al.
Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure
J Am Coll Cardiol
(1998) - et al.
Right ventricular dysfunction: an independent predictor of adverse outcome in patients with myocarditis
Am Heart J
(1994) - et al.
Prognosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines
Chest
(2004) - et al.
Assessment of right ventricular function using two-dimensional echocardiography
Am Heart J
(1984) - et al.
Relation of tissue displacement and strain to invasively determined right ventricular stroke volume
Am J Cardiol
(2005) - et al.
Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy
Am J Cardiol
(2000) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005)
Accuracy of echocardiographic right ventricular parameters in patients with different end-stage lung diseases prior to lung transplantation
J Heart Lung Transplant
Tricuspid annular motion
J Am Soc Echocardiogr
Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and Doppler measures in patients with pulmonary arterial hypertension
J Am Coll Cardiol
The right ventricular annular velocity reduction caused by coronary artery bypass graft surgery occurs at the moment of pericardial incision
Am Heart J
Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy
Eur Heart J
Survival in patients with primary pulmonary hypertension. Results from a national prospective registry
Ann Intern Med
Tricuspid annular displacement predicts survival in pulmonary hypertension
Am J Respir Crit Care Med
Cited by (147)
Acute right ventricular geometric change predicts outcomes in HeartMate 3 patients
2024, Journal of Heart and Lung TransplantationClinical and functional relevance of right ventricular contraction patterns in pulmonary hypertension
2023, Journal of Heart and Lung TransplantationRight heart failure: A narrative review for emergency clinicians
2022, American Journal of Emergency Medicine
Funding/Support: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).