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RV Fractional Area Change and TAPSE as Predictors of Severe Right Ventricular Dysfunction in Pulmonary Hypertension: A CMR Study

  • Pulmonary Hypertension
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Abstract

Background

The right ventricular ejection fraction (RVEF) is a surrogate marker of right ventricular function in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The tricuspid annular plane systolic excursion (TAPSE) measures only the longitudinal component of RV contraction while the right ventricular fractional area change (RVFAC) takes into account both the longitudinal and the transversal components. The aim of our study was to evaluate the relationship between RVEF, RVFAC, and TAPSE according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and Results

Fifty-four patients with PAH (n = 15) and CTEPH (n = 39) underwent right heart catheterization and cardiac magnetic resonance (CMR). The ventricular volumes and areas, TAPSE, and eccentricity index were measured. The RVFAC was more strongly correlated with the RVEF (r = 0.81, p < 0.0001) than the TAPSE (r = 0.63, p < 0.0001). RVEF < 35% was better predicted by the RVFAC than the TAPSE (TAPSE: AUC = 0.77 and RVFAC: AUC = 0.91; p = 0.042). In the group with the worse hemodynamic status, the RVFAC correlated much better with the RVEF than the TAPSE. There were no significant differences in the CMR data analyzed between the groups of PAH and CETPH patients.

Conclusions

The RVFAC is a good index to estimate RVEF in PH patients; even better than the TAPSE in patients with more severe hemodynamic profile, possibly for including the transversal component of right ventricular function in its measurement. Furthermore, RVFAC performance was similar in the two PH groups (PAH and CTEPH).

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Authors and Affiliations

  1. Pulmonary Department, Heart Institute, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil

    Susana Hoette & Rogerio Souza

  2. Physiology and Radiology-EA4533, Faculté de Médecine Paris 11-APHP, Le Kremlin Bicêtre, France

    Nicolas Creuzé & Denis Chemla

  3. Pneumology-APHP-Paris11 University-Inserm UMR_S999, Le Kremlin Bicêtre, France

    Sven Günther, David Montani, Laurent Savale, Xavier Jaïs, Florence Parent, Olivier Sitbon, Gerald Simonneau & Marc Humbert

  4. Cardiovascular Imaging, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil

    Carlos Eduardo Rochitte

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  1. Susana Hoette
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  2. Nicolas Creuzé
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  3. Sven Günther
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  4. David Montani
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  5. Laurent Savale
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  7. Florence Parent
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  10. Gerald Simonneau
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  11. Marc Humbert
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Correspondence to Rogerio Souza.

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Hoette, S., Creuzé, N., Günther, S. et al. RV Fractional Area Change and TAPSE as Predictors of Severe Right Ventricular Dysfunction in Pulmonary Hypertension: A CMR Study. Lung 196, 157–164 (2018). https://doi.org/10.1007/s00408-018-0089-7

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  • DOI: https://doi.org/10.1007/s00408-018-0089-7

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