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Simple and noninvasive method to estimate right ventricular operating stiffness based on echocardiographic pulmonary regurgitant velocity and tricuspid annular plane movement measurements during atrial contraction

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Abstract

It was recently shown that invasively determined right ventricular (RV) stiffness was more closely related to the prognosis of patients with pulmonary hypertension than RV systolic function. So far, a completely noninvasive method to access RV stiffness has not been reported. We aimed to clarify the clinical usefulness of our new echocardiographic index of RV operating stiffness using atrial-systolic descent of the pulmonary artery-RV pressure gradient derived from pulmonary regurgitant velocity (PRPGDAC) and tricuspid annular plane movement during atrial contraction (TAPMAC). We studied 81 consecutive patients with various cardiac diseases who underwent echocardiography and cardiac catheterization. We measured PRPGDAC and TAPMAC using continuous-wave Doppler and M-mode echocardiography, respectively, and calculated PRPGDAC/TAPMAC. RV end-diastolic pressure (RVEDP) and RV pressure increase during atrial contraction (ΔRVPAC) were invasively measured, and RV volume change during atrial contraction (ΔVAC) was calculated from echocardiographic late-diastolic transtricuspid flow time-velocity integral and tricuspid annular area; thus ΔRVPAC/ΔVAC was used as the standard index for RV operating stiffness. PRPGDAC/TAPMAC well correlated with ΔRVPAC/ΔVAC (r = 0.84, p < 0.001) and RVEDP (r = 0.80, p < 0.001), and the area under the receiver operating characteristic curve to discriminate RVEDP > 12 mmHg was 0.94. Multivariate regression analysis revealed that PRPGDAC/TAPMAC was the single independent determinant of ΔRVPAC/ΔVAC (β = 0.86, p < 0.001). PRPGDAC/TAPMAC is useful to estimate RV operating stiffness and a good practical indicator of RVEDP.

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Abbreviations

CMR:

Cardiac magnetic resonance

ΔP:

Pressure change

ΔRVPAC :

RV pressure increase during the atrial contraction

ΔV:

Volume change

ΔVAC :

Right ventricular volume change during atrial contraction

EDPVR:

End-diastolic pressure–volume relation

LV:

Left ventricular

PA:

Pulmonary artery

PAH:

Pulmonary arterial hypertension

PR:

Pulmonary regurgitant

PRPGDAC :

The descent of pulmonary regurgitant pressure gradient during atrial contraction

RV:

Right ventricular

RVEDP:

Right ventricular end-diastolic pressure

TAPMAC :

Tricuspid annular plane movement during atrial contraction

TAPSE:

Tricuspid annular plane systolic excursion

References

  1. Mohammed SF, Hussain I, AbouEzzeddine OF, Takahama H, Kwon SH, Forfia P et al (2014) Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation 130:2310–2320

    Article  Google Scholar 

  2. Meyer P, Filippatos GS, Ahmed MI, Iskandrian AE, Bittner V, Perry GJ et al (2010) Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation 121:252–258

    Article  Google Scholar 

  3. Dokainish H, Sengupta R, Patel R, Lakkis N (2007) Usefulness of right ventricular tissue Doppler imaging to predict outcome in left ventricular heart failure independent of left ventricular diastolic function. Am J Cardiol 99:961–965

    Article  Google Scholar 

  4. Motoki H, Borowski AG, Shrestha K, Hu B, Kusunose K, Troughton RW et al (2014) Right ventricular global longitudinal strain provides prognostic value incremental to left ventricular ejection fraction in patients with heart failure. J Am Soc Echocardiogr 27:726–732

    Article  Google Scholar 

  5. Trip P, Rain S, Handoko ML, van der Bruggen C, van der Bruggen C, Bogaard HJ et al (2015) Clinical relevance of right ventricular diastolic stiffness in pulmonary hypertension. Eur Respir J 45:1603–1612

    Article  Google Scholar 

  6. Gaasch WH, Bing OH, Mirsky I (1982) Chamber compliance and myocardial stiffness in left ventricular hypertrophy. Eur Heart J 3:139–145

    Article  Google Scholar 

  7. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ (2008) Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 117:1436–1448

    Article  Google Scholar 

  8. Redington AN, Gray HH, Hodson ME, Rigby ML, Oldershaw PJ (1988) Characterisation of the normal right ventricular pressure–volume relation by biplane angiography and simultaneous micromanometer pressure measurements. Br Heart J 59:23–30

    Article  CAS  Google Scholar 

  9. Marwick TH, Chandrashekhar Y (2017) The right ventricle: unforgettable with imaging. JACC Cardiovasc Imaging 10:1289–1290

    Article  Google Scholar 

  10. Rain S, Handoko ML, Trip P, Gan CT, Westerhof N, Stienen GJ et al (2013) Right ventricular diastolic impairment in patients with pulmonary arterial hypertension. Circulation 128:2016–2025

    Article  CAS  Google Scholar 

  11. Kanal E, Borgstede JP, Barkovich AJ, Bell C, Bradley WG, Etheridge S et al (2004) American college of radiology white paper on MR safety: 2004 update and revisions. AJR Am J Roentgenol 182:1111–1114

    Article  Google Scholar 

  12. Otsuji Y, Kisanuki A, Toyonaga K, Hamasaki S, Arima S, Nakao S et al (1996) Right ventricular stiffness measured by a new method without volume estimation in coronary artery disease. Am J Cardiol 78:298–303

    Article  CAS  Google Scholar 

  13. Murayama M, Mikami T, Kaga S, Okada K, Hioka T, Masauzi N et al (2017) Usefulness of the continuous-wave Doppler-derived pulmonary arterial-right ventricular pressure gradient just before atrial contraction for the estimation of pulmonary arterial diastolic and wedge pressures. Ultrasound Med Biol 43:958–966

    Article  Google Scholar 

  14. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A et al (2016) 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 Heart 37:67–119

    Article  Google Scholar 

  15. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K 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 23:685–713

    Article  Google Scholar 

  16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L 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. Eur Heart J Cardiovasc Imaging 16:233–270

    Article  Google Scholar 

  17. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29:277–314

    Article  Google Scholar 

  18. Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107:526–531

    Article  CAS  Google Scholar 

  19. Kaga S, Mikami T, Takamatsu Y, Abe A, Okada K, Nakabachi M et al (2014) Quantitative and pattern analyses of continuous-wave Doppler-derived pulmonary regurgitant flow velocity for the diagnosis of constrictive pericarditis. J Am Soc Echocardiogr 27:1223–1229

    Article  Google Scholar 

  20. Kaga S, Mikami T, Murayama M, Okada K, Masauzi N, Nakabachi M et al (2017) A new method to estimate pulmonary vascular resistance using diastolic pulmonary artery-right ventricular pressure gradients derived from continuous-wave Doppler velocity measurements of pulmonary regurgitation. Int J Cardiovasc Imaging 33:31–38

    Article  Google Scholar 

  21. Ten Brinke EA, Burkhoff D, Klautz RJ, Tschöpe C, Schalij MJ, Bax JJ et al (2010) Single-beat estimation of the left ventricular end-diastolic pressure-volume relationship in patients with heart failure. Heart 96:213–219

    Article  Google Scholar 

  22. Grossman W, Stefadouros MA, McLaurin LP, Rolett EL, Young DT (1973) Quantitative assessment of left ventricular diastolic stiffness in man. Circulation 47:567–574

    Article  CAS  Google Scholar 

  23. Gibson TC, Madry R, Grossman W, McLaurin LP, Craige E (1974) The A wave of the apexcardiogram and left ventricular diastolic stiffness. Circulation 49:441–446

    Article  CAS  Google Scholar 

  24. Grossman W, McLaurin LP, Moos SP, Stefadouros M, Young DT (1974) Wall thickness and diastolic properties of the left ventricle. Circulation 49:129–135

    Article  CAS  Google Scholar 

  25. Okada K, Kaga S, Abiko R, Murayama M, Hioka T, Nakabachi M et al (2018) Novel echocardiographic method to assess left ventricular chamber stiffness and elevated end-diastolic pressure based on time–velocity integral measurements of pulmonary venous and transmitral flows. Eur Hear J Cardiovasc Imaging 19:1260–1267

    Article  Google Scholar 

  26. Sakai K, Nakamura K, Satomi G, Kondo M, Hirosawa K (1984) Evaluation of tricuspid regurgitation by blood flow pattern in the hepatic vein using pulsed Doppler technique. Am Heart J 108:516–523

    Article  CAS  Google Scholar 

  27. Zhang-An Himura Y, Kumada T, Hayashida W, Ishikawa N, Noda M et al (1992) The characteristics of hepatic venous flow velocity pattern in patients with pulmonary hypertension by pulsed Doppler echocardiography. Jpn Circ J 56:317–324

    Article  CAS  Google Scholar 

  28. Do DH, Therrien J, Marelli A, Martucci G, Afilalo J, Sebag IA (2011) Right atrial size relates to right ventricular end-diastolic pressure in an adult population with congenital heart disease. Echocardiography 28:109–116

    Article  Google Scholar 

  29. Focardi M, Cameli M, Carbone SF, Massoni A, De Vito R, Lisi M et al (2015) Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 16:47–52

    Article  Google Scholar 

  30. Carlsson M, Ugander M, Heiberg E, Arheden H (2007) The quantitative relationship between longitudinal and radial function in left, right, and total heart pumping in humans. Am J Physiol Heart Circ Physiol 293:636–644

    Article  Google Scholar 

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Authors and Affiliations

  1. Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, 060-8648, Japan

    Michito Murayama, Masahiro Nakabachi, Shinobu Yokoyama, Hisao Nishino, Mutsumi Nishida & Hitoshi Shibuya

  2. Graduate School of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan

    Michito Murayama

  3. Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo, 060-0812, Japan

    Kazunori Okada, Sanae Kaga, Nobuo Masauzi & Taisei Mikami

  4. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Hiroyuki Iwano, Shingo Tsujinaga, Miwa Sarashina & Toshihisa Anzai

Authors
  1. Michito Murayama
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  2. Kazunori Okada
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  3. Sanae Kaga
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  14. Taisei Mikami
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Correspondence to Sanae Kaga.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Instead of obtaining informed consent, the program of the present study had been open to the public both through the home page and on the bulletin board of Hokkaido University Hospital.

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Murayama, M., Okada, K., Kaga, S. et al. Simple and noninvasive method to estimate right ventricular operating stiffness based on echocardiographic pulmonary regurgitant velocity and tricuspid annular plane movement measurements during atrial contraction. Int J Cardiovasc Imaging 35, 1871–1880 (2019). https://doi.org/10.1007/s10554-019-01637-2

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  • DOI: https://doi.org/10.1007/s10554-019-01637-2

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