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Right Ventricular Ejection Efficiency: A New Echocardiographic Measure of Mechanical Performance in Chronic Pulmonary Hypertension
Author(s) -
LópezCandales Angel,
Lopez Francisco R.,
Trivedi Setu,
Elwing Jean
Publication year - 2014
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12419
Subject(s) - cardiology , medicine , pulmonary hypertension , pulmonary artery , area under the curve , ejection fraction , heart failure
Background The severity of pulmonary vascular resistance (PVR) is known to be a critical determinant of right ventricular (RV) systolic function; this relationship remains poorly characterized. We therefore, designed a study to examine the relationship that exists between echocardiographically measured PVR and maximal tricuspid annular plane systolic excursion (TAPSE) to gain some insight regarding RV ejection efficiency (RVEe) in patients with chronic pulmonary hypertension ( cPH ). Methods Standard echocardiographic measures of RV size and systolic performance were recorded from 95 patients (age 54 ± 15 years and pulmonary artery systolic pressures [ PASP ] that range from 20 to 125 mmHg). For this study, RVE e was defined as TAPSE /Echocardiographic PVR . Results A strong negative correlation (R 2 = −0.51, P < 0.001) was seen between TAPSE and PASP ; however, a power curve trend line fit the relationship between RVE e and PASP (R 2 = 0.77; P < 0.01). In a multiple regression analysis, abnormal pulmonary pressures were better identified when RVE e (P < 0.0001) was used. Conclusions Based on these results, it appears that measurement of RVE e might be extremely useful for the assessment of RV mechanics and plasticity. The power curve relationship clearly demonstrates that minimal changes in PASP (up to 50 mmHg) result in dramatic reductions in RVE e. A steady decline in RVE e, though at a lower rate, continues to occur with increasing PASP . Additional studies are required using RVE e into a functional RV imaging algorithm and determine if RVE e correlates with development of symptoms, response to therapy and overall clinical outcomes.