New Aspects of Echocardiographic Assessment of Pulmonary Hypertension
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In recent years, the assessment of pulmonary hypertension (PH) has gained more and more consideration in the clinical and scientific community, since many different conditions, including primary and secondary etiologies, may lead to PH. The possibility to noninvasively estimate pulmonary artery systolic pressure (PASP) by echocardiography is of recognized utility for the screening and follow-up of PH. Along with PH estimation, a thorough evaluation of the right heart morphology, function, and hemodynamics is of paramount importance in patients with PH. In the last few years, many different echocardiographic techniques were proposed to improve the classic 2D assessment of the right heart, which suffers from significant limitations. Together with the more established tissue Doppler imaging, myocardial strain and speckle tracking and 3D echocardiography have emerged as very promising ultrasound methods to improve the overall assessment of patients with PH.
KeywordsEchocardiography Pulmonary hypertension Speckle-tracking Strain 3D-echo
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Conflict of Interest
Luna Gargani declares that she has no conflicts of interest. Rosa Sicari declares that she has no conflicts of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 1.Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the 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 the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.PubMedCrossRefGoogle Scholar
- 3.Badano LP, Ginghina C, Easaw J, Muraru D, Grillo MT, Lancellotti P, et al. Right ventricle in pulmonary arterial hypertension: hemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr. 2010;11:27–37.PubMedCrossRefGoogle Scholar
- 5.Leda Galiuto, Luigi Badano, Kevin Fox, Rosa Sicari, Jose Luis Zamorano. The EAE textbook of echocardiography. Oxford University Press, Oxford. 2011Google Scholar
- 11.•• Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. 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. 2010;23:685–713. This is the first ASE/EAE document on the echocardiographic assessment of the right heart. It is extremely useful and didactic, and allows knowing the state-of-the-art evaluation of the right heart.PubMedCrossRefGoogle Scholar
- 17.Anavekar NS, Gerson D, Skali H, Kwong RY, Yucel EK, Solomon SD. Two-dimensional assessment of right ventricular function: an echocardiographic-MRI correlative study, Echocardiography 2007;24: 452–6.Google Scholar
- 35.Sebbag I, Rudski LG, Therrien J, Hirsch A, Langleben D. Effect of chronic infusion of epoprostenol on echocardiographic right ventricular myocardial performance index and its relation to clinical outcome in patients with primary pulmonary hypertension. Am J Cardiol. 2001;88:1060–3.PubMedCrossRefGoogle Scholar
- 40.Borges AC, Knebel F, Eddicks S, Panda A, Schattke S, Witt C, et al. Right ventricular function assessed by 2-dimensional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy. Am J Cardiol. 2006;98:530–4.PubMedCrossRefGoogle Scholar
- 44.•• Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr. 2011;12:167–205. This is the ASE/EAE consensus statement on the echocardiographic assessment of cardiac mechanics. The paper provides a comprehensive dissertation on the recent echocardiographic techniques developed to assess cardiac mechanics.PubMedCrossRefGoogle Scholar
- 45.Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984;70:657–62.Google Scholar
- 48.Hinderliter AL, Willis PW, Barst RJ, Rich S, Rubin LJ, Badesch DB, et al. Effects of long-term in- fusion of prostacyclin (epoprostenol) on echocardiographic measures of right ventricular structure and function in primary pulmonary hypertension. Circulation. 1997;95:1479–86.PubMedCrossRefGoogle Scholar
- 53.Mahan G, Dabestani A, Gardin J, Allfie A, Burn C, Henry W. Estimation of pulmonary artery pressure by pulsed Doppler echocardiography. Circulation. 1983;68:367.Google Scholar
- 56.Furuno Y, Nagamoto Y, Fujita M, Kaku T, Sakurai S, Kuroiwa A. Reflection as a cause of mid-systolic deceleration of pulmonary flow wave in dogs with acute pulmonary hypertension: comparison of pulmonary artery constriction with pulmonary embolization. Cardiovasc Res. 1991;25:118–24.PubMedCrossRefGoogle Scholar
- 59.Opotowsky AR, Clair M, Afilalo J, Landzberg MJ, Waxman AB, Moko L, et al. A simple echocardiographic method to estimate pulmonary vascular resistance. Am J Cardiol. 2013.Google Scholar
- 60.Oh JK, Seward JB, Tajik AJ. The echo manual. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2006.Google Scholar
- 62.Gruenig E, Weissmann S, Ehlken N, Fijalkowska A, Fischer C, Fourme T, et al. Stress Doppler echocardiography in relatives of patients with idiopathic and familial pulmonary arterial hypertension: results of a multicenter European analysis of pulmonary artery pressure response to exercise and hypoxia. Circulation. 2009;119:1747–57.CrossRefGoogle Scholar
- 63.• Gruenig E, Mereles D, Hildebrandt W, Swenson ER, Kuebler W, Kuecherer H, et al. Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. J Am Coll Cardiol. 2000;35:980–7. This study is of importance because it is the first report showing that asymptomatic gene carriers of familial primary pulmonary hypertension can be identified by their pathological pulmonary artery response to exercise, even before pulmonary artery pressure at rest is elevated.CrossRefGoogle Scholar
- 65.Collins N, Bastian B, Quiqueree L, Jones C, Morgan R, Reeves G. Abnormal pulmonary vascular responses in patients registered with a systemic autoimmunity database: Pulmonary Hypertension Assessment and Screening Evaluation Using Stress Echocardiography (PHASE-I). Eur J Echocardiogr. 2006;7:439–46.PubMedCrossRefGoogle Scholar
- 73.Kuwat SM, Taichman DB, Archer-Chicko CL, Palevsky HI, Kimmel SE. Hemodynamic and survival in patients with pulmonary arterial hypertension related to systemic sclerosis. Chest. 2003;123:344e50.Google Scholar
- 84.Codullo V, Caporali R, Cuomo G, Ghio S, D'Alto M, Fusetti C, et al. Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension. Arthritis Rheum. 2013. doi: 10.1002/art.38043.
- 88.Ohno Y, Hatabu H, Murase K, et al. Quantitative assessment of regional pulmonary perfusion in the entire lung using three-dimensional ultrafast dynamic contrast-enhanced magnetic resonance imaging: preliminary experience in 40 subjects. J Magn Reson Imaging. 2004;20:353–65.PubMedCrossRefGoogle Scholar
- 92.Nogami M, Ohno Y, Koyama H, et al. Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: comparison with right heart catheterization and echocardiography. J Magn Reson Imaging. 2009;30:973–80.PubMedCrossRefGoogle Scholar