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Right ventricular relative wall thickness as a predictor of outcomes and of right ventricular reverse remodeling for patients with pulmonary hypertension

  • Hiroyuki Sano
  • Hidekazu Tanaka
  • Yoshiki Motoji
  • Yuko Fukuda
  • Yasuhide Mochizuki
  • Yutaka Hatani
  • Hiroki Matsuzoe
  • Keiko Hatazawa
  • Hiroyuki Shimoura
  • Junichi Ooka
  • Keiko Ryo-Koriyama
  • Kazuhiko Nakayama
  • Kensuke Matsumoto
  • Noriaki Emoto
  • Ken-ichi Hirata
Original Paper

Abstract

Mid-term right ventricular (RV) reverse remodeling after treatment in patients with pulmonary hypertension (PH) is associated with long-term outcome as well as baseline RV remodeling. However, baseline factors influencing mid-term RV reverse remodeling after treatment and its prognostic capability remain unclear. We studied 54 PH patients. Mid-term RV remodeling was assessed in terms of the RV area, which was traced planimetrically at the end-systole (RVESA). RV reverse remodeling was defined as a relative decrease in the RVESA of at least 15% at 10.2 ± 9.4 months after treatment. Long-term follow-up was 5 years. Adverse events occurred in ten patients (19%) and mid-term RV reverse remodeling after treatment was observed in 37 (69%). Patients with mid-term RV reverse remodeling had more favorable long-term outcomes than those without (log-rank: p = 0.01). Multivariate logistic regression analysis showed that RV relative wall thickness (RV-RWT), as calculated as RV free-wall thickness/RV basal linear dimension at end-diastole, was an independent predictor of mid-term RV reverse remodeling (OR 1.334; 95% CI, 1.039–1.713; p = 0.03). Moreover, patients with RV-RWT ≥0.21 showed better long-term outcomes than did those without (log-rank p = 0.03), while those with RV-RWT ≥0.21 and mid-term RV reverse remodeling had the best long-term outcomes. Patients with RV-RWT <0.21 and without mid-term RV reverse remodeling, on the other hand, had worse long-term outcomes than other sub-groups. In conclusions, RV-RWT could predict mid-term RV reverse remodeling after treatment in PH patients, and was associated with long-term outcomes. Our finding may have clinical implications for better management of PH patients.

Keywords

Pulmonary hypertension Right ventricular function Right ventricular reverse remodeling Echocardiography 

Notes

Compliance with ethical standards

Conflict of interest

Hiroyuki Sano declares that he has no conflict of interest. Hidekazu Tanaka declares that he has no conflict of interest. Yoshiki Motoji declares that he has no conflict of interest. Yuko Fukuda declares that he has no conflict of interest. Yasuhide Mochizuki declares that he has no conflict of interest. Yutaka Hatani declares that he has no conflict of interest. Hiroki Matsuzoe declares that she has no conflict of interest. Keiko Hatazawa declares that he has no conflict of interest. Hiroyuki Shimoura declares that he has no conflict of interest. Junichi Ooka declares that he has no conflict of interest. Keiko Ryo-Koriyama declares that he has no conflict of interest. Kazuhiro Nakayama declares that he has no conflict of interest. Kensuke Matsumoto declares that he has no conflict of interest. Noriaki Emoto declares that he has no conflict of interest. Ken-ichi Hirata declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from the patient.

References

  1. 1.
    Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barbera J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol C, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Voller H, Luis Zamorano J (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 J 37:67–119CrossRefPubMedGoogle Scholar
  2. 2.
    Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, Chamera E, Corretti MC, Champion HC, Abraham TP, Girgis RE, Hassoun PM (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174:1034–1041CrossRefPubMedGoogle Scholar
  3. 3.
    Ghio S, Klersy C, Magrini G, D’Armini AM, Scelsi L, Raineri C, Pasotti M, Serio A, Campana C, Vigano M (2010) Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol 140:272–278CrossRefPubMedGoogle Scholar
  4. 4.
    Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, Kane GC (2013) Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging 6:711–721CrossRefPubMedGoogle Scholar
  5. 5.
    Haeck ML, Scherptong RW, Marsan NA, Holman ER, Schalij MJ, Bax JJ, Vliegen HW, Delgado V (2012) Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging 5:628–636CrossRefPubMedGoogle Scholar
  6. 6.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (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. J Am Soc Echocardiogr 28(1–39):e14Google Scholar
  7. 7.
    Motoji Y, Tanaka H, Fukuda Y, Ryo K, Emoto N, Kawai H, Hirata K (2013) Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 77:756–763CrossRefPubMedGoogle Scholar
  8. 8.
    Chemla D, Castelain V, Herve P, Lecarpentier Y, Brimioulle S (2002) Haemodynamic evaluation of pulmonary hypertension. Eur Respir J 20:1314–1331CrossRefPubMedGoogle Scholar
  9. 9.
    Chin KM, Kim NH, Rubin LJ (2005) The right ventricle in pulmonary hypertension. Coron Artery Dis 16:13–18CrossRefPubMedGoogle Scholar
  10. 10.
    Sano H, Tanaka H, Motoji Y, Fukuda Y, Sawa T, Mochizuki Y, Ryo K, Matsumoto K, Emoto N, Hirata K (2015) Right ventricular function and right-heart echocardiographic response to therapy predict long-term outcome in patients with pulmonary hypertension. Can J Cardiol 31:529–536CrossRefPubMedGoogle Scholar
  11. 11.
    Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G, Guidelines ESCCfP (2009) 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 30:2493–2537CrossRefPubMedGoogle Scholar
  12. 12.
    Pearlman AS, Gardin JM, Martin RP, Parisi AF, Popp RL, Quinones MA, Stevenson JG (1987) Guidelines for optimal physician training in echocardiography. Recommendations of the American society of echocardiography committee for physician training in echocardiography. Am J Cardiol 60:158–163CrossRefPubMedGoogle Scholar
  13. 13.
    Fukuda Y, Tanaka H, Sugiyama D, Ryo K, Onishi T, Fukuya H, Nogami M, Ohno Y, Emoto N, Kawai H, Hirata K (2011) Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 24:1101–1108CrossRefPubMedGoogle Scholar
  14. 14.
    Motoji Y, Tanaka H, Fukuda Y, Sano H, Ryo K, Sawa T, Miyoshi T, Imanishi J, Mochizuki Y, Tatsumi K, Matsumoto K, Emoto N, Hirata K (2016) Association of apical longitudinal rotation with right ventricular performance in patients with pulmonary hypertension: insights into overestimation of tricuspid annular plane systolic excursion. Echocardiography 33:207–215CrossRefPubMedGoogle Scholar
  15. 15.
    Fukuda Y, Tanaka H, Motoji Y, Ryo K, Sawa T, Imanishi J, Miyoshi T, Mochizuki Y, Tatsumi K, Matsumoto K, Shinke T, Emoto N, Hirata K (2014) Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension. Int J Cardiovasc Imaging 30:1269–1277CrossRefPubMedGoogle Scholar
  16. 16.
    Fukuda Y, Tanaka H, Ryo-Koriyama K, Motoji Y, Sano H, Shimoura H, Ooka J, Toki H, Sawa T, Mochizuki Y, Matsumoto K, Emoto N, Hirata K (2016) Comprehensive functional assessment of right-sided heart using speckle tracking strain for patients with pulmonary hypertension. Echocardiography. doi: 10.1111/echo.13205 Google Scholar
  17. 17.
    Motoji Y, Tanaka H, Fukuda Y, Sano H, Ryo K, Imanishi J, Miyoshi T, Sawa T, Mochizuki Y, Matsumoto K, Emoto N, Hirata K (2015) Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension. Int J Cardiovasc Imaging 31:691–698CrossRefPubMedGoogle Scholar
  18. 18.
    Vonk-Noordegraaf A, Haddad F, Chin KM, Forfia PR, Kawut SM, Lumens J, Naeije R, Newman J, Oudiz RJ, Provencher S, Torbicki A, Voelkel NF, Hassoun PM (2013) Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol 62:D22–D33CrossRefPubMedGoogle Scholar
  19. 19.
    Harrison A, Hatton N, Ryan JJ (2015) The right ventricle under pressure: evaluating the adaptive and maladaptive changes in the right ventricle in pulmonary arterial hypertension using echocardiography (2013 Grover Conference series). Pulm Circ 5:29–47CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Ryan JJ, Huston J, Kutty S, Hatton ND, Bowman L, Tian L, Herr JE, Johri AM, Archer SL (2015) Right ventricular adaptation and failure in pulmonary arterial hypertension. Can J Cardiol 31:391–406CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Vonk Noordegraaf A, Galie N (2011) The role of the right ventricle in pulmonary arterial hypertension. Eur Respir Rev 20:243–253CrossRefPubMedGoogle Scholar
  22. 22.
    Piao L, Fang YH, Parikh K, Ryan JJ, Toth PT, Archer SL (2013) Cardiac glutaminolysis: a maladaptive cancer metabolism pathway in the right ventricle in pulmonary hypertension. J Mol Med 91:1185–1197CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Piao L, Fang YH, Parikh KS, Ryan JJ, D’Souza KM, Theccanat T, Toth PT, Pogoriler J, Paul J, Blaxall BC, Akhter SA, Archer SL (2012) GRK2-mediated inhibition of adrenergic and dopaminergic signaling in right ventricular hypertrophy: therapeutic implications in pulmonary hypertension. Circulation 126:2859–2869CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bogaard HJ, Abe K, Vonk Noordegraaf A, Voelkel NF (2009) The right ventricle under pressure: cellular and molecular mechanisms of right-heart failure in pulmonary hypertension. Chest 135:794–804CrossRefPubMedGoogle Scholar
  25. 25.
    Ryan JJ, Archer SL (2014) The right ventricle in pulmonary arterial hypertension: disorders of metabolism, angiogenesis and adrenergic signaling in right ventricular failure. Circ Res 115:176–188CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Badagliacca R, Poscia R, Pezzuto B, Nocioni M, Mezzapesa M, Francone M, Giannetta E, Papa S, Gambardella C, Sciomer S, Volterrani M, Fedele F, Dario Vizza C (2015) Right ventricular remodeling in idiopathic pulmonary arterial hypertension: adaptive versus maladaptive morphology. J Heart Lung Transplant 34:395–403CrossRefPubMedGoogle Scholar
  27. 27.
    Steiner J, Wu WC, Jankowich M, Maron BA, Sharma S, Choudhary G (2015) Echocardiographic predictors of mortality in patients with pulmonary hypertension and cardiopulmonary comorbidities. PLoS One 10:e0119277CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Fukui S, Ogo T, Morita Y, Tsuji A, Tateishi E, Ozaki K, Sanda Y, Fukuda T, Yasuda S, Ogawa H, Nakanishi N (2014) Right ventricular reverse remodelling after balloon pulmonary angioplasty. Eur Respir J 43:1394–1402CrossRefPubMedGoogle Scholar
  29. 29.
    Iino M, Dymarkowski S, Chaothawee L, Delcroix M, Bogaert J (2008) Time course of reversed cardiac remodeling after pulmonary endarterectomy in patients with chronic pulmonary thromboembolism. Eur Radiol 18:792–799CrossRefPubMedGoogle Scholar
  30. 30.
    Berman M, Gopalan D, Sharples L, Screaton N, Maccan C, Sheares K, Pepke-Zaba J, Dunning J, Tsui S, Jenkins DP (2014) Right ventricular reverse remodeling after pulmonary endarterectomy: magnetic resonance imaging and clinical and right heart catheterization assessment. Pulm Circ 4:36–44CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Smith BC, Dobson G, Dawson D, Charalampopoulos A, Grapsa J, Nihoyannopoulos P (2014) Three-dimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 64:41–51CrossRefPubMedGoogle Scholar
  32. 32.
    Vitarelli A, Mangieri E, Terzano C, Gaudio C, Salsano F, Rosato E, Capotosto L, D’Orazio S, Azzano A, Truscelli G, Cocco N, Ashurov R (2015) Three-dimensional echocardiography and 2D-3D speckle-tracking imaging in chronic pulmonary hypertension: diagnostic accuracy in detecting hemodynamic signs of right ventricular (RV) failure. J Am Heart Assoc 4:e001584CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Hiroyuki Sano
    • 1
  • Hidekazu Tanaka
    • 1
  • Yoshiki Motoji
    • 1
  • Yuko Fukuda
    • 1
  • Yasuhide Mochizuki
    • 1
  • Yutaka Hatani
    • 1
  • Hiroki Matsuzoe
    • 1
  • Keiko Hatazawa
    • 1
  • Hiroyuki Shimoura
    • 1
  • Junichi Ooka
    • 1
  • Keiko Ryo-Koriyama
    • 1
  • Kazuhiko Nakayama
    • 1
  • Kensuke Matsumoto
    • 1
  • Noriaki Emoto
    • 1
  • Ken-ichi Hirata
    • 1
  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan

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