Page 64 - Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension Onno Anthonius Spruijt
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or (in)direct Fick method, and also using (Doppler) ECHO or cMRI. It has been shown that changes in SV track RV responses to therapy [11, 12]. In PAH patients, an increased SV is achieved with intravenous infusion of epoprostenol [13, 14] and with oral treatment with Bosentan [15]. Not only is SV a sensitive parameter to measure RV responses, it has been shown that a change in SV of 10ml during follow-up should be considered clinically relevant [16]. An increase in CO in PAH patients has been shown with Ambrisentan, Bosentan, Sildenafil and Epoprostenol [14, 17-20]. In all these studies, improvements in SV and CO may have come about due to a reduction in afterload, an improvement in intrinsic RV function, or both.
   RV parameters
Load-dependent
Stroke volume
Right ventricular ejection fraction Cardiac output
Longitudinal shortening Transverse shortening Eccentricity index
Right ventricular mass Tei
Strain
Load-independent
Ees
Ea
Ees/Ea
Modalities
RHC, cMRI, Doppler-ECHO cMRI, 3D-ECHO
RHC, cMRI, 3D-ECHO 2D-ECHO, cMRI
2D-ECHO, cMRI 2D-ECHO, cMRI cMRI Doppler-ECHO 2D-ECHO, cMRI
RHC (favorably combined with cMRI or 3D-ECHO for assessment of EDV and ESV)
RHC (favorably combined with cMRI or 3D-ECHO for assessment of EDV and ESV)
RHC
     Table 1: Overview of modalities to assess different RV parameters. RHC = right heart catheterization; cMRI = cardiac magnetic resonance imaging; ECHO = echocardiography; EDV = end-diastolic volume; ESV = end-systolic volume
Cardiac Imaging by magnetic resonance and echocardiography
Imaging by means of cMRI or ECHO has the major advantage of being non-invasive. The disadvantage of imaging, however, is that the obtained functional information is load-dependent












































































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