Page 17 - Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension Onno Anthonius Spruijt

Outline of this thesis
In this thesis, a number of techniques and methods were evaluated that may contribute to earlier recognition of PAH and improved monitoring and prognostication.
Early recognition and prognostication in pulmonary hypertension
Due to the non-specific nature of symptoms at presentation, most patients with pulmonary arterial hypertension are diagnosed by the time their disease is already in an advanced stage. Early detection of PH and a timely initiation of treatment can significantly improve clinical outcome. Computed tomography pulmonary angiography (CTPA) is a diagnostic tool often used in the diagnostic process of patients that present with unexplained dyspnea, for example to exclude pulmonary emboli. A well-known clue for the presence of pulmonary hypertension on CTPA is an increased ratio between the diameter of the pulmonary artery and the diameter of the ascending aorta. In chapter 2, we investigated whether a combination of dimensional measurements of the pulmonary artery and the heart would increase the predictive value of computed tomography pulmonary angiography for the presence of pulmonary hypertension. The prognostic value of right ventricular parameters in pulmonary hypertension is well-established. Whether a combination of parameters of the right heart merged into a simple risk score predict outcome in precapillary pulmonary hypertension was investigated in chapter 3.
Treatment response in pulmonary hypertension
Since the prognosis of patients with pulmonary hypertension is determined by right ventricular function, monitoring of right ventricular function is of utmost importance. In chapter 4 we summarized available methods for measuring the right ventricular response to therapy. Cardiac magnetic resonance imaging is the gold standard for monitoring right ventricular function. Since this technique is expensive, not widely available and analyses are time-consuming, monitoring right ventricular function using simple echocardiographic measurements would be ideal in daily practice. Therefore, in chapter 5, we investigated the usage of simple echocardiographic parameters for the serial assessment of RV function. In chapter 6 we investigated whether the hemodynamic and cardiac responses to PH specific therapy are different between patients with idiopathic pulmonary arterial hypertension and a severely reduced diffusion capacity of the lung for carbon monoxide compared to patients with idiopathic pulmonary arterial hypertension with a more preserved diffusion capacity of the lung for carbon monoxide.
Chapter 1
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