Page 76 - Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension Onno Anthonius Spruijt

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Abstract
Introduction: Although cardiac magnetic resonance imaging (CMRI) is the gold standard for the (serial) assessment of right ventricular (RV) function, the technique has several drawbacks: CMRI is relatively expensive, has limited availability and the analyses are time consuming. Echocardiography (echo) can overcome several of these issues. The aim of this study was to compare simple echo- derived parameters of RV systolic function with CMRI-derived RV ejection fraction (RVEF) in patients with precapillary pulmonary hypertension (PH) and to determine which echo parameters best followed the change in CMRI-derived-RVEF during follow-up.
Methods: CMRI and echo were performed in 96 precapillary PH patients. In 38 patients a second set of a CMRI and echo were available. Retrospectively, echo-derived right ventricular fractional area change (RVFAC), tricuspid annulus plane systolic excursion (TAPSE), fractional transversal (FTWM) and longitudinal wall motion (FLWM) were assessed and compared with CMRI-derived-RVEF. Furthermore, the changes in RVFAC, TAPSE, FTWM and FLWM during follow-up were compared with the change in CMRI-derived-RVEF.
Results: All four echo parameters were significantly correlated to CMRI-derived-RVEF. The strongest relationship was seen between CMRI-derived-RVEF and RVFAC (r2=0.567). However, sensitivity for predicting a deterioration in CMRI-derived RVEF was poor for all four echo-derived parameters (ranging from 33-56%).
Conclusions: Although RVFAC, TAPSE, FTWM and FLWN were significantly correlated to CMRI- derived-RVEF, all four echo parameters showed a low sensitivity for predicting a deterioration in CMRI-derived RVEF during follow-up. Therefore, RVFAC, TAPSE, FTWM and FLWN are not suitable parameters for the serial assessment of RV systolic function in patients with precapillary PH.