Page 77 - Assessing right ventricular function and the pulmonary circulation in pulmonary hypertension Onno Anthonius Spruijt

Introduction
Precapillary pulmonary hypertension (PH) is a progressive condition affecting the small pulmonary arteries, that increases the load on the right ventricle (RV). Survival in patients with precapillary PH is strongly related to RV systolic function [1-5] and several studies have shown the strong prognostic value of RV ejection fraction (RVEF) [3, 5]. Therefore, it is of utmost importance to monitor RV systolic function during the follow-up of patients with precapillary PH [3, 4, 6].
Although CMRI-derived-RVEF is the gold standard for the (serial) assessment of RV systolic function, it has several drawbacks: CMRI is relatively expensive, has limited availability and is incompatible with metallic devices [7]. Furthermore, for assessing RVEF it is necessary to manually trace the endocardial border on the complete stack of short-axis slices making determination of RVEF time- consuming. Therefore, using CMRI-derived-RVEF for the assessment of RV systolic function is not always the most practical option during daily practice.
In contrast to CMRI, echocardiography (echo) is inexpensive, readily available and can be applied at the bedside. Several simple and rapidly quantifiable echo-derived parameters of RV systolic function are available [8] and provide important prognostic information in precapillary PH [9, 10]. Two recent studies compared two echo-derived parameters of RV systolic function, RVFAC and tricuspid annulus plane systolic excursion (TAPSE) in precapillary PH patients with CMRI-derived-RVEF [11, 12]. However, these studies were performed in small cohorts and showed conflicting results. More importantly, it is unknown whether simple echo-derived parameter of RV systolic function can follow the change in CMRI-derived-RVEF during follow-up and hence can be used for the serial assessment of RV function in patients with precapillary PH.
The aim of this study was to compare simple echo-derived parameters of RV systolic function with CMRI-derived-RVEF in a large cohort of precapillary PH patients and to investigate whether echo- derived parameters of RV systolic function were able to follow the changes in CMRI-derived-RVEF during follow-up.
Methods
Study population
Retrospectively, precapillary PH patients that underwent an echo and CMRI in the VU University Medical Center between April 2010 and August 2014 were included. Available data was prospectively completed with precapillary patients that underwent an echo and CMRI within one
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