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Improvement in right ventricular function during reversibility testing in pulmonary arterial hypertension: a case report.

Huez S, VachiƩry JL, Naeije R - Cardiovasc Ultrasound (2009)

Bottom Line: In this 24 years-old woman, the inhalation of 5 microg iloprost transiently decreased mean pulmonary artery pressure from 62 to 36 mmHg and pulmonary vascular resistance from 11.0 to 4.9 Wood units, meeting the criteria of a "positive response".Pulsed tissue Doppler imaging of the right ventricle showed a decrease in the isovolumic relaxation time from 102 to 73 ms, and an increase of the E/A ratio from 0.72 to 1.38, together with marked improvements in mid-apical free wall systolic strain and strain rate.A positive response to reversibility testing of pulmonary arterial hypertension may be associated with quasi normalization of right ventricular function, in spite of still elevated pulmonary artery pressure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathophysiology, Erasmus Campus, CP 604, Route de Lennik 808, B-1070 Brussels, Belgium. shuez@ulb.ac.be

ABSTRACT
A right heart catheterization with reversibility testing is recommended for the diagnosis and treatment of pulmonary arterial hypertension. In this 24 years-old woman, the inhalation of 5 microg iloprost transiently decreased mean pulmonary artery pressure from 62 to 36 mmHg and pulmonary vascular resistance from 11.0 to 4.9 Wood units, meeting the criteria of a "positive response". The echocardiographic examination showed normalization of right heart chamber dimensions and of the right ventricular performance (Tei) index. Pulsed tissue Doppler imaging of the right ventricle showed a decrease in the isovolumic relaxation time from 102 to 73 ms, and an increase of the E/A ratio from 0.72 to 1.38, together with marked improvements in mid-apical free wall systolic strain and strain rate. A positive response to reversibility testing of pulmonary arterial hypertension may be associated with quasi normalization of right ventricular function, in spite of still elevated pulmonary artery pressure.

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Systolic strain recorded along the right ventricular free wall, at the mid-base (yellow trace) and at the mid-apex (green trace), before and during reversibility testing. AVO indicates the pulmonary valve opening and AVC the pulmonary valve closure.
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Figure 4: Systolic strain recorded along the right ventricular free wall, at the mid-base (yellow trace) and at the mid-apex (green trace), before and during reversibility testing. AVO indicates the pulmonary valve opening and AVC the pulmonary valve closure.

Mentions: The acceleration time of pulmonary blood flow changed from 80 ms to 81 ms (NO) and 103 ms (iloprost), indicating a decrease in Ppa that was more important with iloprost than with NO. The four chamber apical view showed that the RV came back to a near-normal shape, with a RV/LV end-diastolic area ratio decreased from 91 to 54% with iloprost (Figure 1). The short axis view showed a return of the LV to a normal rounded shape, with an eccentricity index in end-diastole: from 1.8 to 1.1 (NO) and to 1 (iloprost) and in end-systole from 2.3 to 1.2 (NO) and to 1.1 (iloprost) (Figure 2). The RV area shortening fraction increased from 11 to 43% with iloprost, and the RV Tei index was normalized, from 0.31 to 0.14 (NO) and to 0.16 (iloprost). Pulsed TDI recorded at the tricuspid annulus showed a marked increase in S waves, from 11 to 12 and 13.5 cm/sec, and in E waves, from 8 to 9.5 and to 11 cm/sec and a decrease in A wave (from 11 to 8.5 and to 8 cm/sec) with inversion of the E/A ratio (from 0.72 to 1.12 to 1.38), and a decrease in IVRT (from 102 to 75 and to 73 msec), whereas these effects were not observed at the mitral annulus (Figure 3). Along the RV free wall, systolic strain increased at the mid-apex, from 19 to 41 and to 37%, but not at the mid-base, from 23 to 23 and to 22%. The changes in systolic strain rate were similar, with at mid-apex from 1.1 to 3.2 and to 3.6/sec and at mid-base from 1.1 to 1.1 and 1.1/sec (Figures 4 and 5).


Improvement in right ventricular function during reversibility testing in pulmonary arterial hypertension: a case report.

Huez S, VachiƩry JL, Naeije R - Cardiovasc Ultrasound (2009)

Systolic strain recorded along the right ventricular free wall, at the mid-base (yellow trace) and at the mid-apex (green trace), before and during reversibility testing. AVO indicates the pulmonary valve opening and AVC the pulmonary valve closure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651119&req=5

Figure 4: Systolic strain recorded along the right ventricular free wall, at the mid-base (yellow trace) and at the mid-apex (green trace), before and during reversibility testing. AVO indicates the pulmonary valve opening and AVC the pulmonary valve closure.
Mentions: The acceleration time of pulmonary blood flow changed from 80 ms to 81 ms (NO) and 103 ms (iloprost), indicating a decrease in Ppa that was more important with iloprost than with NO. The four chamber apical view showed that the RV came back to a near-normal shape, with a RV/LV end-diastolic area ratio decreased from 91 to 54% with iloprost (Figure 1). The short axis view showed a return of the LV to a normal rounded shape, with an eccentricity index in end-diastole: from 1.8 to 1.1 (NO) and to 1 (iloprost) and in end-systole from 2.3 to 1.2 (NO) and to 1.1 (iloprost) (Figure 2). The RV area shortening fraction increased from 11 to 43% with iloprost, and the RV Tei index was normalized, from 0.31 to 0.14 (NO) and to 0.16 (iloprost). Pulsed TDI recorded at the tricuspid annulus showed a marked increase in S waves, from 11 to 12 and 13.5 cm/sec, and in E waves, from 8 to 9.5 and to 11 cm/sec and a decrease in A wave (from 11 to 8.5 and to 8 cm/sec) with inversion of the E/A ratio (from 0.72 to 1.12 to 1.38), and a decrease in IVRT (from 102 to 75 and to 73 msec), whereas these effects were not observed at the mitral annulus (Figure 3). Along the RV free wall, systolic strain increased at the mid-apex, from 19 to 41 and to 37%, but not at the mid-base, from 23 to 23 and to 22%. The changes in systolic strain rate were similar, with at mid-apex from 1.1 to 3.2 and to 3.6/sec and at mid-base from 1.1 to 1.1 and 1.1/sec (Figures 4 and 5).

Bottom Line: In this 24 years-old woman, the inhalation of 5 microg iloprost transiently decreased mean pulmonary artery pressure from 62 to 36 mmHg and pulmonary vascular resistance from 11.0 to 4.9 Wood units, meeting the criteria of a "positive response".Pulsed tissue Doppler imaging of the right ventricle showed a decrease in the isovolumic relaxation time from 102 to 73 ms, and an increase of the E/A ratio from 0.72 to 1.38, together with marked improvements in mid-apical free wall systolic strain and strain rate.A positive response to reversibility testing of pulmonary arterial hypertension may be associated with quasi normalization of right ventricular function, in spite of still elevated pulmonary artery pressure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathophysiology, Erasmus Campus, CP 604, Route de Lennik 808, B-1070 Brussels, Belgium. shuez@ulb.ac.be

ABSTRACT
A right heart catheterization with reversibility testing is recommended for the diagnosis and treatment of pulmonary arterial hypertension. In this 24 years-old woman, the inhalation of 5 microg iloprost transiently decreased mean pulmonary artery pressure from 62 to 36 mmHg and pulmonary vascular resistance from 11.0 to 4.9 Wood units, meeting the criteria of a "positive response". The echocardiographic examination showed normalization of right heart chamber dimensions and of the right ventricular performance (Tei) index. Pulsed tissue Doppler imaging of the right ventricle showed a decrease in the isovolumic relaxation time from 102 to 73 ms, and an increase of the E/A ratio from 0.72 to 1.38, together with marked improvements in mid-apical free wall systolic strain and strain rate. A positive response to reversibility testing of pulmonary arterial hypertension may be associated with quasi normalization of right ventricular function, in spite of still elevated pulmonary artery pressure.

Show MeSH
Related in: MedlinePlus