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New concepts in the invasive and non invasive evaluation of remodelling of the right ventricle and pulmonary vasculature in pulmonary arterial hypertension.

Domingo E, Aguilar R, López-Meseguer M, Teixidó G, Vazquez M, Roman A - Open Respir Med J (2009)

Bottom Line: Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers.In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle.This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain.

ABSTRACT
Pulmonary arterial hypertension (PAH) is a rare fatal disease defined as a sustained elevation of pulmonary arterial pressure to more than 25 mmHg at rest, with a mean pulmonary-capillary wedge pressure and left ventricular enddiastolic pressure of less than 15 mmHg at rest. Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers. These changes, named as vascular remodelling, include vascular proliferation, fibrosis, and vessel obstruction. In clinical practice the diagnosis of PAH relies on measurements of pulmonary vascular pressure and cardiac output, and calculation of pulmonary vascular resistances. Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio and diminished pulsatility than in control patients. Optical Coherence Tomography, a new high resolution imaging modality that has proven its superiority over intravascular ultrasound (IVUS) for the detection and characterization of coronary atherosclerotic plaque composition, may potentially be a useful technique for the in vivo study of the pulmonary arterial wall. In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle. This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

No MeSH data available.


Related in: MedlinePlus

Tricuspid Annular Plane Systolic Excursion [TAPSE] in a patient with severe PAH during a vasodilatory test with epoprostenol: Left panel depicts the localization of the cursor line over the lateral portion of the tricuspid annulus on an apical view of the right heart chambers [RV: right ventricle; RA: right atrium]. On the right panel the M-mode represents displacement of the annular plane during the cardiac cycle. Main advantages of TAPSE, despite its dependency on volumetric assumptions, are that it is very easy to obtain and quite reproducible.
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Figure 3: Tricuspid Annular Plane Systolic Excursion [TAPSE] in a patient with severe PAH during a vasodilatory test with epoprostenol: Left panel depicts the localization of the cursor line over the lateral portion of the tricuspid annulus on an apical view of the right heart chambers [RV: right ventricle; RA: right atrium]. On the right panel the M-mode represents displacement of the annular plane during the cardiac cycle. Main advantages of TAPSE, despite its dependency on volumetric assumptions, are that it is very easy to obtain and quite reproducible.

Mentions: The majority of the proposed methods of echocardiographic assessment of right ventricular function are based on volumetric approximations of the right ventricle. However such approaches have intrinsic limitations, first since volume related measures such as ejection fraction are load dependent, second because of the complex geometry of the right ventricle [38]. The issue of right ventricular geometry is usually overcome using the so called geometry independent parameters such as tricuspid annular velocity and tricuspid annular plane systolic excursion (TAPSE) [39] (Fig. 3) and three dimensional echocardiography [40]. Nevertheless assessments based on tricuspid annular excursion have important inherent limitations as independent measurements of right ventricular pumping function [41]. However, is it really necessary to analyse right ventricular volumes in order to calculate a variable so dependent on post load such as ejection fraction, particularly in a clinical setting where afterload is so important, such as pulmonary hypertension? It appears that the Echo Doppler technology will be more logically applied to the study of functional aspects unable to be quantified by other imaging techniques.


New concepts in the invasive and non invasive evaluation of remodelling of the right ventricle and pulmonary vasculature in pulmonary arterial hypertension.

Domingo E, Aguilar R, López-Meseguer M, Teixidó G, Vazquez M, Roman A - Open Respir Med J (2009)

Tricuspid Annular Plane Systolic Excursion [TAPSE] in a patient with severe PAH during a vasodilatory test with epoprostenol: Left panel depicts the localization of the cursor line over the lateral portion of the tricuspid annulus on an apical view of the right heart chambers [RV: right ventricle; RA: right atrium]. On the right panel the M-mode represents displacement of the annular plane during the cardiac cycle. Main advantages of TAPSE, despite its dependency on volumetric assumptions, are that it is very easy to obtain and quite reproducible.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2682922&req=5

Figure 3: Tricuspid Annular Plane Systolic Excursion [TAPSE] in a patient with severe PAH during a vasodilatory test with epoprostenol: Left panel depicts the localization of the cursor line over the lateral portion of the tricuspid annulus on an apical view of the right heart chambers [RV: right ventricle; RA: right atrium]. On the right panel the M-mode represents displacement of the annular plane during the cardiac cycle. Main advantages of TAPSE, despite its dependency on volumetric assumptions, are that it is very easy to obtain and quite reproducible.
Mentions: The majority of the proposed methods of echocardiographic assessment of right ventricular function are based on volumetric approximations of the right ventricle. However such approaches have intrinsic limitations, first since volume related measures such as ejection fraction are load dependent, second because of the complex geometry of the right ventricle [38]. The issue of right ventricular geometry is usually overcome using the so called geometry independent parameters such as tricuspid annular velocity and tricuspid annular plane systolic excursion (TAPSE) [39] (Fig. 3) and three dimensional echocardiography [40]. Nevertheless assessments based on tricuspid annular excursion have important inherent limitations as independent measurements of right ventricular pumping function [41]. However, is it really necessary to analyse right ventricular volumes in order to calculate a variable so dependent on post load such as ejection fraction, particularly in a clinical setting where afterload is so important, such as pulmonary hypertension? It appears that the Echo Doppler technology will be more logically applied to the study of functional aspects unable to be quantified by other imaging techniques.

Bottom Line: Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers.In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle.This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Department, Hospital Universitari Vall Hebron, Barcelona, Spain.

ABSTRACT
Pulmonary arterial hypertension (PAH) is a rare fatal disease defined as a sustained elevation of pulmonary arterial pressure to more than 25 mmHg at rest, with a mean pulmonary-capillary wedge pressure and left ventricular enddiastolic pressure of less than 15 mmHg at rest. Histopathology of PAH is founded on structural modifications on the vascular wall of small pulmonary arteries characterized by thickening of all its layers. These changes, named as vascular remodelling, include vascular proliferation, fibrosis, and vessel obstruction. In clinical practice the diagnosis of PAH relies on measurements of pulmonary vascular pressure and cardiac output, and calculation of pulmonary vascular resistances. Direct evaluation of pulmonary vascular structure is not routinely performed in pulmonary hypertension since current imaging techniques are limited and since little is known about the relationship between structural changes and functional characteristics of the pulmonary vasculature. Intravascular ultrasound studies in patients with pulmonary hypertension have shown a thicker middle layer, increased wall-thickness ratio and diminished pulsatility than in control patients. Optical Coherence Tomography, a new high resolution imaging modality that has proven its superiority over intravascular ultrasound (IVUS) for the detection and characterization of coronary atherosclerotic plaque composition, may potentially be a useful technique for the in vivo study of the pulmonary arterial wall. In addition current progress in Echo Doppler technique will quantify right ventricular function with parameters independent of loading conditions and not requiring volumetric approximations of the complex geometry of the right ventricle. This would allow the in vivo study of right ventricular and pulmonary artery remodelling in PAH.

No MeSH data available.


Related in: MedlinePlus