Progressive changes in right ventricular geometric shortening and long-term survival in pulmonary arterial hypertension

Gert Jan Mauritz, Taco Kind, J. Tim Marcus, Harm Jan Bogaard, Marielle C. van de Veerdonk, Pieter E. Postmus, Anco Boonstra, Nico Westerhof, Anton Vonk-Noordegraaf

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118 Citations (Scopus)

Abstract

Background: Until now, many investigators have focused on describing right ventricular (RV) dysfunction in groups of patients with pulmonary arterial hypertension (PAH), but very few have addressed the deterioration of RV function over time. The aim of this study was to investigate time courses of RV geometric changes during the progression of RV failure. Methods: Forty-two patients with PAH were selected who underwent right-sided heart catheterization and cardiac MRI at baseline and after 1-year follow-up. Based on the survival after this 1-year run-in period, patients were classifi ed into two groups: survivors (26 patients; subsequent survival of >4 years) and nonsurvivors (16 patients; subsequent survival of >4 years). Four-chamber cine imaging was used to quantify RV longitudinal shortening (apex-base distance change), RV transverse shortening (septum-free wall distance change), and RV fractional area change (RVFAC) between end diastole and end systole. Results: Longitudinal shortening, transverse shortening, and RVFAC measured at the beginning of the run-in period and 1 year later were signifi cantly higher in subsequent survivors than in nonsurvivors (P < .05). Longitudinal shortening did not change during the run-in period in either patient group. Transverse shortening and RVFAC did not change during the run-in period in subsequent survivors but did decrease in subsequent nonsurvivors (P < .05). This decrease was caused by increased leftward septal bowing. Conclusions: Progressive RV failure in PAH is associated with a parallel decline in longitudinal and transverse shortening until a fl oor effect is reached for longitudinal shortening. A further reduction of RV function is due to progressive leftward septal displacement. Because transverse shortening incorporates both free wall and septum movements, this parameter can be used to monitor the decline in RV function in end-stage PAH.

Original languageEnglish
Pages (from-to)935-943
Number of pages9
JournalChest
Volume141
Issue number4
DOIs
Publication statusPublished - Apr 2012

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