title: Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects.
abstract: Although right ventricular (RV) failure is the main cause of death in patients with pulmonary arterial hypertension (PAH), there is insufficient data about the effects of PAH treatment on RV geometry and function mainly because the RV assessment has been hampered by its complex crescentic shape, large infundibulum, and its trabecular nature. Echocardiography is a widely available imaging technique particularly suitable for follow-up studies, because of its non-invasive nature, low cost, and lack of ionizing radiation or radioactive agent. Real-time three-dimensional echocardiography (RT3DE) has been shown to be accurate in assessing RV and left ventricular (LV) volumes, stroke volumes, and ejection fractions in comparison with cardiac magnetic resonance imaging. In this review, we describe RV structural and functional changes which occur in patients with PAH and strengths and weaknesses of current non-invasive imaging techniques to assess them. Finally, we describe an ongoing multicentre, prospective observational study involving seven centres expert in treating patients with PAH from four different countries. Investigators will use conventional and advanced echo parameters from RT3DE and speckle-tracking echocardiography to assess the extent of LV and RV remodelling before symptom onset and during pharmacological treatment in patients with PAH. Seventy patients who will survive for at least 1 year will be recruited. All the participating institutions will perform comprehensive standard 2D and Doppler as well as RT3DE examinations with a pre-defined imaging protocol. Measurements will be performed at the core echocardiography laboratory by experienced observers who will be unaware of each patient's treatment assignment and whether the examination was a baseline or a follow-up study. Enrolment duration is expected to be 1 year.
authors.affiliation: Department of Cardiopulmonary Sciences, University Hospital S Maria della Misericordia, P.le S Maria della Misericordia 15, 33100 Udine, Italy. lbadan@tin.it
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghina
authors.forename: Jacob
authors.initials: J
authors.lastname: Easaw
authors.forename: Denisa
authors.initials: D
authors.lastname: Muraru
authors.forename: Maria T
authors.initials: MT
authors.lastname: Grillo
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.forename: Gerry
authors.initials: G
authors.lastname: Coghlan
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
mesh_terms: D000704:Analysis of Variance; D019560:Echocardiography, Three-Dimensional; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D013318:Stroke Volume; D018608:Ultrasonography, Doppler; D020257:Ventricular Remodeling