title: Is Right Ventricular Remodeling in Pulmonary Hypertension Dependent on Etiology? An Echocardiographic Study.
abstract: OBJECTIVE
  Survival in patients (pts) with pulmonary hypertension (PH) differs between subgroups at similar levels of pressure overload. We set to analyze right ventricular (RV) morphology and function in different types of PH using conventional and deformation imaging echocardiography.
  
  
  METHODS
  Thirty-four pts with PH: 12 pts with idiopathic pulmonary arterial hypertension (IPAH, 42.2 ± 13 years), 11 pts with chronic thromboembolic PH (CTEPH, 50.8 ± 12 years), 11 pts with Eisenmenger syndrome [ES 41.2 ± 15 years, 4 with atrial septal defect (ASD) and 7 with ventricular septal defect (VSD)], and 13 age-matched healthy individuals (38.1 ± 15 years) were evaluated. The following echocardiographic parameters were measured: echo-derived systolic pulmonary pressure (sPAPecho), RV end-diastolic diameter (RVEDD), RV wall thickness (RVWT), TAPSE, RV fractional area change (RVFAC), Tei index, peak systolic velocity of the tricuspid ring (S't), and speckle tracking-derived RV free wall strain. Furthermore, right heart catheterization (RHC) was performed in pts with PH and mean, and systolic pulmonary artery pressure (mPAPcath, sPAPcath), cardiac output (CO), cardiac index (COi), and pulmonary vascular resistance (PVR) were noted.
  
  
  RESULTS
  The levels of mPAPcath and sPAPcath were similar between pts with PH (pANOVA = NS). Patients with ES had higher COi compared to other groups (2.94 ± 0.79, 2.28 ± 0.69, and 1.74 ± 0.46 L/min/m(2) for pts with ES, IPAH, and CTEPH respectively, pANOVA = 0.004, P post hoc ES versus all other groups < 0.05). TAPSE, Tei index, and S't were similar between groups and impaired versus controls (pANOVA < 0.001, P post hoc between groups of patients = NS). Patients with ES had better RVFAC (41.1 ± 9, 30.5 ± 10.8, 23.2 ± 9.8%) and RV free wall strain (-20.6 ± 3.5, -16.3 ± 7.5, -10.8 ± 5%), as well as an increased thickness of the RV free wall compared to other groups of patients (9.2 ± 1.5, 7.2 ± 1 and 7.2 ± 1.6 mm for pts with ES, IPAH and CTEPH, respectively) (pANOVA<0.001, P post hoc <0.05 ES versus all other groups). RVFAC and RV free wall strain significantly correlated with COi (r = 0.53, P = 0.006 and r = -0.77, P < 0.001, respectively).
  
  
  CONCLUSIONS
  Patients with ES have a more hypertrophied RV free wall, better RV performance as assessed by RVFAC and RV free wall strain and increased COi compared to other types of PH. Furthermore, RV performance appears to be less dependent on the level of pressure overload. These findings could contribute to the better survival profile of patients with ES.
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.|University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Sorin
authors.initials: S
authors.lastname: Giusca
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.|University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Elena
authors.initials: E
authors.lastname: Popa
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.
authors.forename: Mihaela Silvia
authors.initials: MS
authors.lastname: Amzulescu
authors.affiliation: University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Ioana
authors.initials: I
authors.lastname: Ghiorghiu
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.|University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Ioan Mircea
authors.initials: IM
authors.lastname: Coman
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.|University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.affiliation: Pneumology Department, Gasthuisberg Hospital, Catholic University Leuven, Leuven, Belgium.
authors.forename: Marion
authors.initials: M
authors.lastname: Delcroix
authors.affiliation: Cardiovascular Imaging Department, Gasthuisberg Hospital, Catholic University Leuven, Leuven, Belgium.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.|University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghina
authors.affiliation: Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu,", Bucharest, Romania.|University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Jurcut
mesh_terms: D000328:Adult; D005260:Female; D006343:Heart Septal Defects / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging*; D020257:Ventricular Remodeling
keywords: Eisenmenger syndrome; echocardiography; pulmonary arterial hypertension; right ventricle