Tei指数评价海滨疗养对高原肺动脉高压患者右室功能的康复作用

目的：应用Tei指数评价鼓浪屿海滨综合疗养对高原肺动脉高压患者右室功能的康复作用。方法：选择平原地区正常成人20例为平原正常组,高原地区观察者73例[按肺动脉压的程度分为：正常组（20例）、轻度组（20例）、中度组（18例）、重度组（15例）],所有观察对象均参与15～30d的鼓浪屿海滨综合疗养,并于疗养前、后行心脏超声检查,测量传统右心室参数：右室前后径（RVD）、右房横径（RAD）、肺动脉主干内径（PA）、三尖瓣舒张期血流峰值比值（E／A）,右室射血分数（RVEF）;同时运用脉冲多普勒技术测量并计算出右室Tei指数（RV—Tei）,并作疗养前后比较。结果：（1）疗养前,与平原正常组比较,高原正常组,高原肺动脉压组右心功能均有显著异常,高原肺动脉压组的最差,3组间两两比较,P均〈0．01;（2）疗养后高原肺动脉高压各组的RV—Tei指数较疗养前有显著改善[轻度：（0．46±0．08）比（0．49±0．09）,中度：（0．59±0．11）比（0．61±0．11）,重度：（0．70±0．10）比（0．74±0.10）,P〈0．05～〈0.01],而传统右心参数仅有轻度组和中度组的E／A较疗养前有显著改善（P均〈0．05）。结论：鼓浪屿海滨综合疗养对高原肺动脉高压患者的右心室功能有积极地康复作用。右室Tei指数优于传统右心参数,是评价高原肺动脉高压患者右心室功能康复的敏感指标。     

B型脑钠肽在慢性阻塞性肺病中的诊断价值

目的 探讨慢性阻塞性肺病肺动脉高压、低氧血症与血浆B型脑钠肽（BNP）水平变化关系。方法 56例慢性阻塞性肺病患者分成肺动脉高压组和正常肺动脉压组,测定动脉血气分析和血浆BNP值,应用心脏超声测定肺动脉压力,收缩末期右室内径大小、右室与左室内径比值。结果 肺动脉高压组血浆BNP水平显著高于正常肺动脉压组（271．8±153．7ng／L vs 47．1±29．3ng／L;P〈0．01=;收缩末期右室内径、右室内径／左室内径明显大于正常肺动脉压组（P〈0．05=;肺动脉高压组肺动脉压力与血浆BNP值呈正相关（r=0．45）;而正常肺动脉压组血氧分压与血浆BNP值呈负相关（r=-0．32）。结论 血浆BNP是慢性阻塞性肺病肺动脉高压、右室扩张（右室功能不全）的敏感指标。     

组织多普勒室壁运动时间对肺动脉高压患者右室功能的评价

目的：利用脉冲组织多普勒技术（PW—TDI）测量右室室壁运动时间间期评价肺动脉高压（PH）患者右心功能的变化。方法：PH患者150例,根据PH的程度分为轻度组、中度组、重度组,每组50例,应用PW-TDI测量心尖四腔心切面三尖瓣前瓣瓣环心肌运动的时间间期指标包括：电一机械时间（EMD）、射血前期（PEP）、等容收缩时间（ICT）、心室射血时间（ET）、等容舒张时间（IRT）、充盈时间（FT）,计算Tei指数。将PH组与正常对照组的心肌运动时间间期参数进行比较,通过统计分析了解不同程度PH患者右心功能变化。结果：与正常对照组比较,轻度组IRT延长（P〈0．01）;中度组IRT延长、fvr缩短（均P〈0．01）;重度组IRT、ICT和PEP延长、ET和丌缩短（均P〈0．01）。Tei指数在PH组均增大（均P〈0．01）。中度组较轻度组、重度组较轻度组、重度组较中度组IRT延长、FT缩短（均P〈0．05）;重度组较轻度组ICT和PEP延长、ET缩短、Tei指数增大（均P〈0．05）。EMD在不同水平PH组和正常对照组间无显著性差异。结论：PH导致右室收缩和舒张功能降低,舒张功能降低早于收缩功能降低。     

评价致心律失常性右室心肌病右室功能超声指标与磁共振的相关性

目的用目前公认的5个超声指标评价致心律失常性右室心肌病（ARVC）患者的右室功能,研究其与磁共振（MRI）结果的相关性。方法对11例ARVC患者行超声及MRI检查,测量右室功能指标并行相关分析。本研究除了运用传统的心尖四腔心法测量右室面积改变分数（RVFAC 4C）外,增加了胸骨旁右室三腔心切面法测量右室面积改变分数（RVFAC RV 3C）。结果 5个指标中胸骨旁短轴RVFAC RV 3C、三尖瓣环收缩峰值速度、三尖瓣环收缩位移与MRI结果相关,r值分别为0.72、0.65、0.67。结论胸骨旁短轴RVFAC RV3C是评价ARVC患者右室功能的重要指标并且其与MRI测量的结果具有高度的相关性。     

经胸实时三维超声心动图评估特发性肺动脉高压患者三尖瓣几何构型的价值

目的：研究经胸实时三维超声心动图在评估特发性肺动脉高压（IPAH）患者的三尖瓣几何构型中的应用价值。方法：前瞻性入选2017年9月至2018年12月在中国医学科学院阜外医院就诊的IPAH患者30例（为IPAH组）,健康志愿者15例为对照组。所有研究对象均行经胸二维及三维超声心动图检查,并使用四维自动三尖瓣定量（4D Auto-TVQ）在聚焦右心室切面分析三尖瓣结构。肺动脉高压患者均在超声心动图检查后48 h内采用右心导管检查确诊。结果：IPAH组的三尖瓣形态学参数瓣环面积、瓣环周长、四腔心直径、瓣叶结合点高度、幕状区最大高度和幕状区容积均显著大于对照组（P均<0.05）。与对照组相比,IPAH组瓣环收缩期位移明显更小（P <0.05）。两组的瓣环面积变化率和两腔心直径差异均无统计学意义（P均> 0.05）。IPAH患者的三尖瓣幕状区最大高度和瓣叶接合点高度均与右心室舒张末期容积具有良好相关性（r=0.710、 0.515,P均<0.05）;瓣环周长、四腔心直径和瓣环面积均与右心房收缩末期容积具有良好相关性（r=0.712、 0.558、 0.545,P均<...     

Tei指数对系统性硬皮病患者右室功能的诊断价值评估

目的应用脉冲多普勒超声(PW)测定右室Tei指数评价系统性硬皮病(SSc)患者的右室功能,并观察肺动脉高压(PH)对右室Tei指数的影响。方法纳入2009年1月~2010年1月包头医学院第一附属医院SSc患者30例作为观察组,同期纳入正常体检者30例作为对照组,应用PW对所有入组人员进行右室Tei指数测定,即测量三尖瓣口血流频谱A波终末至下一个三尖瓣口血流频谱E波起始的时间(a)和肺动脉血流频谱的起止时间(b),Tei指数=(a-b)/b;应用三尖瓣返流法估测肺动脉收缩压(PASP),并应用Pearson相关分析评价右室Tei指数和PASP的相关性。结果①病例组右室Tei指数显著高于对照组[(0.36±0.13)vs.(0.23±0.08),P0.05];②右室Tei指数与肺动脉收缩压(PASP)呈正相关(r=0.702,P0.001)。结论 SSc患者右室Tei指数显著升高,可作为提示肺动脉高压的重要指标。     

实时三维超声心动图及速度向量成像技术评价肺动脉高压患者右心功能的研究

目的 探讨实时三维超声心动图联合速度向量成像技术评价肺动脉高压患者右心功能的价值。 方法 对86例肺动脉高压患者及30例正常对照组行常规二维及实时三维超声心动图检查。得出二维右室游离及室间隔收缩期的纵向、横向峰值应变（LS）及（TS）、纵向、横向峰值应变率（LSR）及（TSR）。由三维图像分析得出右室舒张末期容积指数(RVEDVI)、右室收缩末期容积指数(RVESVI)、右室每搏输出量(RVSV)、右室射血分数(RVEF)等参数。 结果 （1） 实时三维超声心动图值在对照组、肺动脉高压轻、中、重度组间比较差异均有统计学意义(P<0.05)。（2）各组的应变及应变率绝对值在对照组、肺动脉高压轻、中、重度组间部分阶段差异具有统计学意义(P<0.05)。（3）Pearson相关性分析得出:各组的应变及应变率绝对值地部分阶段与实时三维超声心动图值及肺动脉压力有良好的相关性。 结论 肺动脉高压患者右室心肌形变能力及收缩功能不同程度受损,随肺动脉压力升高呈减低趋势,速度向量成像技术及实时三维超声心动联合可以对肺动脉高压右室功能进行早期评估     

组织多普勒在评价MS患者二尖瓣置换术前后右心室功能中的应用

目的 观察组织多普勒在评价风湿性二尖瓣狭窄（MS）患者二尖瓣置换术前后右心室功能中的价值。方法选择45例MS患者（MS组）和30例健康查体者（对照组）,分别（MS组二尖瓣置换术前后）测量右室收缩横径（RVD）、三尖瓣反流速度,并估测肺动脉收缩压（PASP）,测量三尖瓣反流面积（TRA）与右房面积（RAA）,计算TRA／RAA值,定量组织速度成像（QTVI）测量右心室游离壁基底段收缩期峰值速度（Vs）。结果与对照组比较,MS组术前Vs降低、RVD增大（P〈0．01）,Vs与PASP、RVD、TRA／RAA均呈负相关（r=-0．29、-0．30、-0．43,P〈0．05、〈0．05、〈0．01）;MS组术后Vs较术前明显提高（P〈0．05）,RVD、TRA／RAA明显降低（P〈0．01）。结论组织多普勒在评价MS患者二尖瓣置换术前后右心室功能中具有重要价值,其优点为无创、简便、快速。     

三维超声心动图对中重度肺动脉高压患者射血分数与右室容积评估应用价值分析

目的分析实时三维超声心动图(RT-3DE)对中重度肺动脉高压(PAH)患者射血分数与右室容积评估应用价值。方法选取2016年9月至2018年1月于内蒙古自治区人民医院和内蒙古医科大学附属医院接受治疗PAH中度及重度患者各50例,同时选取同时间段在内蒙古自治区人民医院和内蒙古医科大学附属医院体检健康者50例作为对照组,RT-3DE检测右室射血分数(RVEF)、右室舒张末期容积(RVEDV)、右室每搏输出量(RVSV)及右室收缩末期容积(RVESV),常规超声心动图检测右室面积变化分数(RVFAC)、三尖瓣环收缩期峰值速度(S’)、三尖瓣环收缩期位移(TAPSE)、右室心肌做功指数(RIMP)、右室游离壁厚度(RV-FW)、右心房左右径(RA-D1)、右心室基底部左右径(RV-D)及右心房上下径(RA-D2),并分析肺动脉收缩压(PASP)和各参数间相关性状况。结果中度、重度组患者RC-FW、RA-D1、RA-D2及重度组RV-D均高于对照组,重度组RA-D1、RA-D及RA-D2高于中度组,差异均有统计学意义(P0.05);中度、重度组RVEF低于对照组,RVEDV、RVESV及重度组RVSV高于对照组,重度组RVEF低于中度组,RVEDV及RVESV高于中度组,差异均有统计学意义(P0.05);中度、重度组RVFAC、TAPSE及重度组S’低于对照组,RIMP高于对照组,重度组RVFAC、TAPSE低于中度组,差异均有统计学意义(P0.05)。结论 RT-3DE技术能够准确、客观对中度及重度PAH患者射血分数与右室容积做出评价,为临床患者诊疗提供参考。     

多普勒超声心动图估价肺动脉高压对左心室功能的影响

目的：探讨肺动脉高压对左心室结构和功能的影响。方法：将58例患者分为肺动脉高压组（n=29）和无肺动脉高压的对照组（n=29）。肺动脉高压组依据肺动脉收缩压进一步分为3个亚组：A组9例,肺动脉收缩压≥40mm Hg（1mm Hg=0．133kPa）但≤70mm Hg;B组11例,肺动脉收缩压〉70mm Hg但〈100mm Hg;C组9例,肺动脉收缩压≥100mm Hg。采用多普勒超声心动图测量相关参数。结果：①与对照组相比,肺动脉高压组左心室舒张末期内径明显缩小、室间隔厚度显著增厚、舒张早期流速峰值（E峰）与舒张晚期流速峰值（A峰）比值和左心室射血分数下降（均P〈0．05）。②在肺动脉高压亚组中,各组间仅E峰值存在显著性差异,且随肺动脉收缩压升高,E峰值下降（r=-0．892,P〈0．01）。结论：肺动脉高压不仅引起左心室结构改变,且导致舒张充盈障碍．并随肺动脉收缩压升高而加重。     

Relation of right ventricular free wall mechanical delay to right ventricular dysfunction as determined by tissue Doppler imaging

Several well-established echocardiographic parameters used in the assessment of right ventricular (RV) performance, as well as tissue Doppler imaging (TDI) to investigate RV free wall mechanical events, were prospectively obtained from a heterogenous group of 20 patients with varying degrees of pulmonary hypertension (mean age 51 +/- 13 years; World Health Organization class average 2.8, mean pulmonary systolic pressure 78 +/- 24 mm Hg) and compared with similar data retrospectively obtained from 20 healthy volunteers (mean age 45 +/- 15 years). Patients with varying degrees of pulmonary hypertension had worse RV performance parameters than healthy volunteers (RV fractional area change 37 +/- 13% vs 52 +/- 5%, p < 0.0001; RV myocardial performance index 0.76 +/- 0.31 vs 0.29 +/- 0.11, p < 0.0001; and eccentricity index 1.41 +/- 0.57 vs 0.98 +/- 0.06, p < 0.005). Similarly, in these patients with abnormal RV performance, TDI showed statistically significant smaller peak longitudinal RV free wall strain (-21.5 +/- 9.0% vs -28.0 +/- 4.1%, p < 0.01) and significantly delayed time to peak strain (459 +/- 76 vs 388 +/- 29 ms, p < 0.0005) values than in healthy volunteers; a very strong correlation between RV mechanical delay and RV fractional area change (r = -0.89) was noted.     

A delayed time of the peak tricuspid regurgitation signal: marker of right ventricular dysfunction

BACKGROUND:: Worsening degrees of tricuspid regurgitation (TR) have been associated with worse outcomes. We investigated the time it takes for the TR jet to attain its maximum peak (tmpTR) with measures of right ventricular (RV) function. METHODS:: Several echocardiographic variables of RV size and function and tmpTR corrected for heart rate were collected from 140 patients (mean age 57 +/- 20 years). RESULTS:: Mean RV end systolic (15 +/- 9 cm) and end diastolic (25 +/- 9 cm) areas, RV fractional area change (44 +/- 19%), maximal tricuspid annular motion (1.98 +/- 0.71 cm), pulmonary artery systolic pressure (57 +/- 33 mm Hg) and tmpTR (248 +/- 75 ms). A negative correlation was seen between tmpTR and RV fractional area change (r = -0.74; P < 0.0001) and between tmpTR and maximal tricuspid annular excursion (r = -0.69; P < 0.0001). On a multiple stepwise linear regression analysis tmpTR was better than pulmonary artery systolic pressure in predicting RV dysfunction (P < 0.001). Receiver operating characteristic curve analysis demonstrated that a tmpTR value >240 ms identified RV systolic dysfunction (sensitivity 79% and specificity 94%, areas under the curves 0.923, P = 0.0001). The longest tmpTR values were seen in patients with both RV systolic dysfunction and pulmonary hypertension (310 +/- 30 ms, P < 0.0001). CONCLUSION:: A delayed time to peak of the maximum TR jet correlates with RV dysfunction. Patients with normal RV function and no pulmonary hypertension had abnormal tmpTR values (243 +/- 57 ms) implying an underlying RV mechanical abnormality that requires further investigation.     

An abnormal right ventricular apical angle is indicative of global right ventricular impairment

The presence of right ventricular (RV) dysfunction is an adverse prognostic indicator but current echocardiographic methods have some limitations. RV apical angles in systole and diastole were correlated with known parameters of RV function in patients without pulmonary hypertension (Group 1) and in patients with pulmonary hypertension (Group 2). RV apical angles were significantly smaller in both systole (22 +/- 7 degrees) and diastole (33 +/- 6 degrees) in Group 1 patients when compared to Group 2 (54 +/- 18 degrees, p < 0.0001 and 59 +/- 17 degrees, p < 0.0001, respectively). RV apical angles, both in systole and diastole, were strongly correlated with RV end-systolic area (R = 0.89, p < 0.0001) and end-diastolic area (R = 0.81, p < 0.0001), respectively. Similarly, the apical systolic and diastolic angle correlated well with decreased tricuspid annular plane systolic excursion (TAPSE, R = -0.76 and R = -0.73, p < 0.001) as well as with decreased RV fractional area change (R = -0.81 and R = -0.77, p < 0.001). Therefore, we conclude that this new measurement of RV apical angle is simple and useful to quantify RV apical structural and functional abnormalities that are well correlated with global RV impairment in patients with chronic pulmonary hypertension.     

Standard measures of right ventricular function assessment in adult patients with acute sickle cell crises

Chronic sickle cell (SC) disease is known to cause pulmonary hypertension (PH) which eventually affects right as well as left ventricular function. However, the acute effects of SC crisis on right ventricular (RV) function in adults have not been well described. Our echocardiography database was queried for patients followed in the outpatient hematology clinic, who were admitted with SC crises, and had an inpatient echocardiogram. Comparisons of RV fractional area change (RVFAC) and tricuspid annular peak systolic excursion (TAPSE) were then made to a group of healthy patients and a group with mild PH. TAPSE was normal in patients with SC disease (3.05+/-0.56). However, the SC patients had significantly larger RV's compared to controls and mild PH patients (31.33+/-7.23 cm(2) vs. 19.07+/-4.49 cm(2) and 21.51+/-6.07 cm(2), respectively, P<0.0001). RVFAC was reduced in SC patients, and was comparable to patients with mild PH (46+/-9% vs. 49 +/-14%, P=0.4). We found no correlation between hemoglobin level (8.1+/-2.5 g) and RVFAC, TAPSE, or PH severity. We found that adult patients admitted with SC crises have frequent dilatation of the RV with an abnormal reduction in RVFAC, despite normal TAPSE values. Therefore, caution should be exercised in using TAPSE to estimate RV function in this patient population.     

Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures

Assessment of right ventricular (RV) systolic function can be somewhat difficult, particularly in pulmonary hypertension (PH). RV fractional area change (FAC) and tricuspid valve annular motion (TAPSE) although useful in the assessment of RV performance, their use can be sometimes limited and tedious. Thus, a quicker but yet reliable alternative is needed. Accordingly, we compared peak tricuspid annulus systolic (TA Sa) velocities derived from Doppler tissue imaging (DTI) with both RVFAC and TAPSE to estimate RV function in 52 patients (53 +/- 16 years) with varying degrees of PH. In this group, mean was RVFAC 49 +/- 20, TAPSE was 2.3 +/- 0.7 cm, peak TA Sa velocity by DTI was 10.4 +/- 3.8 cm/s, left ventricular systolic function was 57 +/- 18%, and pulmonary artery systolic pressure was 47 +/- 28 mmHg. An excellent correlation was noted between TAPSE and RVFAC (r = 0.91, P < 0.001). Similar correlations were noted between peak TA Sa velocity and RVFAC (r = 0.84, P < 0.001) and between peak TA Sa velocity and TAPSE (r = 0.90, P < 0.001). A TA Sa >10.5 cm/s identified individuals with both a normal RV function and without significant PH. Therefore, we conclude that TA Sa velocity, an easily obtainable DTI measure, that has an excellent correlation with more time-consuming methods to assess RV systolic function regardless of the degree of PH should be routinely assessed during the initial evaluation and eventual follow-up of patients either at risk or with documented PH.     

Assessment of right ventricular mechanics in patients with mitral stenosis by two-dimensional deformation imaging

Background: It is well known that right ventricular (RV) dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Therefore, we aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. Methods: Fifty-nine patients with isolated MS (mild and moderate) and 31 healthy control subjects constituted the study population. RV peak longitudinal strain (RV-LS) and strain rate (RV-LSr) measurements were obtained from apical four-chamber view. Results: There were no significant differences in left ventricular ejection fraction (LV-EF) and RV fractional area change between control and MS groups. RV strain (23.5 ± 7.2 vs. 18.63 ± 6.3, P = 0.001) and RV strain rate (1.72 ± 0.54 vs. 1.37 ± 0.66, P = 0.01) measurements were significantly lower in patients with MS than the control group. However, RV strain and strain rate measurements were comparable between MS subgroups. Correlation analysis revealed that there was poor correlation between RV-LS/LSr and mean-maximum gradients and echoscore but moderate correlation between RV-LS and RV-Sr in systolic pulmonary artery pressure and planimetric mitral valve area. Conclusion: We demonstrated that patients with MS had lower RV functions using 2D strain imaging and this is independent from severity of MS. In the detection of subclinical RV dysfunction in patients with MS, 2D strain imaging appears to be useful. (Echocardiography, 2012;00:1-6).     

Normal range of mechanical variables in pulmonary hypertension: a tissue Doppler imaging study

Background: Tissue Doppler imaging (TDI) has been quite useful in determining the mechanical properties of right ventricular (RV) function in patients with pulmonary hypertension (PH). However, to what extent these mechanical properties are expected to identify RV dysfunction in PH patients is less clear. Methods: Our echocardiography database was queried for patients with PH of different etiologies (111 patients, age 55 ± 14 years, mean pulmonary artery pressure 63 ± 24 mmHg) who had undergone TDI analysis and compared to similarly collected data from a group of healthy individuals (35 patients, mean age 45 ± 15 years, mean pulmonary artery pressure 27 ± 5 mmHg). Results: ROC analysis demonstrated that a mechanical delay between the RVFw and IS > 25 ms detects PH while a delay > 37 ms detects abnormal RV performance. Peak RV strain < ?20% identifies PH greater than 40 mmHg and a reduced RV systolic function. However, on a stepwise multiple regression analysis model RV dyssynchrony was the most significant predictor of PH (r = 0.515; P = 0.0003) over peak longitudinal RV strain (r = 0.553; P = 0.02) and RVFAC (r =?0.603; P = 0.01). Peak longitudinal strain was the most significant predictor (r =?0.722; P < 0.0001) of an abnormal RVFAC over PH (r =?0.603; P = 0.004) and RV dyssynchrony (r =?0.471; P = 0.01). Conclusion: A normal range of RV mechanical variables in PH patients are provided that can be applied in the assessment of RV performance.     

Abnormal right ventricular myocardial strain generation in mild pulmonary hypertension

BACKGROUND: Although right ventricular (RV) dyssynchrony has been identified in patients with severe pulmonary hypertension due to significant RV enlargement and compromise in systolic function, a more clinically relevant question pertains to RV mechanical properties in patients with mild elevation in pulmonary artery systolic pressures (PASP). METHODS: Several echocardiographic parameters and peak longitudinal strain were measured in 40 patients and divided into two groups of 20 patients based on their PASP. RESULTS: Group I included 20 individuals (mean age 48 +/- 16 years with a mean PASP of 27 +/- 5 mmHg) and Group II included 20 patients (mean age 63 +/- 14 years with a mean PASP of 49 +/- 7 mmHg.) All time intervals were adjusted for heart rate. RV fractional area change and tricuspid annular plane systolic excursion for Group I (62 +/- 12% and 2.74 +/- 0.56 cm) and Group II (49 +/- 14%; P < 0.02 and 2.09 +/- 0.40; P < 0.002) were both normal. However, Group II had lower peak longitudinal RV free wall (RVF) strain (-27.3 +/- 7.1 % vs. -31.9 +/- 8.7%, P < 0.04), longer time to peak RVF strain (448 +/- 57 ms vs. 411 +/- 43 ms; P < 0.03) and evidence of significant RV dyssynchrony (-83 +/- 55 ms vs. 1 +/- 17 ms, P < 0.00001) in contrast to Group I. CONCLUSION: In conclusion, mild elevations in PASP affect the mechanical properties of the RV and result in RV dyssynchrony despite absence of gross abnormalities in RV size or function.     

NT-proBNP can be used to detect right ventricular systolic dysfunction in pulmonary hypertension.

Right ventricular systolic dysfunction (RVSD) at baseline (pre-treatment) predicts early death in patients with pulmonary hypertension (PH). However, RVSD can only be detected reliably by prohibitively invasive or expensive techniques. N-terminal B-type natriuretic peptide concentration ([NT-proBNP]) correlates with RV function in PH; however, an [NT-proBNP] threshold that indicates RVSD in individual patients has not previously been determined. Twenty-five patients with PH (pulmonary arterial hypertension (n = 19) or chronic thromboembolic PH (n = 6)) underwent cardiovascular magnetic resonance (CMR) imaging and NT-proBNP measurement at baseline. [NT-proBNP] was correlated against RV dimensions and ejection fraction (RVEF) measured directly by CMR imaging. The ability of NT-proBNP to detect RVSD (defined as a CMR-derived RVEF >2 SDS below control values) was tested and predictors of [NT-proBNP] identified. [NT-proBNP] correlated negatively with RVEF. RVSD was present in nine out of 25 patients. An [NT-proBNP] threshold of 1,685 pg.mL(-1) was sensitive (100%) and specific (94%) in detecting RVSD. RVEF and RV mass index independently predicted [NT-proBNP]. In pulmonary hypertension, a baseline N-terminal B-type natriuretic peptide concentration of >1,685 ng.L(-1) suggests right ventricular systolic dysfunction, and thus an increased risk of early death. N-terminal B-type natriuretic peptide could prove useful as an objective, noninvasive means of identifying patients with pulmonary hypertension who have right ventricular systolic dysfunction at presentation.     

Pulmonary hypertension and right ventricular function in advanced heart failure

Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequently encountered in patients with advanced heart failure (HF). Both conditions aggravate prognosis and influence clinical decisions. Echocardiography is the screening tool of choice for pulmonary pressures and RV function, although invasive assessment of PH is necessary when advanced therapies are considered. Reversibility of PH in response to short-term pharmacologic treatment or even to long-term unloading after left ventricular assist device (LVAD) implantation is a favorable prognostic sign for both medically treated patients and heart transplant candidates. Although patients with severe PH secondary to HF have not derived benefit from pulmonary arterial hypertension therapies thus far, agents that modulate the cyclic guanosine monophosphate pathway, including phosphodiesterase 5A inhibitors, hold promise and are being actively investigated in advanced HF. Therapies that lead to reduction in left-sided pressures, including cardiac resynchronization and LVAD placement, also have a favorable effect on pulmonary pressures and RV function. However, no specific medical treatment for RV dysfunction exists to date, highlighting an important gap in the management of patients with advanced HF.