Ewha Med J.  2019 Jul;42(3):39-45. 10.12771/emj.2019.42.3.39.

Assessment of Right Ventricular Function by Tissue Doppler Imaging in Pulmonary Arterial Hypertensive Rat

• Hong JE
• Kim KC
• Hong YM

• KMID: 2454664
• DOI: http://doi.org/10.12771/emj.2019.42.3.39

Abstract

OBJECTIVES
Elevated pulmonary pressure and right ventricular (RV) dysfunction are the hallmarks of pulmonary vascular disease in animal models and human patients with pulmonary arterial hypertension (PAH). Monocrotaline models of PAH are widely used to study the pathophysiology of PAH. The purpose of this study was to evaluate the severity of PAH rat model by tissue Doppler imaging (TDI).
METHODS
PAH was induced in Sprague-Dawley rats by monocrotaline (M) group. The peak systolic (s'), early diastolic (e'), and late diastolic myocardial velocities (a') were measured using TDI at basal segments. Tricuspid annular plane systolic excursion (TAPSE) was measured in the 4-chamber view. Velocity of a tricuspid regurgitation (TR) jet was measured to estimate the pulmonary artery pressure to assess the severity of PAH.
RESULTS
Decrease in the RV shortening fraction and ejection fraction were observed in the M group compared with the control (C) group. RV e' velocity and s' velocity were significantly lower in the M group compared with the C group. The TAPSE was significantly lower in the M group compared with the C group (1.26±0.22 mm vs. 2.83±0.34 mm). The TR velocity was significantly higher in the M group compared with the C group (4.48±0.34 m/sec vs. 1.23±0.02 m/sec).
CONCLUSION
TAPSE is an easily obtainable, widely recognized and clinically useful echocardiographic parameter of global RV function in the PAH rat model. We recommend that TDI would be a helpful diagnostic tool to evaluate the RV function in PAH rat model.

Keyword

Hypertension, pulmonary; Monocrotaline; Echocardiography; Right ventricular dysfunction

MeSH Terms

Animals
Echocardiography
Humans
Hypertension
Hypertension, Pulmonary
Models, Animal
Monocrotaline
Pulmonary Artery
Rats*
Rats, Sprague-Dawley
Tricuspid Valve Insufficiency
Vascular Diseases
Ventricular Dysfunction, Right
Ventricular Function, Right*
Monocrotaline

Figure

• 

  Fig. 1 Tissue Doppler imaging at basal portion of right ventricle (RV) in pulmonary arterial hypertension (PAH) rat model. The isovolumetric contraction time (IVCT) was determined as the time that has passed between the end of the a' wave to the onset of the next s' wave, and the isovolumetric relaxation time (IVRT) was determined as the time that has passed between the end of the s' wave to the onset of the next e wave. Ejection time (ET) was also measured. The Tei index was then calculated from the tissue Doppler imaging using the following formula: IVRT+IVCT/ET. s', systolic myocardial velocity; e', early diastolic myocardial velocity; a', late diastolic myocardial velocity; LVET, left ventricle ejection time.

• 

  Fig. 2 Tricuspid regurgitation (TR) by echocardiography in pulmonary arterial hypertension rat model. The TR was measured from the termination of TR to the onset of the subsequent TR tracing. TR velocity was significantly higher in the monocrotaline group group (4.48±0.34 m/sec ΔP 80.81±12.12 mmHg). Heart rate was 265/min.

Reference

1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016; 37:67–119.

2. Yang T, Liang Y, Zhang Y, Gu Q, Chen G, Ni XH, et al. Echocardiographic parameters in patients with pulmonary arterial hypertension: correlations with right ventricular ejection fraction derived from cardiac magnetic resonance and hemodynamics. PLoS One. 2013; 8:e71276.

3. Dutta T, Aronow WS. Echocardiographic evaluation of the right ventricle: clinical implications. Clin Cardiol. 2017; 40:542–548.

4. Sato T, Tsujino I, Ohira H, Oyama-Manabe N, Yamada A, Ito YM, et al. Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension. J Am Soc Echocardiogr. 2012; 25:280–286.

5. Cheng HW, Fisch S, Cheng S, Bauer M, Ngoy S, Qiu Y, et al. Assessment of right ventricular structure and function in mouse model of pulmonary artery constriction by transthoracic echocardiography. J Vis Exp. 2014; 84:e51041.

6. Aloia E, Cameli M, D'Ascenzi F, Sciaccaluga C, Mondillo S. TAPSE: an old but useful tool in different diseases. Int J Cardiol. 2016; 225:177–183.

7. De Castro S, Cavarretta E, Milan A, Caselli S, Di Angelantonio E, Vizza Carmine D, et al. Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension: a comparison with 3D echoderived right ventricular ejection fraction. Echocardiography. 2008; 25:289–293.

8. Vizzardi E, Bonadei I, Sciatti E, Pezzali N, Farina D, D'Aloia A, et al. Quantitative analysis of right ventricular (RV) function with echocardiography in chronic heart failure with no or mild RV dysfunction: comparison with cardiac magnetic resonance imaging. J Ultrasound Med. 2015; 34:247–255.

9. Thibault HB, Kurtz B, Raher MJ, Shaik RS, Waxman A, Derumeaux G, et al. Noninvasive assessment of murine pulmonary arterial pressure: validation and application to models of pulmonary hypertension. Circ Cardiovasc Imaging. 2010; 3:157–163.

10. Pristera N, Musarra R, Schilz R, Hoit BD. The role of echocardiography in the evaluation of pulmonary arterial hypertension. Echocardiography. 2016; 33:105–116.

11. Sade LE, Gulmez O, Ozyer U, Ozgul E, Agildere M, Muderrisoglu H. Tissue Doppler study of the right ventricle with a multisegmental approach: comparison with cardiac magnetic resonance imaging. J Am Soc Echocardiogr. 2009; 22:361–368.

12. Nogueira-Ferreira R, Vitorino R, Ferreira R, Henriques-Coelho T. Exploring the monocrotaline animal model for the study of pulmonary arterial hypertension: a network approach. Pulm Pharmacol Ther. 2015; 35:8–16.

13. Gomez-Arroyo JG, Farkas L, Alhussaini AA, Farkas D, Kraskauskas D, Voelkel NF, et al. The monocrotaline model of pulmonary hypertension in perspective. Am J Physiol Lung Cell Mol Physiol. 2012; 302:L363–L369.

14. Naeije R, Dewachter L. Animal models of pulmonary arterial hypertension. Rev Mal Respir. 2007; 24(4 Pt 1):481–496.

15. Currie PJ, Seward JB, Chan KL, Fyfe DA, Hagler DJ, Mair DD, et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol. 1985; 6:750–756.

16. Lee MY, Tsai KB, Hsu JH, Shin SJ, Wu JR, Yeh JL. Liraglutide prevents and reverses monocrotaline-induced pulmonary arterial hypertension by suppressing ET-1 and enhancing eNOS/sGC/PKG pathways. Sci Rep. 2016; 6:31788.

17. Dandel M, Hetzer R. Echocardiographic assessment of the right ventricle: impact of the distinctly load dependency of its size, geometry and performance. Int J Cardiol. 2016; 221:1132–1142.

18. Geva T, Powell AJ, Crawford EC, Chung T, Colan SD. Evaluation of regional differences in right ventricular systolic function by acoustic quantification echocardiography and cine magnetic resonance imaging. Circulation. 1998; 98:339–345.

19. Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westerhof N, Vonk-Noordegraaf A. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson. 2010; 12:35.

20. Ueti OM, Camargo EE, Ueti Ade A, de Lima-Filho EC, Nogueira EA. Assessment of right ventricular function with Doppler echocardiographic indices derived from tricuspid annular motion: comparison with radionuclide angiography. Heart. 2002; 88:244–248.

21. Wang Z, Yang Z, Wan Z, Yu T, Jia L, Du X, et al. Association between echocardiography derived right ventricular function parameters with cardiac magnetic resonance derived right ventricular ejection fraction and 6-minute walk distance in pulmonary hypertension patients. Zhonghua Xin Xue Guan Bing Za Zhi. 2014; 42:748–752.

22. Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984; 107:526–531.

23. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010; 23:685–713.

24. Smolarek D, Gruchala M, Sobiczewski W. Echocardiographic evaluation of right ventricular systolic function: the traditional and innovative approach. Cardiol J. 2017; 24:563–572.

25. Sato T, Tsujino I, Ohira H, Oyama-Manabe N, Ito YM, Takashina C, et al. Accuracy of echocardiographic indices for serial monitoring of right ventricular systolic function in patients with precapillary pulmonary hypertension. PLoS One. 2017; 12:e0187806.