J Cardiovasc Imaging.  2020 Jan;28(1):1-9. 10.4250/jcvi.2019.0104.

Echocardiographic Screening Methods for Pulmonary Hypertension: A Practical Review

Affiliations
  • 1Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea. msshin@gilhospital.com
  • 2Gachon University, College of Medicine, Incheon, Korea.

Abstract

Pulmonary hypertension (PH) is a debilitating condition defined as mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg. The importance of impaired right ventricular (RV) hemodynamics is increasingly being recognized in treatment of patients with PH. In World Health Organization Group 1 patients with pulmonary arterial hypertension, upfront combination therapy has recently been proposed to improve long-term survival. Also, the mPAP in Group 2 and 3 PH patients has been shown to be strongly associated with clinical outcomes. Thus, screening and monitoring of RV hemodynamics are becoming increasingly important. The gold standard for measuring RV hemodynamics is right heart catheterization (RHC). Although RHC can obtain the most accurate results, it is invasive, cumbersome to patients, and often associated with complications, making it unsuitable for a screening or monitoring modality. Echocardiography is useful in estimating hemodynamic parameters that can be obtained from RHC. Accordingly, the role of echocardiography in evaluating such patients with PH is becoming more important. In this article, we review practical echocardiographic methods in approximating RV hemodynamics for PH.

Keyword

Pulmonary hypertension; Mean pulmonary artery pressure; Echocardiography

MeSH Terms

Arterial Pressure
Cardiac Catheterization
Cardiac Catheters
Echocardiography*
Hemodynamics
Humans
Hydrogen-Ion Concentration
Hypertension
Hypertension, Pulmonary*
Mass Screening*
Methods*
World Health Organization

Figure

  • Figure 1 Echocardiographic images of methods for estimating mPAP. Estimation of mPAP using peak TR velocity (A); RVOTAT (B); peak and end PR velocity (C); and TR velocity TVI (D). mPAP: mean pulmonary artery pressure, PR: pulmonary regurgitation, RVOTAT: right ventricular outflow tract acceleration time, TR: tricuspid regurgitation, TVI: time velocity integral.

  • Figure 2 Echocardiographic methods for evaluating RV function. Assessment of MPA diameter (A); left ventricular eccentricity index (B); TAPSE (C); and RV fractional area change by measuring RVAd and RVAs for assessment of RV function (D). D1: axis parallel to interventricular septum, D2: axis perpendicular to interventricular septum, MPA: main pulmonary artery, RV: right ventricle, RVAd: RV area at diastole, RVAs: RV area at systole, TAPSE: tricuspid annular plane excursion.

  • Figure 3 Additional echocardiographic methods for evaluating RV function. RV function can be estimated by evaluating the RV dimensions (A); and RV pulsed tissue Doppler S wave (S') velocity (B). RV: right ventricular, RVD1: basal diameter of RV measured at the basal one-third of the RV, RVD2: RV diameter measured at the left ventricular papillary muscle level.


Reference

1. Galie N, Humbert M, Vachiery JL, 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. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019; 53.
Article
3. Seo HS, Lee H. Assessment of Right Ventricular Function in Pulmonary Hypertension with Multimodality Imaging. J Cardiovasc Imaging. 2018; 26:189–200.
Article
4. Lee JH, Park JH. Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography. J Cardiovasc Imaging. 2018; 26:111–124.
Article
5. Jang AY, Chung WJ. Current status of pulmonary arterial hypertension in Korea. Korean J Intern Med. 2019; 34:696–707.
Article
6. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation. 1984; 70:657–662.
Article
7. Currie PJ, Seward JB, Chan KL, 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.
Article
8. Rudski LG, Lai WW, Afilalo J, 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. quiz 86-8.
9. Chemla D, Castelain V, Humbert M, et al. New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure. Chest. 2004; 126:1313–1317.
Article
10. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16:233–270.
Article
11. Roberts JD, Forfia PR. Diagnosis and assessment of pulmonary vascular disease by Doppler echocardiography. Pulm Circ. 2011; 1:160–181.
Article
12. Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ. Echocardiographic determination of mean pulmonary artery pressure. Am J Cardiol. 2003; 92:1373–1376.
Article
13. Masuyama T, Kodama K, Kitabatake A, Sato H, Nanto S, Inoue M. Continuous-wave Doppler echocardiographic detection of pulmonary regurgitation and its application to noninvasive estimation of pulmonary artery pressure. Circulation. 1986; 74:484–492.
Article
14. Dabestani A, Mahan G, Gardin JM, et al. Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol. 1987; 59:662–668.
Article
15. Aduen JF, Castello R, Lozano MM, et al. An alternative echocardiographic method to estimate mean pulmonary artery pressure: diagnostic and clinical implications. J Am Soc Echocardiogr. 2009; 22:814–819.
Article
16. Kuriyama K, Gamsu G, Stern RG, Cann CE, Herfkens RJ, Brundage BH. CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol. 1984; 19:16–22.
Article
17. Haimovici JB, Trotman-Dickenson B, Halpern EF, et al. Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program. Acad Radiol. 1997; 4:327–334.
18. Marcus JT, Gan CT, Zwanenburg JJ, et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol. 2008; 51:750–757.
19. Ghio S, Klersy C, Magrini G, et al. Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2010; 140:272–278.
Article
20. Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006; 174:1034–1041.
Article
21. Saxena N, Rajagopalan N, Edelman K, Lopez-Candales A. Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures. Echocardiography. 2006; 23:750–755.
Article
22. Gottdiener JS, Gay JA, Maron BJ, Fletcher RD. Increased right ventricular wall thickness in left ventricular pressure overload: echocardiographic determination of hypertrophic response of the “nonstressed” ventricle. J Am Coll Cardiol. 1985; 6:550–555.
Article
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