Patients With Pulmonary Hypertension And Right Ventricular Function And Prognostic Evaluation

Part I:Echocardiographic Parameters in Patients with Pulmonary Arterial Hypertension:Correlations with Right Ventricular Ejection Fraction Derived From Cardiac Magnetic Resonance and HemodynamicsPurpose:To analyze the correlations between the echocardiographic parameters and RVEF as well as hemodynamics, in order to systematically elucidate the role of these parameters to assess the right ventricular function in patients with pulmonary arterial hypertension.Methods:Thirty patients were enrolled prospectively including24with idiopathic PAH,5with PAH associated with connective tissue diseases and1with hereditary PAH. Right heart catheterization, echocardiography and cardiac magnetic resonance (CMR) were performed within1week interval. The echocardiographic parameters measured included: tricuspid annular plane systolic excursion (TAPSE), tricuspid annular plane systolic velocity (S’), right ventricular fractional area changes,(RVFAC), isovolumic contraction acceleration (IVA), right ventricular myocardial performance index,(RVMPI) and ratio of right ventricular end-diastolic transverse diameter to left ventricular end-diastolic transverse diameter (RVETD/LVETD). The correlations between echocardiographic parameters and right ventricular ejection fraction (RVEF) derived from CMR as well as hemodynamics were analyzed.Results:All echocardiographic parameters except RVMPI correlated significantly with RVEF (TAPSE,r=0.440, P=0.015; S’,r=0.444, P=0.016; IVA,r=0.600, P=0.001; RVFAC, r=0.416, P=0.022; RVETD/LVETD, r=-0.649, P<0.001; RVMPI,r=-0.027, P=0.888). After adjusted for mean right atrial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance (PVR), only IVA and RVETD/LVETD could independently predict RVEF. Four echocardiographic parameters displayed significant correlations with PVR (TAPSE, r=-0,615, P<0.001; S’,r=-0.557, P=0.002; RVFAC, r=-0.454, P=0.012; RVETD/LVETD, r=0.543, P=0.002). Moreover, TAPSE (r=-0.403, P=0.027), IVA (r=-0.408, P=0.025) and RVETD/LVETD (r=0.395, P=0.031) had significant relationships with mRAP. TAPSE, RVFAC and RVMPI showed significant correlations with mPAP (r=-0.378,P=0.039; r=-0.369, P=0.045; r=0.367, P=0.046).Conclusions:The echocardiographic parameters IVA and RVETD/LVETD can reflect RVEF independently regardless of hemodynamics in patients with PAH. In addition, TAPSE, S’, RVFAC and RVETD/LVETD can also reflect PVR in PAH patients. Part II:Significance of PET in evaluating right ventricular function in patients with Pulmonary HypertensionPurpose:This study was designed to measure18F-fluorodeoxyglycose (FDG) uptake of ventricles in patients with pulmonary hypertension by positron emission tomography (PET) in fasting and glucose loading conditions, and to investigate the correlations between FDG uptake parameters and right ventricular function as well as hemodynamics.Methods:Thirty eight patients were included prospectively idiopathic pulmonary arterial hypertension21patients, congenital heart disease associated pulmonary arterial hypertension after repair surgery5patients, pulmonary hypertension associated with connective tissue diseases6patients, pulmonary hypertension with hereditary haemorrhagic telangiectasia1patient, hereditary pulmonary hypertension1patient and chronic thromboembolic pulmonary hypertension4patients. All patients erolled underwent FDG PET imaging in fasting and glucose loading conditions. The FDG standardized uptake value (SUV) corrected for partial volume effect in both right ventricle (RV) and left ventricle (LV) were measured, in addition, the ratio of RV to LV SUV (SUV-R/L) was calculated. Right heart catheterization and cardiac magnetic resonance (CMR) were performed in all patients within1week. The correlations between FDG uptake parameters and right ventricular function as well as hemodynamics were analyzed.Results:SUV of RV (SUV-R) and SUV of LV (SUV-L) were significantly higher in glucose loading than in fasting condition. SUV-R and SUV-R/L in fasting condition showed significant relations with RV ejection fraction (RVEF) derived from CMR (r=-0.341, P=0.036and r=-0.345, P=0.034), and in glucose loading condition (r=-0.362, P=0.028and r=-0.512, P=0.001). In fasting condition, SUV-R and SUV-R/L showed significantly positive correlations with pulmonary vascular resistance (PVR)(r=0.627, P<0.001and r=0.576, P<0.001) as well as in glucose loading condition (r=0.392, P=0.016and r=0.615, P<0.001). Only SUV-R/L in glucose loading condition could independently predict RVEF after adjusted for age, body mass index, gender, mean right atrial pressure, mean pulmonary arterial pressure and PVR (P=0.048).Conclusions:The glucose uptake of right ventricle increases with right ventricular function decrease in PH patients, which is more significant in glucose loading than in fasting condition. Part â…¢:Increased Levels of Plasma CXC-Chemokine Ligand10,12and16are associated with Right Ventricular Function in Patients with Idiopathic Pulmonary Arterial HypertensionPurpose:To investigate the significance of plasma CXC-Chemokine Ligand10(CXCL10), CXC-Chemokine Ligand12(CXCL12) and CXC-Chemokine Ligand16(CXCL16) for assessing right ventricular function in patients with idiopathic pulmonary arterial hypertension (IPAH).Methods:Sixty one patients with IPAH from Pulmonary Vascular Diseases Center of Fu Wai hospital between October2010and July2012were enrolled prospectively. Peripheral venous blood samples were collected from61patients with IPAH and20healthy volunteers. Plasma levels of all three biomarkers CXCL10, CXCL12and CXCL16were measured by enzyme-linked immunosorbent assay. Echocardiography and right heart catheterization were performed in all patients, while cardiac magnetic resonance was performed in29patients. Echocardiography, cardiac magnetic resonance, RHC and blood samples collection were conducted in three-day interval. The Spearman correlation test was performed to assess correlations between levels of biomarkers and right functional parameters.Results:Plasma CXCL10, CXCL12and CXCL16concentrations were increased significantly in IPAH patients compared with controls (202.79±104.58pg/ml vs103.56±65.00pg/ml, P<0.001;2656.55±459.52pg/ml vs.2323.02±400.87pg/ml, P=0.004å'Œ2.83±0.62ng/ml vs2.28±0.47ng/ml, P=0.001). CXCL10, CXCL12and CXCL16correlated significantly with NT-proBNP (r=0.452, P<0.001;r=0.364, P<0.001and r=0.300, P=0.026), TAPSE derived from echocardiography (r=-0.458, P=0.001; r=-0.479, P<0.001and r=-0.302, P=0.026) and RVEF derived from cardiac magnetic resonance (r=-0.590, P=0.001;r=-0.569, P=0.017and r=-0.507, P=0.003).Conclusions:Increased levels of CXCL10, CXCL12and CXCL16can reflect right ventricular dysfunction in patients with IPAH. Part â…£:Red Blood Cell Distribution Width Predicts Survival in Patients with Eisenmenger SyndromePurpose:This study aimed to investigate the significance of RDW for predicting survival in patients with Eisenmenger syndrome (ES).Methods:We retrospectively reviewed the clinical records and collected baseline data for patients newly diagnosed with ES in our hospital between January2005and October2009. Follow-up data were collected periodically using a specifically designed network database until December31,2012. The end point was all-cause death. A receiver operating characteristic (ROC) curve was generated to identify the optimal cutoff value of RDW for predicting survival. Survival curves were calculated using the Kaplan-Meier method and compared using log-rank tests. Univariate Cox regression analyses were performed to identify variables related to survival. All variables with a P value<0.05were tested in a forward stepwise multivariate Cox proportional hazards model, and hazard ratios with95%confidence intervals (CI) were expressed.Results:A total of109patients with ES were included in the study. Twenty-one patients (19.3%) died during a median follow-up period of4.2years (interquartile range3.7-5.0years). Baseline RDW was significantly correlated with mixed venous oxygen saturation (r=-0.286, P=0.003), arterial oxygen saturation (r=-0.423, P<0.001), mean pulmonary arterial pressure (r=0.271, P=0.004) and total pulmonary resistance (r=0.465, P<0.001). The1-,3-and5-year survival rates for all109patients were94%,87%and78%, respectively. Kaplan-Meier analysis showed that patients with RDW>13.9%had a lower survival rate than patients with RDW<13.9%(P=0.001). Multivariate Cox regression analysis showed that RDW was an independent prognostic marker in ES, with a hazard ratio of1.162(95%CI1.036-1.302; P=0.010).Conclusions:Baseline RDW correlates with hemodynamics and is an independent prognostic marker in ES.