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Heart 2010;96:281-288 doi:10.1136/hrt.2009.171728
  • Cardiac imaging and non-invasive testing

Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring

  1. S Giusca1,
  2. V Dambrauskaite1,
  3. C Scheurwegs1,
  4. J D'hooge1,
  5. P Claus1,
  6. L Herbots1,
  7. M Magro1,
  8. F Rademakers1,
  9. B Meyns2,
  10. M Delcroix3,
  11. J-U Voigt1
  1. 1Department of Cardiology, University Hospital Gasthuisberg, Catholic University Leuven, Belgium
  2. 2Department of Cardiac Surgery, University Hospital Gasthuisberg, Catholic University Leuven, Belgium
  3. 3Department of Pulmonology, University Hospital Gasthuisberg, Catholic University Leuven, Belgium
  1. Correspondence to Professor Dr Jens-Uwe Voigt, Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium; jens.uwe.voigt{at}gmx.net
  • Accepted 11 August 2009
  • Published Online First 30 August 2009

Abstract

Aims To quantify right ventricular (RV) function in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after pulmonary endarterectomy (PEA).

Methods Out of 33 patients, 16 were evaluated clinically and with echocardiography (conventional and myocardial deformation parameters) before PEA (preop) and at 1 week, 1 month, 3 months and 6 months after PEA. RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) as well as mid-apical and basal peak ejection strain (S) and strain rate (SR) of the RV free wall were measured. Left ventricular (LV) apical lateral wall motion was regarded as indicating changes in overall heart rocking motion (RM). Heart catheterisation was performed before, within 1 week and at 6 months after PEA.

Results Clinical and haemodynamic parameters improved significantly after PEA. This correlated with the improvement in RVFAC, S and SR. TAPSE, on the other hand, showed a biphasic response (14.5 (4) mm preop, 8.5 (2.7) mm at 1 week and 11 (1.5) mm at 6 months). Changes in LV apical motion explain this finding. At baseline, TAPSE was enhanced by rocking motion of the heart as a result of the failing RV. Unloading the RV by PEA normalised the rocking motion and TAPSE decreased.

Conclusions RV function of CTEPH patients improves steadily after PEA. Unlike S, SR and RVFAC, this is not reflected by TAPSE because of postoperative changes in overall heart motion. Motion independent deformation parameters (S, SR) appear superior in the accurate description of regional RV function

Footnotes

  • VD is now affiliated to the European Commission, Brussels, Belgium; CS is now affiliated to the St Maarten Hospital, Mechelen, Belgium; LH is now affiliated to the Virga Jesse Hospital, Hasselt, Belgium.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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