Novel Echocardiographic Algorithm for Right Ventricular Mass Quantification: Cardiovascular Magnetic Resonance and Clinical Prognosis Validation - 03/08/21
Abstract |
Background |
Right ventricular hypertrophy (RVH) provides a key remodeling index alterable by pulmonary hypertension. Although echocardiography commonly integrates linear wall thickness and chamber dimensions to quantify left ventricular remodeling, the utility of an equivalent right ventricular (RV)-based approach is unknown.
Methods |
This was a retrospective analysis of 200 patients undergoing transthoracic echocardiography and cardiac magnetic resonance (CMR) within 30 days (median = 3 days; interquartile range, 15 days), stratified by echocardiography-quantified pulmonary artery systolic pressure (<35, 35 to <55, 55 to <75, or ≥75 mm Hg). Echocardiographic assessment included RV linear dimensions in parasternal long-axis and apical four-chamber views and wall thicknesses in parasternal long-axis, four-chamber, and subcostal views. Subcostal wall thickness was integrated with chamber diameters to calculate RV mass, which was tested in relation to CMR-quantified RV mass and all-cause mortality.
Results |
Echocardiography-based quantification of all linear dimensions was feasible in 95% of patients (190 of 200). RV wall thicknesses in all orientations increased in relation to pulmonary artery systolic pressure (P < .001) and was greater among patients with, versus those without, CMR-evidenced RVH (P < .001 for all). Correlations between echocardiography and CMR were greatest for RV basal diameter (r = 0.73), RV subcostal wall thickness (r = 0.71), and global RV mass (r = 0.82; P < .001 for all). Echocardiography-derived global RV mass cutoffs were established in a derivation cohort and tested in a validation cohort. Results demonstrated good sensitivity and specificity (75.5% and 74.0%, respectively) in relation to CMR-quantified RVH. During follow-up (median, 4.2 years), 18% of patients (n = 36) died. Echocardiography-evidenced RVH (hazard ratio, 1.98; 95% CI, 1.09–3.88; P = .048) conferred similar mortality risk compared with RVH on CMR (hazard ratio, 2.41; 95% CI, 1.22–4.78; P = .01).
Conclusions |
Echocardiography-quantified RV parameters provide a robust index of RV afterload. Global RV mass calculated using a novel echocardiographic formula based on readily available linear indices yields good diagnostic performance for CMR-evidenced RVH and confers increased mortality risk.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The authors tested echo-derived parameters for RV mass quantification. |
• | Echo-quantified RV mass has good diagnostic performance in relation to RVH on CMR. |
• | Echo-derived RVH confers similar mortality risk compared with RVH on CMR. |
• | Echo RV parameters are important diagnostic and prognostic indices of RV afterload. |
Keywords : Right ventricular hypertrophy, Echocardiography, Cardiac magnetic resonance
Abbreviations : ASE, CMR, EDV, ESV, HR, LV, PA, PASP, PH, RV, RVH, WHO
Plan
This work was supported by the National Institutes of Health, United States (grants 1K23 HL140092, 1R01HL128278, and 5T32 HL7854-23) and the Glorney-Raisbeck Fellowship Program via the Corlette Glorney Foundation and the New York Academy of Medicine, United States. |
|
Conflicts of interest: None. |
Vol 34 - N° 8
P. 839 - août 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?