Validation Study on the Accuracy of Echocardiographic Measurements of Right Ventricular Systolic Function in Pulmonary Hypertension

• Published in: Journal of the American Society of Echocardiography Vol. 25; no. 3; pp. 280 - 286
• Main Authors: Sato, Takahiro, MD, Tsujino, Ichizo, MD, PhD, Ohira, Hiroshi, MD, PhD, Oyama-Manabe, Noriko, MD, PhD, Yamada, Asuka, MD, Ito, Yoichi M., PhD, Goto, Chisa, MD, Watanabe, Taku, MD, Sakaue, Shinji, MD, PhD, Nishimura, Masaharu, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-03-2012
• Subjects: Cardiovascular; Echocardiography; Echocardiography - instrumentation; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - drug effects; Humans; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - pathology; Magnetic Resonance Imaging, Cine - instrumentation; Male; Middle Aged; Pulmonary hypertension; Regression Analysis; Reproducibility of Results; Right ventricular systolic function; Statistics as Topic; Stroke Volume - physiology; Systole; Tricuspid annular plane systolic excursion; Ventricular Function, Right - physiology; Intraclass correlation coefficient; TV lat; Echocardiography; RVEF; Right ventricular systolic function; RV; Left ventricular; MPI; ICC; LV; Myocardial performance index; TAPSE; RHC; Pulmonary hypertension; Right-heart catheterization; Tricuspid annular plane systolic excursion; RVFS; PH; Right ventricular; Right ventricular ejection fraction; Systolic lateral tricuspid annular motion velocity; CMRI; Cardiac magnetic resonance imaging; Percentage right ventricular fractional shortening; TVlat
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2011.12.012

Background The accuracy of echocardiographic parameters of right ventricular (RV) function has not been sufficiently validated in patients with pulmonary hypertension (PH). The aim of this study was to evaluate whether echocardiographic measurements reliably reflect RV systolic function in PH using cardiac magnetic resonance imaging (CMRI)–derived RV ejection fraction (RVEF) as a gold standard. Methods A total of 37 consecutive patients with PH, 20 with pulmonary arterial hypertension, 12 with chronic thromboembolic PH, and five others, were prospectively studied. All patients underwent echocardiography, CMRI, and right-heart catheterization within a 1-week interval. Associations between five echocardiography-derived parameters of RV systolic function and CMRI-derived RVEF were evaluated. Results All five echocardiography-derived parameters were significantly correlated with CMRI-derived RVEF (percentage RV fractional shortening: r  = 0.48, P  = .0011; percentage RV area change: r  = 0.40, P  = .0083; tricuspid annular plane systolic excursion [TAPSE]: r  = 0.86, P < .0001; RV myocardial performance index: r  = −0.59, P < .0001; and systolic lateral tricuspid annular motion velocity: r  = 0.63, P < .0001). Compared with the other indices, TAPSE exhibited the highest correlation coefficient. Of the five echocardiographic measurements, only TAPSE significantly predicted CMRI-derived RVEF in multiple regression analysis ( P  < .0001). Intraobserver and interobserver reproducibility was favorable for all five indices and was particularly high for TAPSE and systolic lateral tricuspid annular motion velocity. Conclusions Echocardiographic measurements are promising noninvasive indices of RV systolic function in patients with PH. In particular, TAPSE is superior to other indices in accuracy.