Serial assessment of right ventricular systolic function in patients with precapillary pulmonary hypertension using simple echocardiographic parameters: A comparison with cardiac magnetic resonance imaging

BACKGROUND: Although cardiac magnetic resonance imaging (CMRI) is the gold standard for the (serial) assessment of right ventricular (RV) function, the technique has several drawbacks: CMRI is relatively expensive, has a limited availability, and the analyses are time consuming. Echocardiography (echo) can overcome several of these issues. The aim of this study was to compare simple echo-derived parameters of RV systolic function with CMRI-derived RV ejection fraction (RVEF) in patients with precapillary pulmonary hypertension (PH) and to determine which echo parameters best followed the change in CMRI-derived-RVEF during follow-up.

METHODS: CMRI and echo were performed in 96 precapillary PH patients. In 38 patients a second set of a CMRI and echo were available. Retrospectively, echo-derived right ventricular fractional area change (RVFAC), tricuspid annulus plane systolic excursion (TAPSE), fractional transversal (FTWM), and longitudinal wall motion (FLWM) were assessed and compared with CMRI-derived-RVEF. Furthermore, the changes in RVFAC, TAPSE, FTWM, and FLWM during follow-up were compared with the change in CMRI-derived-RVEF.

RESULTS: All four echo parameters were significantly correlated to CMRI-derived-RVEF. The strongest relationship was seen between CMRI-derived-RVEF and RVFAC (r2=0.567). However, sensitivity for predicting a deterioration in CMRI-derived RVEF was poor for all four echo-derived parameters (ranging from 33% to 56%).

CONCLUSIONS: Although RVFAC, TAPSE, FTWM, and FLWM were significantly correlated to CMRI-derived-RVEF, all four echo parameters showed a low sensitivity for predicting a deterioration in CMRI-derived RVEF during follow-up. Therefore, RVFAC, TAPSE, FTWM, and FLWM are not suitable parameters for the serial assessment of RV systolic function in patients with precapillary PH.