Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

<p>Aortic stenosis is the most common valvular disease in the adult population. A significant aortic stenosis is a serious condition, and if a symptomatic patient is not operated on, it may in most cases cause death. We have examined how many aortic stenoses that were diagnosed during one year, and a follow-up of the patients was also performed. We found 77 patients with significant aortic stenosis with a mean age of 76±13 years. At the time of follow-up 30 (39%) patients, aged between 29-85 years, had been surgically treated with implantation of a valve prosthesis within 2-23 months after the initial examination. At this initial examination 14 of the 30 patients who later underwent surgery had no symptoms. A coronary bypass operation was also performed on seven patients. Postoperative complications were observed in six patients, but none of them was fatal. At the initial examinations there were 26 (34%) patients with a significant aortic stenosis and symptoms who were not treated surgically. The main reason why these patients were not operated was high age, unwillingness, or severe left ventricular dysfunction. This study indicates the importance of repeated clinical and echocardiograpic examinations in patients with aortic stenosis. Almost half of the patients, that later underwent surgery, had no symptoms at the initial examination, but later developed symptoms which made surgery necessary. In one third of the patients no surgery was performed in spite of clinical symptoms.</p>

Introdução: A fração de ejeção do ventrículo direito (FEVD) é um importante fator prognóstico em pacientes com hipertensão pulmonar (HP), porém a sua medida é complicada e demorada devido à complexidade anatômica do ventrículo direito (VD). O TAPSE (Tricuspid Annular Plane Systolic Excursion) é um bom índice da FEVD, mas ele avalia apenas o componente longitudinal da contração ventricular direita. A RVFAC (Right Ventricular Fractional Area Change) parece ser um melhor índice da FEVD por incluir os componentes longitudinal e transversal da contração ventricular direita. O objetivo deste estudo foi avaliar a performance da RVFAC de acordo com a gravidade do acometimento hemodinâmico em dois grupos distintos de pacientes portadores de HP pré-capilar: hipertensão arterial pulmonar (HAP) e tromboembolismo pulmonar crônico hipertensivo (TEPCH). Métodos: 62 pacientes realizaram cateterismo cardíaco direito e ressonância magnética cardíaca em ±72h. As áreas sistóica e diastólica finais do ventrículo direito (ASFVD, ADFVD), a área diastólica final do ventrículo esquerdo (ADFVE) e o TAPSE foram medidos nas imagens de quatro cavidades. A RVFAC (ADFVD-ASFVD/ADFVD) e a relação entre as áreas diastólica finais ventriculares (ADFVD/ADFVE) foram calculadas. Os diâmetros entre as paredes livre e septal (dL-S) e antero-posterior (dA-P) do ventículo esquerdo (VE) foram medidos nas imagens em eixo curto e o índice de excentricidade do VE (IE) foi calculado (=dA-P/dL-S). A FEVD foi calculada a partir de imagens consecutivas de 6mm no eixo curto. . Resultados: A população tinha 58 anos em média, a maioria era do sexo feminino e estava em classe funcional III, 23 tinham HAP e 39 TEPCH. A FEVD apresentou correlações fracas com as medidas hemodinâmicas de sobrecarga e de função do VD. A RVFAC apresentou melhor correlação (R2=0,65, p < 0,001) do que o TAPSE (R2=0,35, p<0,001) com a FEVD e melhor capacidade para estimar FEVD<35% do que o TAPSE (TAPSE: AUC 0,73 e RVFAC: AUC 0,93, p=0,0065). Dividimos a população pela mediana da resistência vascular pulmonar (RVP) e observamos que no grupo com maior gravidade hemodinâmica essa diferença se acentuou: no grupo com RVP<8,5UW (RVFAC: R2=0,66, p<0,001 e TAPSE: R2=0,30, e p=0,002) e no grupo com RVP>8,5UW (RVFAC: R2=0,51, p<0,001 e TAPSE: R2=0,14, e p=0,041). O grupo com RVP>8,5UW apresentou maior ADFVD/ADFVE e maior IE. As correlações da RVFAC e TAPSE com FEVD foram semelhantes entre os grupos HAP e TEPCH. Conclusão: A RVFAC se correlacionou melhor com a FEVD do que o TAPSE tanto no grupo com menor como no grupo com maior gravidade hemodinâmica. No grupo com maior gravidade as correlações da RVFAC com a FEVD foram ainda mais significativas, não havendo diferenças na performance da RVFAC entre os pacientes com HAP e TEPCH. A RVFAC foi um melhor índice da FEVD talvez por incluir o movimento transversal da contração ventricular / Introduction: The right ventricular ejection fraction (RVEF) is a surrogate marker in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The TAPSE (Tricuspid Annular Plane Systolic Excursion) is a good index of RVEF, though it measures only the longitudinal component of right ventricular contraction. The RVFAC (Right Ventricular Fractional Area Change) seems to be a better index of RVEF because it takes into account the longitudinal and the transversal components of right ventricular contraction. The aim of our study was to evaluate the RVFAC performance according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methos: Sixty-two patients with PAH and CTEPH underwent right heart catheterization and cardiac MR in a 72-hour delay. The right and left ventricle end diastolic areas (RVEDA, LVEDA), the right ventricle end systolic area (RVESA) and TAPSE were measured in the four chamber view. The RVFAC (=RVEDARVESA/RVEDA) and the RVEDA/LVEDA relationship were calculated. The diameter between the left ventricle (LV) free wall and the septum (dF-S) and the diameter between the LV anterior and posterior walls (dA-P) were measured and the LV eccentricity index (EI) was calculated (=dA-P/dF-S). The RVEF was calculated by using 6 mm RV short axis cines. Results: The population had mean age of 58 years with female majority, most of the patients were in functional class III, 23 had PAH and 39 CTEPH. The RVEF was weakly correlated to the hemodynamic variables of RV afterload and function. The RVFAC was more strongly correlated to RVEF (R2=0.65, p<0.001) than TAPSE (R2=0.35, p<0.001). RVEF<35% was better predicted by RVFAC than TAPSE (TAPSE: AUC 0.73 and RVFAC: AUC 0.93, p=0.0065). We divided the population by the median of the pulmonary vascular resistance (PVR) and we observed that in the group with worse hemodynamic severity this difference increased: in the group with PVR<8,5WU (RVFAC: R2=0.66, p<0.001 and TAPSE: R2=0.30, p=0.002) and in the group with PVR>8,5 WU (RVFAC: R2=0.51, p<0.001 and TAPSE: R2=0.14, p=0.041). The group with PVR>8,5WU had an increased RVEDA/LVEDA and an increased EI. There was no differences in the RVEF relationships between the groups of PAH and CETPH. Conclusion: The RVFAC was better correlated to RVEF than TAPSE in the groups with less severe and more severe hemodynamics. In patients with increased hemodynamic severity RVFAC perfomed even better, there was no difference in the performance of RVFAC in PAH or CTEPH. RVFAC was a better index of RVEF possibly because it takes into account the transversal component of right ventricular function

La fraction d'éjection du ventricule droit (FEVD) est un marqueur de survie en cas d'hypertension pulmonaire (PH), mais sa mesure est compliquée et fastidieuse. Le TAPSE (Tricuspid Annular Plane Systolic Excursion) est un bon indice de la FEVD mais il ne mesure que la composante longitudinale de la contraction ventriculaire droite. La fraction de variation surfacique du ventricule droit RVFAC (Right Ventricular Fractional Area Change) semble être un meilleur indice de FEVD car il prend en compte le sens longitudinal et transversal des éléments de la contraction du ventricule droit. Le but de notre étude était d'évaluer la performance RVFAC fonction de la sévérité hémodynamique chez les deux groupes de patients atteints de PH:l'hypertension artérielle pulmonaire (HAP) et l'hypertension pulmonaire thromboembolique chronique (CTEPH).Methodes: Soixante-deux patients atteints d'HTAP et CTEPH ont bénéficié d’un cathétérisme cardiaque droit et d’une IRM cardiaque dans un délai de 72 heures. Les surfaces ventriculaires droite et gauche a la fin de la diastole (RVEDA, LVEDA), la surface du ventricule droit a la fin da la systole (RVESA) et TAPSE ont été mesurés dans la vue quatre cavités. Le RVFAC (RVFAC=RVEDA-RVESA/RVEDA) et le rapport RVEDA/LVEDA ont été calculés. Le diamètre entre la paroi libre et le septum (DF-S) et le diamètre entre les parois antérieure et postérieures du ventricule gauche (DA-P) ont été mesurés et l'indice d’excentricité LV (IE) a été calculé (= DA-P / DF-S). Le RVEF a été calculée à l'aide de coupes jointives de 6 mm en petit axe du ventricule droit.Résultats: La population avait un âge moyen de 58 ans avec une majorité des femmes, la plupart des patients étaient en classe fonctionnelle III, 23 avaient des HAP) et 39 des CTEPH. La RVEF était faiblement corrélée aux variables hémodynamiques de la post-charge et de la fonction VD. Le RVFAC était plus fortement corrélée à FEVD (R2 = 0,65, p <0,001) que TAPSE (R2 = 0,35, p <0,001). Une FEVD <35% était mieux prédite par un RVFAC bas que par une diminution de TAPSE (TAPSE: AUC 0,73 et RVFAC: AUC 0,93, p = 0,0065). Nous avons divisé la population par la médiane de la résistance artérielle pulmonaire (RAP) et nous avons observé que dans le groupe avec la pire sévérité hémodynamique, cette différence a augmenté: dans le groupe avec PVR < 8,5 UW (RVFAC: R2 = 0,66, p <0,001 et TAPSE: R2 = 0,30, p =0,002) et dans le groupe avec PVR > 8,5 UW (RVFAC: R2 = 0,51, p <0,001 et TAPSE: R2 = 0,14, p = 0,041). Le groupe avec PVR> 8,5 WU avait un rapport RVEDA/LVEDA augmenté et une augmentation de l`indice excentricité. Les relations RVEF-RVFAC n’étaient pas différentes entre les groupes de HAP et CETPH.Conclusion: La fraction de variation surfacique du ventricule droit RVFAC fournit un reflet simple et fiable de la FEVD peut-être parce que contrairement à TAPSE qui ne prend en compte que le raccourcissement longitudinal, RFVAC prend également en compte la composante transversale de la fonction ventriculaire droite. / The right ventricular ejection fraction (RVEF) is a surrogate marker in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The TAPSE (Tricuspid Annular Plane Systolic Excursion) is a good index of RVEF, though it measures only the longitudinal component of right ventricular contraction. The RVFAC (Right Ventricular Fractional Area Change) seems to be a better index of RVEF because it takes into account the longitudinal and the transversal components of right ventricular contraction. The aim of our study was to evaluate the RVFAC performance according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolicpulmonary hypertension (CTEPH).Methos: Sixty-two patients with PAH and CTEPH underwent right heart catheterization and cardiac MR in a 72-hour delay. The right and left ventricle end diastolic areas (RVEDA, LVEDA), the right ventricle end systolic area (RVESA) and TAPSE were measured in the four chamber view. The RVFAC (RVFAC=RVEDA–RVESA/RVEDA) and the RVEDA/LVEDA relationship werecalculated. The diameter between the left ventricle (LV) free wall and the septum (dL-S) and the diameter between the anterior and posterior walls (dAP) were measured and the LV eccentricity index (EI) was calculated (EI=dAP/dL-S). The RVEF was calculated by using 6 mm RV short axis cines.Results: The population had mean age of 58 years with female majority, most of the patients were in functional class III, 23 had pulmonary arterial hypertension (PAH) and 39 had chronic thromboembolic pulmonary hypertension (CTEPH). The RVEF was weakly correlated to the hemodynamic variables of RV afterload and function. The RVFAC was morestrongly correlated to RVEF (R2=0.65, p<0.001) than TAPSE (R2=0.35, p<0.001). RVEF<35% was better predicted by RVFAC than TAPSE (TAPSE: AUC 0.73 and RVFAC: AUC 0.93, p=0.0065). We divided the population by the median of the pulmonary vascular resistance (PVR) and we observed that in the group with worse hemodynamic severity this difference increased: inthe group with PVR<8,5WU (RVFAC: R2=0.66, p<0.001 and TAPSE: R2=0.30, p=0.002) and in the group with PVR>8,5 WU (RVFAC: R2=0.51, p<0.001 and TAPSE: R2=0.14, p=0.041). The group with PVR>8,5WU had an increased RVEDA/LVEDA and an increased EI. There was no differences in the RVEF relationships between the groups of PAH and CETPH.Conclusion: The RVFAC was better correlated to RVEF than TAPSE in the groups with less severe and more severe hemodynamics. In patients with increased hemodynamic severity, with no difference in the performance in theHAP or CTEPH groups. RVFAC was a better index of RVEF possibly because it takes into account the transversal component of right ventricular function.

A doença de Chagas ainda permanece como um importante problema de saúde em regiões endêmicas na América Latina, onde se estima 8 a 10 milhões de infectados. A isquemia microvascular é frequente na cardiomiopatia chagásica crônica (CCC) e pode estar envolvida nos processos fisiopatogênicos que levam à disfunção sistólica ventricular esquerda (DSVE). Lança-se a hipótese que a redução da isquemia microvascular possa atenuar a progressão da DSVE na CCC. Desta forma, nosso objetivo foi avaliar os efeitos do uso prolongado do dipiridamol (DIPI), um agente vasodilatador da microcirculação coronária, sobre a perfusão miocárdica e sobre a função sistólica do ventrículo esquerdo mediante emprego de métodos de imagem in vivo. Foram utilizados 60 hamsters fêmeas adultas divididas em: animais infectados com T. cruzi e tratados com DIPI (Chagas + DIPI, n=15); infectados tratados com placebo (Chagas + Placebo, n=15); animais não infectados, tratados com DIPI (Controle + DIPI, n=15) e tratados com placebo (Controle + placebo, n=15). Após 6 meses de infecção (condição basal), os animais foram submetidos a ecocardiograma e a cintilografia de perfusão miocárdica por SPECT com Sestamibi-Tc99m. Em seguida, foram tratados com injeções intraperitoneais de DIPI (4mg/Kg) duas vezes ao dia ou igual volume de salina, durante 30 dias. Após o tratamento, os animais foram reavaliados com os mesmos métodos de imagem e a seguir sofreram eutanásia e o tecido cardíaco foi preparado para análise histológica quantitativa para extensão de fibrose (coloração de picrosírius vermelho) e do infiltrado inflamatório (coloração de hematoxilinaeosina). Na condição basal os animais do grupo Chagas + placebo e Chagas + DIPI apresentaram maior área de defeito de perfusão (19,2 ± 5,4% e 20,9 ± 4,2%, respectivamente, quando comparados aos grupos controle + placebo e controle + DIPI (3,8 ± 0,7% e 3,6 ± 0,9%, respectivamente), p=0<0,05, mas valores semelhantes de fração de ejeção do ventrículo esquerdo (FEVE), p=0,3, e de diâmetro diastólico do ventrículo esquerdo (DdVE,), p=0,2. Após o tratamento, observou-se redução significativa dos defeitos de perfusão somente no grupo Chagas + DIPI (p=0,02). Quando comparados os valores basais e após tratamento, os animais dos grupos Chagas + DIPI e Chagas + placebo apresentaram redução da FEVE (65,3 ± 2,5% para 53,6 ± 1,9% e 69,3 ± 1,4% para 54,4 ± 2,5%, respectivamente (p<0,001), e aumento do DdVE de 0,68 ± 0,5 cm para 0,76 ±0,17 cm e 0,64 ± 0,01 cm para 0,71 ± 0,23 cm, respectivamente (p<0,002). Na análise histológica quantitativa, observou-se maior número de núcleos de células inflamatórias mononucleares nos grupos Chagas + DIPI (998,1 ± 116,0 cel/mm²) e Chagas + Placebo (1191,4 ± 133,2 cel/mm²) quando comparados aos grupos Controle + DIPI (396,5 ± 28,3 cel/mm²) e Controle + Placebo (257,1 ± 21,6 cel/mm²), p=0,05. A porcentagem de fibrose foi maior nos grupos Chagas + DIPI (4,7 ± 0,4%) e Chagas + Placebo (5,4 ± 0,2%) quando comparados com o grupo controle + Placebo (3,2 ± 0,3%). Não houve diferença entre os grupos Chagas + DIPI e Chagas + Placebo em ambas as variáveis da histologia. Conclusões: O uso prolongado de DIPI em animais com CCC associou-se à significativa redução dos defeitos de perfusão miocárdica avaliados in vivo. Contudo, a resolução da isquemia microvascular mediante emprego de DIPI não impediu a progressão da disfunção ventricular esquerda. Esses resultados sugerem que a isquemia microvascular não seja um mecanismo lesivo miocárdico central no complexo fisiopatogênico neste modelo de CCC. É plausível supor que a isquemia microvascular seja um marcador da presença de processo lesivo subjacente, provavelmente de natureza inflamatória. / Chagas disease continues to be an important public health problem in endemic regions of Latin America, where 8 to 10 million infected people are estimated to live. Microvascular ischemia is frequent in chronic chagasic cardiomyopathy (CCC) and may be involved in the physiopathogenic processes that lead to left ventricular systolic dysfunction (LVSD). The hypothesis is raised that reduction of microvascular ischemia may attenuate the progression of LVSD in CCC. Thus, our objective was to assess the effects of prolonged use of dipyridamole (DIPY), a coronary microvascular dilator agent, on myocardial perfusion and on left ventricular systolic function using imaging methods in vivo. A total of 60 adult female hamsters were divided into the following groups: T. cruzi-infected animals treated with DIPY (Chagas + DIPY, n=15); infected animals treated with placebo (Chagas + Placebo, n=15); uninfected animals treated with DIPY (Control + DIPY, n=15) and treated with placebo (Control + placebo, n=15). After 6 months of infection (baseline condition), the animals were submitted to an echocardiogram and to rest myocardial perfusion scintigraphy by SPECT with SestamibiTc99m. Next, the animals were treated with intraperitoneal injections of DIPY (4 mg/kg) twice a day or with an equal volume of saline for 30 days. After treatment, the animals were reevaluated by the same imaging methods and euthanized. Cardiac tissue was prepared for quantitative histological analysis of the extent of fibrosis (picrosirius red staining) and of the inflammatory infiltrate (hematoxylin-eosin staining). At baseline, the group Chagas + placebo and Chagas + DIPY showed a larger area of perfusion defect (19.2 ± 5.4% and 20.9 ± 4.2%, respectively) compared to control + placebo and control + DIPY (3.8 ± 0.7% e 3.6 ± 0.9%, respectively), p<0.05, but similar left ventricular ejection fraction (LVEF), p=0.3, and left ventricular diastolic diameter (LVdD), p=0.2. After treatment, a significant reduction of perfusion defects was observed only in the Chagas + DIPY group (p=0.02). When the values after treatment were compared to baseline values, Chagas + DIPY and Chagas + placebo animals showed a reduction of LVEF (from 65.3 ± 2.5% to 53.6 ± 1.9% and from 69.3 ± 1.4% to 54.4 ± 2.%5, respectively), p<0.001, and an increase of LVdD from 0.68 ± 0,15 cm to 0.76 ± 0.17 cm and from 0.64 ± 0.01 cm to 0.70 ± 0,02 cm, respectively, p<0.002. Quantitative histological analysis revealed a larger number of nuclei of mononuclear inflammatory cells in the Chagas + DIPY (998.1 ± 116.0 cel/mm²) and Chagas + Placebo (1191.4 ± 133.2 cells/mm²) groups compared to the Control + DIPY (396.5 ± 28.3 cells/mm²) and Control + Placebo (257.1 ± 21.6 cells/mm²) groups, p=0.05. The percentage of fibrosis was higher in the Chagas + DIPY (4.7 ± 0.4%) and Chagas + Placebo (5.4 ± 0.2%) groups compared to the Control + Placebo group (3.2 ± 0.3%). There was no difference between the Chagas + DIPY and Chagas + Placebo groups regarding the two histological variables. Conclusions: The prolonged use of DIPY in animals with CCC was associated with a significant reduction of myocardial perfusion defects assessed in vivo. However, the resolution of microvascular ischemia with the use of DIPY did not prevent the progression of left ventricular dysfunction. These results suggest that microvascular ischemia may not be a central myocardial injury mechanism in the physiopathogenic complex of this CCC model. It is plausible to assume that microvascular ischemia may be a marker of the presence of an underlying injury process probably of an inflammatory nature.

Introdução: A fração de ejeção do ventrículo direito (FEVD) é um importante fator prognóstico em pacientes com hipertensão pulmonar (HP), porém a sua medida é complicada e demorada devido à complexidade anatômica do ventrículo direito (VD). O TAPSE (Tricuspid Annular Plane Systolic Excursion) é um bom índice da FEVD, mas ele avalia apenas o componente longitudinal da contração ventricular direita. A RVFAC (Right Ventricular Fractional Area Change) parece ser um melhor índice da FEVD por incluir os componentes longitudinal e transversal da contração ventricular direita. O objetivo deste estudo foi avaliar a performance da RVFAC de acordo com a gravidade do acometimento hemodinâmico em dois grupos distintos de pacientes portadores de HP pré-capilar: hipertensão arterial pulmonar (HAP) e tromboembolismo pulmonar crônico hipertensivo (TEPCH). Métodos: 62 pacientes realizaram cateterismo cardíaco direito e ressonância magnética cardíaca em ±72h. As áreas sistóica e diastólica finais do ventrículo direito (ASFVD, ADFVD), a área diastólica final do ventrículo esquerdo (ADFVE) e o TAPSE foram medidos nas imagens de quatro cavidades. A RVFAC (ADFVD-ASFVD/ADFVD) e a relação entre as áreas diastólica finais ventriculares (ADFVD/ADFVE) foram calculadas. Os diâmetros entre as paredes livre e septal (dL-S) e antero-posterior (dA-P) do ventículo esquerdo (VE) foram medidos nas imagens em eixo curto e o índice de excentricidade do VE (IE) foi calculado (=dA-P/dL-S). A FEVD foi calculada a partir de imagens consecutivas de 6mm no eixo curto. . Resultados: A população tinha 58 anos em média, a maioria era do sexo feminino e estava em classe funcional III, 23 tinham HAP e 39 TEPCH. A FEVD apresentou correlações fracas com as medidas hemodinâmicas de sobrecarga e de função do VD. A RVFAC apresentou melhor correlação (R2=0,65, p < 0,001) do que o TAPSE (R2=0,35, p<0,001) com a FEVD e melhor capacidade para estimar FEVD<35% do que o TAPSE (TAPSE: AUC 0,73 e RVFAC: AUC 0,93, p=0,0065). Dividimos a população pela mediana da resistência vascular pulmonar (RVP) e observamos que no grupo com maior gravidade hemodinâmica essa diferença se acentuou: no grupo com RVP<8,5UW (RVFAC: R2=0,66, p<0,001 e TAPSE: R2=0,30, e p=0,002) e no grupo com RVP>8,5UW (RVFAC: R2=0,51, p<0,001 e TAPSE: R2=0,14, e p=0,041). O grupo com RVP>8,5UW apresentou maior ADFVD/ADFVE e maior IE. As correlações da RVFAC e TAPSE com FEVD foram semelhantes entre os grupos HAP e TEPCH. Conclusão: A RVFAC se correlacionou melhor com a FEVD do que o TAPSE tanto no grupo com menor como no grupo com maior gravidade hemodinâmica. No grupo com maior gravidade as correlações da RVFAC com a FEVD foram ainda mais significativas, não havendo diferenças na performance da RVFAC entre os pacientes com HAP e TEPCH. A RVFAC foi um melhor índice da FEVD talvez por incluir o movimento transversal da contração ventricular / Introduction: The right ventricular ejection fraction (RVEF) is a surrogate marker in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The TAPSE (Tricuspid Annular Plane Systolic Excursion) is a good index of RVEF, though it measures only the longitudinal component of right ventricular contraction. The RVFAC (Right Ventricular Fractional Area Change) seems to be a better index of RVEF because it takes into account the longitudinal and the transversal components of right ventricular contraction. The aim of our study was to evaluate the RVFAC performance according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methos: Sixty-two patients with PAH and CTEPH underwent right heart catheterization and cardiac MR in a 72-hour delay. The right and left ventricle end diastolic areas (RVEDA, LVEDA), the right ventricle end systolic area (RVESA) and TAPSE were measured in the four chamber view. The RVFAC (=RVEDARVESA/RVEDA) and the RVEDA/LVEDA relationship were calculated. The diameter between the left ventricle (LV) free wall and the septum (dF-S) and the diameter between the LV anterior and posterior walls (dA-P) were measured and the LV eccentricity index (EI) was calculated (=dA-P/dF-S). The RVEF was calculated by using 6 mm RV short axis cines. Results: The population had mean age of 58 years with female majority, most of the patients were in functional class III, 23 had PAH and 39 CTEPH. The RVEF was weakly correlated to the hemodynamic variables of RV afterload and function. The RVFAC was more strongly correlated to RVEF (R2=0.65, p<0.001) than TAPSE (R2=0.35, p<0.001). RVEF<35% was better predicted by RVFAC than TAPSE (TAPSE: AUC 0.73 and RVFAC: AUC 0.93, p=0.0065). We divided the population by the median of the pulmonary vascular resistance (PVR) and we observed that in the group with worse hemodynamic severity this difference increased: in the group with PVR<8,5WU (RVFAC: R2=0.66, p<0.001 and TAPSE: R2=0.30, p=0.002) and in the group with PVR>8,5 WU (RVFAC: R2=0.51, p<0.001 and TAPSE: R2=0.14, p=0.041). The group with PVR>8,5WU had an increased RVEDA/LVEDA and an increased EI. There was no differences in the RVEF relationships between the groups of PAH and CETPH. Conclusion: The RVFAC was better correlated to RVEF than TAPSE in the groups with less severe and more severe hemodynamics. In patients with increased hemodynamic severity RVFAC perfomed even better, there was no difference in the performance of RVFAC in PAH or CTEPH. RVFAC was a better index of RVEF possibly because it takes into account the transversal component of right ventricular function

No description available.