Pulmonary Department, Heart Institute, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
Physiology and Radiology-EA4533, Faculté de Médecine Paris 11-APHP, Le Kremlin Bicêtre, France.
Lung. 2018 Apr;196(2):157-164. doi: 10.1007/s00408-018-0089-7. Epub 2018 Feb 12.
The right ventricular ejection fraction (RVEF) is a surrogate marker of right ventricular function in pulmonary hypertension (PH), but its measurement is complicated and time consuming. The tricuspid annular plane systolic excursion (TAPSE) measures only the longitudinal component of RV contraction while the right ventricular fractional area change (RVFAC) takes into account both the longitudinal and the transversal components. The aim of our study was to evaluate the relationship between RVEF, RVFAC, and TAPSE according to hemodynamic severity in two groups of patients with PH: pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).
Fifty-four patients with PAH (n = 15) and CTEPH (n = 39) underwent right heart catheterization and cardiac magnetic resonance (CMR). The ventricular volumes and areas, TAPSE, and eccentricity index were measured. The RVFAC was more strongly correlated with the RVEF (r = 0.81, p < 0.0001) than the TAPSE (r = 0.63, p < 0.0001). RVEF < 35% was better predicted by the RVFAC than the TAPSE (TAPSE: AUC = 0.77 and RVFAC: AUC = 0.91; p = 0.042). In the group with the worse hemodynamic status, the RVFAC correlated much better with the RVEF than the TAPSE. There were no significant differences in the CMR data analyzed between the groups of PAH and CETPH patients.
The RVFAC is a good index to estimate RVEF in PH patients; even better than the TAPSE in patients with more severe hemodynamic profile, possibly for including the transversal component of right ventricular function in its measurement. Furthermore, RVFAC performance was similar in the two PH groups (PAH and CTEPH).
右心室射血分数（RVEF）是肺动脉高压（PH）中右心室功能的替代标志物，但测量较为复杂且耗时。三尖瓣环平面收缩期位移（TAPSE）仅测量 RV 收缩的纵向分量，而右心室分数面积变化（RVFAC）则同时考虑了纵向和横向分量。我们的研究目的是根据两组 PH 患者（肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH））的血流动力学严重程度评估 RVEF、RVFAC 和 TAPSE 之间的关系。
54 例 PAH 患者（n=15）和 CTEPH 患者（n=39）接受了右心导管检查和心脏磁共振（CMR）。测量心室容积和面积、TAPSE 和偏心指数。RVFAC 与 RVEF 的相关性强于 TAPSE（r=0.81，p<0.0001 比 r=0.63，p<0.0001）。RVFAC 比 TAPSE 更好地预测 RVEF<35%（TAPSE：AUC=0.77 和 RVFAC：AUC=0.91；p=0.042）。在血流动力学状态较差的组中，RVFAC 与 RVEF 的相关性明显优于 TAPSE。PAH 和 CETPH 患者的 CMR 数据分析之间无显著差异。
RVFAC 是一种很好的 PH 患者 RVEF 估算指标；在血流动力学状态更差的患者中，甚至优于 TAPSE，可能是因为在其测量中包括了右心室功能的横向分量。此外，RVFAC 在两组 PH 患者（PAH 和 CTEPH）中的表现相似。
