Kim Bong-Joon, Thomas James D
Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
Division of Cardiology, Center for Heart Valve Disease, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA.
Korean Circ J. 2025 Apr;55(4):259-274. doi: 10.4070/kcj.2024.0313. Epub 2025 Jan 31.
To diagnose pulmonary hypertension (PH) and assess its severity, accurate measurement of pulmonary artery (PA) pressure is crucial. However, there can be significant discrepancies between echocardiography (Echo) and invasive catheterization. The right ventricle (RV) has a complex structure, and its remodeling in PH is diverse, making it challenging to evaluate RV physiology with a single imaging modality. While right heart catheterization is the gold standard, its practicality in clinical settings is limited. Cardiac magnetic resonance imaging (MRI) is valuable for RV evaluation, with 4-dimensional flow MRI showing promise, yet accessibility remains a concern. Thus, in PH patient management, Echo plays a central role as a practical decision-making tool. This review aims to elucidate Echo parameters in PH patients, highlighting differences in PA systolic pressure measurements, RV-PA coupling, RV remodeling patterns crucial for understanding PH progression, and clinical evidence regarding RV strain. Additionally, it aims to introduce new Echo parameters that help understand RV in PH.
为了诊断肺动脉高压(PH)并评估其严重程度,准确测量肺动脉(PA)压力至关重要。然而,超声心动图(Echo)与侵入性导管检查之间可能存在显著差异。右心室(RV)结构复杂,其在PH中的重塑多种多样,使得用单一成像方式评估RV生理学具有挑战性。虽然右心导管检查是金标准,但其在临床环境中的实用性有限。心脏磁共振成像(MRI)对RV评估有价值,四维血流MRI显示出前景,但可及性仍是一个问题。因此,在PH患者管理中,Echo作为一种实用的决策工具发挥着核心作用。本综述旨在阐明PH患者的Echo参数,突出PA收缩压测量、RV-PA耦合、对理解PH进展至关重要的RV重塑模式以及关于RV应变的临床证据方面的差异。此外,它旨在引入有助于理解PH中RV的新Echo参数。