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. 2022 Jun 21;23(7):958-969.
doi: 10.1093/ehjci/jeab065.

Comprehensive echocardiographic evaluation of the right heart in patients with pulmonary vascular diseases: the PVDOMICS experience

Christine L Jellis  1 , Margaret M Park  1 , Aiden Abidov  2 , Barry A Borlaug  3 , Evan L Brittain  4 , Robert Frantz  3 , Paul M Hassoun  5 , Evelyn M Horn  6 , Wael A Jaber  1 , Kim Jiwon  6 , Maria G Karas  6 , Deborah Kwon  1 , Jane A Leopold  7 , Bradley Maron  7 , Stephen C Mathai  5 , Reena Mehra  8 , Franz Rischard  9 , Erika B Rosenzweig  10 , W H Wilson Tang  1 , Rebecca Vanderpool  9 , James D Thomas  11 ; PVDOMICS Study Group
Affiliations

Comprehensive echocardiographic evaluation of the right heart in patients with pulmonary vascular diseases: the PVDOMICS experience

Christine L Jellis et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: There is a wide spectrum of diseases associated with pulmonary hypertension, pulmonary vascular remodelling, and right ventricular dysfunction. The NIH-sponsored PVDOMICS network seeks to perform comprehensive clinical phenotyping and endophenotyping across these disorders to further evaluate and define pulmonary vascular disease.

Methods and results: Echocardiography represents the primary non-invasive method to phenotype cardiac anatomy, function, and haemodynamics in these complex patients. However, comprehensive right heart evaluation requires the use of multiple echocardiographic parameters and optimized techniques to ensure optimal image acquisition. The PVDOMICS echo protocol outlines the best practice approach to echo phenotypic assessment of the right heart/pulmonary artery unit.

Conclusion: Novel workflow processes, methods for quality control, data for feasibility of measurements, and reproducibility of right heart parameters derived from this study provide a benchmark frame of reference. Lessons learned from this protocol will serve as a best practice guide for echocardiographic image acquisition and analysis across the spectrum of right heart/pulmonary vascular disease.

Keywords: TAPSE; echocardiography; fractional area change; pulmonary hypertension; right ventricle; strain.

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Figures

Figure 1
Figure 1
Optimizing tricuspid velocity spectral Doppler signal with UEA.
Figure 2
Figure 2
Conventional LV focused (A) vs. RV-focused (B) apical four-chamber (A4C) view.
Figure 3
Figure 3
Parameters of right heart structure: (A) End-diastolic basal RV diameter (RVd1) and length (RVd3); RV diastolic (B) and systolic (C) area; proximal (D); and distal (E) RVOT linear end-diastolic diameter and RV free wall end-diastolic thickness.
Figure 4
Figure 4
Inferior vena cava (IVC) size and collapsibility sniff on 2D (A) and M-mode (B) imaging.
Figure 5
Figure 5
Two-dimensional and Doppler parameters of RV function. (A) RV FAC derived using end-diastolic (RVAd) and end-systolic (RVAs) areas. (B) TAPSE measured with M-Mode (red arrow). (C) TV annular peak systolic velocity (S’) using TDI. (D) MPI derived from RV systolic ejection time, isovolumetric contraction time (IVCT), and isovolumetric relation time (IVRT) using TDI, where MPI = (IVCT + IVRT)/ET. (E) VVI derived three-segment and six-segment RV longitudinal strains.
Figure 6
Figure 6
Multiple beat capture 3D imaging renders RV end-systolic and end-diastolic volumes to estimate RVEF.
Figure 7
Figure 7
RV haemodynamic parameters. (A) Pulmonary artery pressure (PASP) estimated using CW peak TR velocity (TRV, red arrow). (RVSP = 4V2) (PASP = RVSP + RAP). (B) mPAP estimated from pulmonary insufficiency using CW Doppler (CW, yellow arrow) [mPAP = 4V2 + RAP]. (C) Pulmonary artery end-diastolic pressure (PAEDP) estimated from pulmonary insufficiency using CW Doppler (green arrow) [PAEDP = 4V2 + RAP]. (D) Estimation of pulmonary vascular resistance (PVR) from (D) the peak TRV (blue arrow) and (E) the RVOT velocity time integral (VTI, white trace). (PVR = TRV m/s ÷ RVOT VTI cm × 10 + 0.16). (F) Interventricular septal flattening (orange arrows) correlates with right-sided pressure (systolic) and/or volume (diastolic) overload.
Figure 8
Figure 8
Agitated saline bubble study assessing for a right to left intra-cardiac shunt.
See this image and copyright information in PMC

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