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The right ventricle in pulmonary hypertension

  • Assessing right ventricular function with echocardiography, presented by G Habib (Marseille, FR) - Slides
  • Assessing right ventricular function with cardiac magnetic resonance, presented by A Vonk Noordegraaf (Amsterdam, NL) - Slides
  • Assessing right ventricular function with cardiopulmonary exercise testing, presented by R J Oudiz (Torrance, US) - Slides
  • Can we treat the right ventricle itself? Presented by R T Schermuly (Giessen, DE)
Pulmonary Hypertension

The session was prepared jointly by the ESC WG on Pulmonary Circulation and Right Ventricular Function and its twin brother from European Respiratory Society. ERS was, represented by Andrew Peacock as Chairmen and two speakers – Ralph Shermuly, and Ronald Oudiz.

Assessing right ventricular function with echocardiography

Assessing right ventricular function with cardiac magnetic resonance

Dr Oudiz gave a talk on the comprehensive interpretation of the spiroergometric test with special focus on the role of VE/VCO2 (marker of ventilator inefficiency). He admitted that spiroergometry does not correlate directly with indices of RV function but may still be helpful in assessing its consequences in PAH. Two first lectures dealt with cardiovascular imaging. Prof Habib from Marseille presented contemporary echocardiographic methods useful in the assessment of RV function. He highlighted new prognostic information which could be derived from speckle tracking imaging. During the discussion, tricuspid insufficiency was mentioned as a factor which may blunt the role of some of the echo-derived RV functional parameters, such as TAPSE, RV fractional area change etc.

Assessing right ventricular function with cardiopulmonary exercise testing

Can we treat the right ventricle itself?

Anton vonk Nordegraaf from Amsterdam gave an overview of existing evidence on CMR evaluation of the RV in PAH, mostly originating from the trials performed by his own group. Most recent findings include strong adverse prognostic significance of decreasing RVEF, regardless direction of concomitant changes of PVR achieved with therapy or resulting from PAH progression. Also, stepwise changes in RV functional remodeling due to PAH, starting from decreased longitudinal contraction but progressing to interventricular septal hypo/dyskinesis might help in better interpretation of some of the echocardiographic indices, such as TAPSE. Finally, Dr Shermully from Giesen presented new experimental trials assessing possibility of treating RV failure based on pulmonary artery constriction model. Some doubts regarding the validity of such model invariably leading to early death of the experimental animals, not allowing for development of potential adaptive mechanisms, emerged during the discussion. Potential role of beta blockers in early prevention of RV remodeling of failure was not totally excluded as a subject for a future trial.

The session was well attended and the audience was quite active in the discussion




The right ventricle in pulmonary hypertension

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.