Physiological assessment of pressure overloaded right ventricle

Projekt: Forskning



Adult patients with pulmonary arterial hypertension (PAH) have a high morbidity and mortality due to right ventricular (RV) failure. In PAH there is a significant increase of the afterload on the right ventricle. RV adaptation is crucial to overcome a chronically increased pressure. Patient’s clinical state deteriorates when RV compensatory mechanisms are failing. Disease progression is highly variable and quite often, poorly understood. Doctors experiences daily challenges in optimizing treatment strategies and timing of transplant referral and listing, despite currently existing prognostic factors.
Non-invasive assessment of RV function is mainly performed by transthoracic echocardiography (ECHO) and has several known limitations due to complex RV geometry. Correct assessment of RV function is crucial but not easy to perform. Several parameters have been suggested for echocardiographic evaluation but more reliable methods are warranted for a better understanding of RV function. Right Ventricular Stroke Work Index (RVSWI), measured by right heart catheterization (RHC), is an important determinant of outcome in adults with PAH. RVSWI is calculated using both pressures and flow through RV. RHC is an invasive method but not available in all the hospitals. Cardiac magnetic resonance (CMR) remains the gold standard method for non-invasive measurements but it is time-consuming, not always feasible in everyday clinical practice and is costly.
Echocardiography remains the first and the most frequently method to evaluate RV, it is highly available, reproducible and relatively unexpansive tool.
We aim to study four non-invasive echocardiographic measures to calculate RVSWI (RVSWIECHO), the correlation with clinical parameters, invasive, CMR measurements and serum markers.
Will also intend to assess the clinical utility of RVSWIECHO in relation to long-term outcomes such as clinical and haemodynamically worsening, lung or heart-lung transplantation and death in adult patients with PAH.

Gällande start-/slutdatum2020/05/012024/09/01