Echocardiographic estimation of right ventricular diastolic stiffness based on pulmonary regurgitant velocity waveform analysis in precapillary pulmonary hypertension

Yui Nagai; Michito Murayama; Sanae Kaga; Hideki Shima; Satonori Tsuneta; Shinobu Yokoyama; Hisao Nishino; Mana Goto; Yukino Suzuki; Yusuke Yanagi; Suguru Ishizaka; Hiroyuki Iwano; Junichi Nakamura; Takahiro Sato; Ichizo Tsujino

doi:10.1007/s10554-024-03083-1

Echocardiographic estimation of right ventricular diastolic stiffness based on pulmonary regurgitant velocity waveform analysis in precapillary pulmonary hypertension

Int J Cardiovasc Imaging. 2024 Mar 27. doi: 10.1007/s10554-024-03083-1. Online ahead of print.

Authors

Yui Nagai^#¹, Michito Murayama^#², Sanae Kaga³, Hideki Shima⁴, Satonori Tsuneta⁵, Shinobu Yokoyama⁶, Hisao Nishino⁶, Mana Goto⁶, Yukino Suzuki⁶, Yusuke Yanagi⁶, Suguru Ishizaka^{6

7}, Hiroyuki Iwano^{6

8}, Junichi Nakamura⁴, Takahiro Sato^{4

9}, Ichizo Tsujino^{4

9}

Affiliations

¹ Graduate School of Health Sciences, Hokkaido University, N12, W5, Kita-ku, Sapporo, 060-0812, Japan.
² Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, N12, W5, Kita-ku, Sapporo, 060-0812, Japan.
³ Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, N12, W5, Kita-ku, Sapporo, 060-0812, Japan. sanae@med.hokudai.ac.jp.
⁴ Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, N14, W5, Kita-ku, Sapporo, 060-8648, Japan.
⁵ Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
⁶ Diagnostic Center for Sonography, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan.
⁷ Department of Cardiovascular Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo, 060-8638, Japan.
⁸ Division of Cardiology, Teine Keijinkai Hospital, 1-40, Maeda 1-jo 12-chome Teine-ku, Sapporo, 006-8555, Japan.
⁹ Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, N14, W5, Kita-ku, Sapporo, 060-8648, Japan.

^# Contributed equally.

PMID: 38536607
DOI: 10.1007/s10554-024-03083-1

Abstract

Right ventricular (RV) diastolic stiffness is an independent predictor of survival and is strongly associated with disease severity in patients with precapillary pulmonary hypertension (PH). Therefore, a fully validated echocardiographic method for assessing RV diastolic stiffness needs to be established. This study aimed to compare echocardiography-derived RV diastolic stiffness and invasively measured pressure-volume loop-derived RV diastolic stiffness in patients with precapillary PH. We studied 50 consecutive patients with suspected or confirmed precapillary PH who underwent cardiac catheterization, magnetic resonance imaging, and echocardiography within a 1-week interval. Single-beat RV pressure-volume analysis was performed to determine the gold standard for RV diastolic stiffness. Elevated RV end-diastolic pressure (RVEDP) was defined as RVEDP ≥ 8 mmHg. Using continuous-wave Doppler and M-mode echocardiography, an echocardiographic index of RV diastolic stiffness was calculated as the ratio of the atrial-systolic descent of the pulmonary artery-RV pressure gradient derived from pulmonary regurgitant velocity (PRPGD_AC) to the tricuspid annular plane movement during atrial contraction (TAPM_AC). PRPGD_AC/TAPM_AC showed significant correlation with β (r = 0.54, p < 0.001) and RVEDP (r = 0.61, p < 0.001). A cut-off value of 0.74 mmHg/mm for PRPGD_AC/TAPM_AC showed 83% sensitivity and 93% specificity for identifying elevated RVEDP. Multivariate analyses indicated that PRPGD_AC/TAPM_AC was independently associated with disease severity in patients with precapillary PH, including substantial PH symptoms, stroke volume index, right atrial size, and pressure. PRPGD_AC/TAPM_AC, based on pulmonary regurgitation velocity waveform analysis, is useful for the noninvasive assessment of RV diastolic stiffness and is associated with prognostic risk factors in precapillary PH.

Keywords: Diastolic function; Echocardiography; Pulmonary hypertension; Pulmonary regurgitation; Right ventricular diastolic stiffness; Right ventricular hemodynamic evaluation.

Grants and funding

22K20497/Japan Society for the Promotion of Science