Right Ventricular Function in Adult Patients with Eisenmenger Physiology: Insights from Quantitative Echocardiography

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 27; no. 8; pp. 937 - 945
• Main Authors: Kalogeropoulos, Andreas P., Border, William L., Georgiopoulou, Vasiliki V., Pernetz, Maria A., Howell, Sharon, McConnell, Michael, Lerakis, Stamatios, Butler, Javed, Book, Wendy M., Martin, Randolph P.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.09.2010
• Subjects: Adult; Algorithms; congenital heart disease; echocardiography; Echocardiography - methods; Eisenmenger Complex - diagnostic imaging; Eisenmenger Complex - physiopathology; Female; Humans; Image Enhancement - methods; Image Interpretation, Computer-Assisted - methods; Male; Middle Aged; pulmonary hypertension; Reproducibility of Results; right ventricular function; Sensitivity and Specificity; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/j.1540-8175.2010.01194.x

Background: The favorable outcomes of Eisenmenger syndrome (ES) relative to other forms of pulmonary arterial hypertension (PAH) have been partially attributed to a unique adaptation of the right ventricle (RV). However, conventional measures of RV function may not adequately express this adaptation. Methods: We studied 23 patients with ES (age 43 ± 17 years, 16 women, pulmonary artery systolic pressure [PASP] 93 ± 26 mmHg), 25 patients with PAH (age 44 ± 13 years, 17 women, PASP 92 ± 19 mmHg), and 25 subjects without known structural disease (age 45 ± 16 years, 17 women). We evaluated long‐ and short‐axis function of the RV with two‐dimensional strain and anatomical M‐mode echocardiography, respectively. Results: Long‐axis function of the RV was comparable between patients with ES and PAH although depressed relative to controls (global strain, −15.6 ± 4.7, −14.9 ± 4.3, and −22.4 ± 2.8%, respectively, P < 0.001; global RV systolic strain rate, −0.77 ± 0.26, −0.84 ± 0.24, and −1.11 ± 0.21 1/sec, respectively, P < 0.001). However, short‐axis RV function was significantly better in patients with ES versus those with PAH and preserved relative to controls (RV fractional shortening by anatomical M‐mode, median [interquartile range], 21%[14–33%], 14%[10–16%], and 26%[22–36%], respectively, P = 0.002 for ES vs. PAH, P = 0.09 for ES vs. controls). This differential was not reflected in conventional measures of RV function (fractional area change, 32 ± 10 vs. 29 ± 8% in ES and PAH, respectively, P = 0.26). Conclusion: In patients with ES, the RV is characterized by preserved short‐axis function, despite a depressed long‐axis function. Thus, conventional assessment of RV function might not be suitable for patients with ES. (Echocardiography 2010;27:937‐945)