A proposed multicenter observational study will enroll 70 patients with pulmonary arterial hypertension to assess right and left ventricular remodeling before and during pharmacological treatment.
Observational (n=70)
Single-blind (observers)
Yes
Does pharmacological treatment affect LV and RV remodelling in patients with pulmonary arterial hypertension as assessed by advanced echocardiography?
This paper reviews RV imaging in PAH and proposes a multicenter observational study protocol using 3D and speckle-tracking echocardiography to assess RV remodeling during pharmacological treatment.
Although right ventricular (RV) failure is the main cause of death in patients with pulmonary arterial hypertension (PAH), there is insufficient data about the effects of PAH treatment on RV geometry and function mainly because the RV assessment has been hampered by its complex crescentic shape, large infundibulum, and its trabecular nature. Echocardiography is a widely available imaging technique particularly suitable for follow-up studies, because of its non-invasive nature, low cost, and lack of ionizing radiation or radioactive agent. Real-time three-dimensional echocardiography (RT3DE) has been shown to be accurate in assessing RV and left ventricular (LV) volumes, stroke volumes, and ejection fractions in comparison with cardiac magnetic resonance imaging. In this review, we describe RV structural and functional changes which occur in patients with PAH and strengths and weaknesses of current non-invasive imaging techniques to assess them. Finally, we describe an ongoing multicentre, prospective observational study involving seven centres expert in treating patients with PAH from four different countries. Investigators will use conventional and advanced echo parameters from RT3DE and speckle-tracking echocardiography to assess the extent of LV and RV remodelling before symptom onset and during pharmacological treatment in patients with PAH. Seventy patients who will survive for at least 1 year will be recruited. All the participating institutions will perform comprehensive standard 2D and Doppler as well as RT3DE examinations with a pre-defined imaging protocol. Measurements will be performed at the core echocardiography laboratory by experienced observers who will be unaware of each patient's treatment assignment and whether the examination was a baseline or a follow-up study. Enrolment duration is expected to be 1 year.
Badano et al. (2009) conducted an observational in Pulmonary arterial hypertension (n=70). Pharmacological treatment vs. Baseline (before treatment) was evaluated on Extent of LV and RV remodelling. A proposed multicenter observational study will enroll 70 patients with pulmonary arterial hypertension to assess right and left ventricular remodeling before and during pharmacological treatment.