Right ventricular diastolic dysfunction in PAH is associated with significantly increased A-wave vorticity in the RV (2343 vs 492 1/s, P=0.028) and RA (30 vs 9 1/s, P=0.005) compared to controls.
Case-Control (n=23)
Does right heart vorticity measured by 4D flow CMR correlate with echocardiographic markers of right ventricular diastolic dysfunction in patients with pulmonary arterial hypertension?
Right heart vorticity measured by 4D flow CMR correlates with echocardiographic markers of right ventricular diastolic dysfunction in patients with pulmonary arterial hypertension, suggesting it may be a robust noninvasive research tool.
Absolute Event Rate: 2343% vs 492%
p-value: p=0.028
Right ventricular diastolic dysfunction (RVDD) is an important prognostic indicator in pulmonary arterial hypertension (PAH). RV vortex rings have been observed in healthy subjects, but their significance in RVDD is unknown. Vorticity, the local spinning motion of an element of fluid, may be a sensitive measure of RV vortex dynamics. Using four-dimensional (4D) flow cardiac magnetic resonance imaging (CMR), we investigated the relationship between right heart vorticity with echocardiographic indexes of RVDD. Thirteen (13) PAH subjects and 10 controls underwent same-day 4D flow CMR and echocardiography. RV diastolic function was assessed using trans-tricuspid valve (TV) early (E) and late (A) velocities, E/A ratio, and e' and a' tissue Doppler velocities. RV and right atrial (RA) integrated mean vorticity was calculated for E and A-wave filling periods using 4D datasets. Compared with controls, A-wave vorticity was significantly increased in RVDD subjects in both the RV 2343 (1,559-3,295) vs. 492 (267-2,649) 1/s, P = 0.028 and RA 30 (27-44) vs. 9 (5-27) 1/s, P = 0.005. RA E vorticity was significantly decreased 13 (7-22) vs. 28 (15-31) 1/s, P = 0.038 in RVDD. E-wave vorticity correlated TV e', E-,and TV E/A (P < 0.05), and A-wave vorticity associated with both TV A and E/A (P < 0.02). RVDD is associated with alterations in E- and A-wave vorticity, and vorticity correlates with multiple echocardiographic markers of RVDD. Vorticity may be a robust noninvasive research tool for the investigation of RV fluid and tissue mechanical interactions in PAH.
Fenster et al. (2015) conducted a case-control in Pulmonary arterial hypertension (n=23). 4D flow cardiac magnetic resonance imaging (CMR) vs. Healthy controls was evaluated on RV A-wave vorticity (1/s) (p=0.028). Right ventricular diastolic dysfunction in PAH is associated with significantly increased A-wave vorticity in the RV (2343 vs 492 1/s, P=0.028) and RA (30 vs 9 1/s, P=0.005) compared to controls.