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Correspondence |

Longitudinal and Transverse Movements of the Right VentricleLongitudinal and Transverse Movements: Both Are Important in Pulmonary Arterial Hypertension FREE TO VIEW

Taco Kind, MD; J. Tim Marcus, PhD; Nico Westerhof, PhD; Anton Vonk-Noordegraaf, MD, PhD
Author and Funding Information

From the Department of Pulmonary Diseases (Drs Kind, Westerhof, and Vonk-Noordegraaf), the Department of Physics and Medical Technology (Dr Marcus), and the Department of Physiology (Dr Westerhof), Institute for Cardiovascular Research, VU University Medical Center.

Correspondence to: Taco Kind, MD, Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; e-mail: t.kind@vumc.nl


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):556-557. doi:10.1378/chest.10-3195
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To the Editor:

In a recently published article in CHEST (July 2011), Brown et al1 concluded that longitudinal motion accounted for the majority of overall right ventricular (RV) function in normal subjects and patients with pulmonary arterial hypertension (PAH) and that RV function in PAH is characterized by more prominent impairment of longitudinal motion than of transverse motion. We agree with the authors that longitudinal motion is a useful measure of quantifying RV dysfunction and that it is of prognostic relevance, as was reported previously by Forfia et al.2 However, we feel that two issues must be taken into account when interpreting the results of the transverse movements of the RV free wall.

First, although transverse wall movements are relatively small, this does not necessarily imply that they are unimportant in volume ejection or do not reflect RV function.2 Close relations between transverse movements and RV ejection fraction have been reported by our group and by others.4,5 These results can be explained by the large surface area of the free wall; the small movements observed in a two-dimensional view can cause a significant volume ejection when observed in three dimensions.2 Furthermore, in PAH, when RV dilation occurs mainly in the transverse direction, the loss of ejection is mainly due to loss of transverse motion rather than longitudinal motion. In this situation, longitudinal contraction contributes most to ejection, but the decreased transverse motion is a better reflection of RV dysfunction.3

Second, Brown et al1 reported that the absolute transverse shortening was larger in the PAH group compared with the control group. Although not mentioned by the authors, different studies exist that do not support these findings. An echocardiography study demonstrated a significant reduction in centerline excursions, of which transverse wall motion is the main component, in patients with acute pulmonary embolism and idiopathic PAH compared with normal subjects.6 We reported a similar observation in an MRI study, although it should be noted that septal movements were incorporated into the transverse measures in this study.4 All studies used the same four-chamber image plane, and, therefore, the choice of image plane cannot explain the difference in results. Possibly, the computational method used by Brown et al1 explains some of the difference. They computed transverse movements as the transverse area between the end-diastolic and end-systolic free wall, thereby neglecting the rigid body motion of the whole heart. Therefore, the computed area may not be solely determined by free-wall movements. We would appreciate the authors’ view regarding the difference in results.

Brown SB, Raina A, Katz D, Szerlip M, Wiegers SE, Forfia PR. Longitudinal shortening accounts for the majority of right ventricular contraction and improves after pulmonary vasodilator therapy in normal subjects and patients with pulmonary arterial hypertension. Chest. 2011;1401:27-33. [CrossRef] [PubMed]
 
Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006;1749:1034-1041. [CrossRef] [PubMed]
 
Rushmer RF. Cardiovascular Dynamics. 1976;4th ed Philadelphia, PA WB Saunders Co:91
 
Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westerhof N, Vonk-Noordegraaf A. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson. 2010;12:35. [CrossRef] [PubMed]
 
Sakuma M, Ishigaki H, Komaki K, et al. Right ventricular ejection function assessed by cineangiography—importance of bellows action. Circ J. 2002;666:605-609. [CrossRef] [PubMed]
 
McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996;784:469-473. [CrossRef] [PubMed]
 

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References

Brown SB, Raina A, Katz D, Szerlip M, Wiegers SE, Forfia PR. Longitudinal shortening accounts for the majority of right ventricular contraction and improves after pulmonary vasodilator therapy in normal subjects and patients with pulmonary arterial hypertension. Chest. 2011;1401:27-33. [CrossRef] [PubMed]
 
Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006;1749:1034-1041. [CrossRef] [PubMed]
 
Rushmer RF. Cardiovascular Dynamics. 1976;4th ed Philadelphia, PA WB Saunders Co:91
 
Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westerhof N, Vonk-Noordegraaf A. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson. 2010;12:35. [CrossRef] [PubMed]
 
Sakuma M, Ishigaki H, Komaki K, et al. Right ventricular ejection function assessed by cineangiography—importance of bellows action. Circ J. 2002;666:605-609. [CrossRef] [PubMed]
 
McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996;784:469-473. [CrossRef] [PubMed]
 
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