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Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: determinants and impact on pump function.
J Heart Lung Transplant. 2015 Mar; 34(3):381-9.JH

Abstract

BACKGROUND

Right ventricular (RV) dyssynchrony has been described in pulmonary arterial hypertension (PAH), but no evidence is available on its morphologic determinants and its effect on systolic function. The aim of this study was to evaluate the morphologic determinants of RV dyssynchrony by echocardiographic and cardiac magnetic resonance imaging and its effect on systolic function.

METHODS

In 60 consecutive idiopathic PAH (IPAH) patients with narrow QRS, RV dyssynchrony was evaluated by 2D speckle-tracking echocardiography, calculating the standard deviation of the times to peak systolic strain for the four mid-basal RV segments (RV-SD4). Patients were grouped by the median value of RV-SD4 (19 milliseconds) and compared for RV remodeling and systolic function parameters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT).

RESULTS

Despite similar pulmonary vascular resistance and mean pulmonary arterial pressure, patients with RV-SD4 at >19 milliseconds had advanced WHO class and worse 6MWT, RV hemodynamics, RV remodeling and systolic function parameters compared with patients at ≤19 milliseconds. The morphologic determinants of RV dyssynchrony resulted RV end-diastolic area, LV diastolic eccentricity index and RV mass volume ratio (r = 0.69, r(2) = 0.47, p < 0.0001). Finally, we found a significant inverse correlation between RV mid-basal segments post-systolic shortening time and cardiac index (r = -0.64, r(2) = 0.41, p = 0.001), accounting for the significant correlation between RV-SD4 and cardiac index (r = 0.57, r(2) = 0.32, p = 0.003).

CONCLUSIONS

In IPAH with narrow QRS, RV dyssynchrony is associated with RV dilation and eccentric hypertrophy pattern, suggesting a role of segmental wall stress heterogeneity as the major determinant of mechanical delay. Post-systolic shortening, as inefficient contraction, contributes to pump dysfunction.

Authors+Show Affiliations

Departments of a?>Cardiovascular and Respiratory Science. Electronic address: roberto.badagliacca@uniroma1.it.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.Radiological Science, Sapienza University of Rome, Rome, Italy.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.Radiological Science, Sapienza University of Rome, Rome, Italy.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.Departments of a?>Cardiovascular and Respiratory Science.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25087105

Citation

Badagliacca, Roberto, et al. "Right Ventricular Dyssynchrony in Idiopathic Pulmonary Arterial Hypertension: Determinants and Impact On Pump Function." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 34, no. 3, 2015, pp. 381-9.
Badagliacca R, Poscia R, Pezzuto B, et al. Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: determinants and impact on pump function. J Heart Lung Transplant. 2015;34(3):381-9.
Badagliacca, R., Poscia, R., Pezzuto, B., Papa, S., Gambardella, C., Francone, M., Mezzapesa, M., Nocioni, M., Nona, A., Rosati, R., Sciomer, S., Fedele, F., & Dario Vizza, C. (2015). Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: determinants and impact on pump function. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 34(3), 381-9. https://doi.org/10.1016/j.healun.2014.06.010
Badagliacca R, et al. Right Ventricular Dyssynchrony in Idiopathic Pulmonary Arterial Hypertension: Determinants and Impact On Pump Function. J Heart Lung Transplant. 2015;34(3):381-9. PubMed PMID: 25087105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: determinants and impact on pump function. AU - Badagliacca,Roberto, AU - Poscia,Roberto, AU - Pezzuto,Beatrice, AU - Papa,Silvia, AU - Gambardella,Cristina, AU - Francone,Marco, AU - Mezzapesa,Mario, AU - Nocioni,Martina, AU - Nona,Alfred, AU - Rosati,Riccardo, AU - Sciomer,Susanna, AU - Fedele,Francesco, AU - Dario Vizza,Carmine, Y1 - 2014/06/21/ PY - 2013/12/03/received PY - 2014/05/09/revised PY - 2014/06/18/accepted PY - 2014/8/4/entrez PY - 2014/8/5/pubmed PY - 2015/12/17/medline KW - 2D speckle-tracking echocardiography KW - echocardiography KW - pulmonary arterial hypertension KW - right ventricular dyssynchrony KW - right ventricular function KW - right ventricular wall stress SP - 381 EP - 9 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 34 IS - 3 N2 - BACKGROUND: Right ventricular (RV) dyssynchrony has been described in pulmonary arterial hypertension (PAH), but no evidence is available on its morphologic determinants and its effect on systolic function. The aim of this study was to evaluate the morphologic determinants of RV dyssynchrony by echocardiographic and cardiac magnetic resonance imaging and its effect on systolic function. METHODS: In 60 consecutive idiopathic PAH (IPAH) patients with narrow QRS, RV dyssynchrony was evaluated by 2D speckle-tracking echocardiography, calculating the standard deviation of the times to peak systolic strain for the four mid-basal RV segments (RV-SD4). Patients were grouped by the median value of RV-SD4 (19 milliseconds) and compared for RV remodeling and systolic function parameters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT). RESULTS: Despite similar pulmonary vascular resistance and mean pulmonary arterial pressure, patients with RV-SD4 at >19 milliseconds had advanced WHO class and worse 6MWT, RV hemodynamics, RV remodeling and systolic function parameters compared with patients at ≤19 milliseconds. The morphologic determinants of RV dyssynchrony resulted RV end-diastolic area, LV diastolic eccentricity index and RV mass volume ratio (r = 0.69, r(2) = 0.47, p < 0.0001). Finally, we found a significant inverse correlation between RV mid-basal segments post-systolic shortening time and cardiac index (r = -0.64, r(2) = 0.41, p = 0.001), accounting for the significant correlation between RV-SD4 and cardiac index (r = 0.57, r(2) = 0.32, p = 0.003). CONCLUSIONS: In IPAH with narrow QRS, RV dyssynchrony is associated with RV dilation and eccentric hypertrophy pattern, suggesting a role of segmental wall stress heterogeneity as the major determinant of mechanical delay. Post-systolic shortening, as inefficient contraction, contributes to pump dysfunction. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/25087105/Right_ventricular_dyssynchrony_in_idiopathic_pulmonary_arterial_hypertension:_determinants_and_impact_on_pump_function_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(14)01177-2 DB - PRIME DP - Unbound Medicine ER -