Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: determinants and impact on pump function
| Autor: | Martina Nocioni, Beatrice Pezzuto, Francesco Fedele, Mario Mezzapesa, Riccardo Rosati, Roberto Badagliacca, Carmine Dario Vizza, Susanna Sciomer, Silvia Papa, Alfred Nona, Cristina Gambardella, Marco Francone, Roberto Poscia |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
Ventricular Dysfunction Right Cardiac index Hemodynamics right ventricular wall stress pulmonary arterial hypertension Ventricular Dysfunction echocardiography Ventricular Function 2D speckle-tracking echocardiography Pulmonary hemodynamics medicine.diagnostic_test Ventricular Remodeling Pulmonary Middle Aged Prognosis Magnetic Resonance Imaging Right medicine.anatomical_structure Cine right ventricular dyssynchrony right ventricular function Echocardiography Female Follow-Up Studies Humans Hypertension Pulmonary Magnetic Resonance Imaging Cine Pulmonary Wedge Pressure Retrospective Studies Stroke Volume Vascular Resistance Ventricular Function Right Surgery Pulmonary and Respiratory Medicine Cardiology and Cardiovascular Medicine Transplantation Hypertension Cardiology medicine.medical_specialty Diastole Cardiac magnetic resonance imaging Internal medicine medicine Ventricular dyssynchrony business.industry Idiopathic Pulmonary Arterial Hypertension medicine.disease Vascular resistance business |
| Popis: | 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.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).Despite similar pulmonary vascular resistance and mean pulmonary arterial pressure, patients with RV-SD4 at19 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, p0.0001). 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).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. |
| Databáze: | OpenAIRE |
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