Impaired Right and Left Ventricular Longitudinal Function in Patients with Fibrotic Interstitial Lung Diseases

Abstract

Background: Left ventricular (LV) and right ventricular (RV) dysfunction is recognized in idiopathic pulmonary fibrosis (IPF). Little is known about cardiac involvement in non-idiopathic pulmonary fibrosis (no-IPF). This issue can be explored by advanced echocardiography. Methods: Thirty-three clinically stable and therapy-naive fibrotic IPF and 28 no-IPF patients, and 30 healthy controls were enrolled. Exclusion criteria were autoimmune systemic diseases, coronary disease, heart failure, primary cardiomyopathies, chronic obstructive lung diseases, pulmonary embolism, primary pulmonary hypertension. Lung damage was evaluated by diffusion capacity for carbon monoxide (DLCOsb). All participants underwent an echo-Doppler exam including 2D global longitudinal strain (GLS) of both ventricles and 3D echocardiographic RV ejection fraction (RVEF). Results: We observed LV diastolic dysfunction in IPF and no-IPF, and LV GLS but not LV EF reduction only in IPF. RV diastolic and RV GLS abnormalities were observed in IPF versus both controls and no-IPF. RV EF did not differ significantly between IPF and no-IPF. DLCOsb and RV GLS were associated in the pooled pulmonary fibrosis population and in the IPF subgroup (β = 0.708, p < 0.001), independently of confounders including pulmonary arterial systolic pressure. Conclusion: Our data highlight the unique diagnostic capabilities of GLS in distinguishing early cardiac damage of IPF from no-IPF patients.

Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases

“…There is evidence that the assessment of longitudinal strain by STE may help clinicians track changes in RV function with a relevant impact on disease management and outcome prediction [ 27 , 28 ]. In this regard, we previously reported that early reduction of RV strain was associated with clinical deterioration and was correlated with lung function impairment in patients affected by IPF [ 29 ]. As an emerging and attractive biomarker, RV-to-pulmonary circulation coupling is an indicator of the relationship between the RV contractility and its afterload; therefore, any perturbation of this interaction reflects early RV dysfunction, as previously shown in studies that invasive measured the pressure–volume loop-derived Ees/Ea ratio [ 30 , 31 ].…”

Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

“…In addition to the reduction of RV GWI, GCW, GWE and increase of GWW in HF patients compared to controls, they demonstrated that RV GCW is the only echocardiographic parameter associated with invasively measured stroke volume [ 65 ]. Therefore, MW seems to also be able to provide an all-around evaluation of the RV function, integrating information on contractility, dyssynchrony and pulmonary pressure, and overcoming the limitations of other standard parameters such as TAPSE, RV GLS or fractional area change [ 66 ]. Further and larger studies are needed to validate the application of MW software in studying the right chamber and extending its applicability in other clinical settings.…”

Cardiac Magnetic Resonance Imaging Feature Tracking for Quantifying Left Ventricle Deformation in Type 2 Diabetic Patients

“…Diabetic cardiomyopathy can be categorized as either having coronary artery disease or hypertension [4]. In addition to advanced glycation end products, atherosclerosis, microinfarctions in the subclinical stage, mitochondrial dysfunction, and lipotoxicity, several metabolic impairments contribute to diabetic cardiomyopathy [5] These impairments may affect both left ventilatory function (LV) and right ventilatory function (RV), due to their systematic nature [6]. It is believed that cardiovascular diseases represent a significant international public health burden due to the difficulty of evaluating heart contractile function in modern cardiology, which continues to be an issue [6].…”

“…In addition to advanced glycation end products, atherosclerosis, microinfarctions in the subclinical stage, mitochondrial dysfunction, and lipotoxicity, several metabolic impairments contribute to diabetic cardiomyopathy [5] These impairments may affect both left ventilatory function (LV) and right ventilatory function (RV), due to their systematic nature [6]. It is believed that cardiovascular diseases represent a significant international public health burden due to the difficulty of evaluating heart contractile function in modern cardiology, which continues to be an issue [6]. In fact, the conventional parameter that describes left ventricular (LV) function, ejection fraction (EF), has considerable limitations due to its volumetric nature, suboptimal reproducibility, and a loss of ability to reflect local LV function.…”