Right Intraventricular Dyssynchrony in Idiopathic, Heritable, and Anorexigen-Induced Pulmonary Arterial Hypertension

Badagliacca, Roberto; Reali, Manuela; Poscia, Roberto; Pezzuto, Beatrice; Papa, Silvia; Mezzapesa, Mario; Nocioni, Martina; Valli, Gabriele; Giannetta, Elisa; Sciomer, Susanna; Iacoboni, Carlo; Fedele, Francesco; Vizza, Carmine Dario

doi:10.1016/j.jcmg.2015.02.009

Cited by 88 publications

(93 citation statements)

References 24 publications

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“…In the present study, we investigated all the echocardiographic and hemodynamic parameters associated with RV function, and found that among many RV parameters including RV strain, and RV dyssynchrony, 3DRVEF showed the strongest correlation with hemodynamics and prognosis. Historically, hemodynamic parameters including cardiac index and mPAP are used as prognostic predictors in PAH [19], with RV strain and RV dyssynchrony also used to predict clinical outcomes [17, 20]. However, consistent with our results, CMR studies demonstrated the prognostic importance of a decrease in RVEF [8, 21], which also accompanies late disease progression [22].…”

Section: Discussionsupporting

confidence: 84%

Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

et al. 2016

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BackgroundRight ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, it remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH. The aim of this study was to identify the most useful parameter that correlates with hemodynamics and predicts clinical outcomes in PAH.ResultsMost of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan-Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH.Materials and MethodsEighty-six consecutive patients were enrolled in this study. RV hemodynamic parameters were measured by right heart catheterization (RHC). RV function was assessed using two-dimensional speckle-tracking echocardiography and three-dimensional transthoracic echocardiography (3DTTE) to evaluate RV free wall global strain (RVFS) and RVEF.ConclusionsRVEF measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in PAH patients.

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Section: Discussionsupporting

confidence: 84%

Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

et al. 2016

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“…16,17 Appropriate tracking of the segment of interest was acquired by manual tracing with fine-tuning of the RV endocardial border. 16,17 Appropriate tracking of the segment of interest was acquired by manual tracing with fine-tuning of the RV endocardial border.…”

Section: Assessment Right Ventricular Dyssynchronymentioning

confidence: 99%

Right ventricular dyssynchrony and functional capacity before and after percutaneous balloon mitral valvuloplasty in patients with mitral stenosis: Determinants and clinical impact

et al. 2018

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Objective We aimed to investigate the utility of right ventricular (RV) dyssynchrony to assess functional capacity utilizing 6‐minute walking test distance (6MWTD) and to measure brain natriuretic peptide levels (BNP) in patients with mitral stenosis (MS) and to study its value to predict adverse outcome following percutaneous balloon mitral valvuloplasty (PBMV). Methods A total of 108 patients with moderate to severe MS (26.5 ± 7.5 years) were included in this study. All were candidates for PBMV. RV strain curves were obtained using two‐dimensional speckle‐tracking echocardiography, and standard deviation (SD) of 4 segments without RV apex (‐SD4) was also assessed. 6MWT and BNP were before and after 12 months following PBMV. Results RV‐SD4 was significantly prolonged in patients with MS compared with controls (P < 0.001). Patients with 6MWTD ≤300 m had a significantly increased RV‐SD4 (P < 0.001) and had higher BNP values (P < 0.03) compared with those with 6MWTD >300 m. RV‐SD4 showed a strong correlation with 6MWT and BNP level. RV‐SD4 was the strongest independent predictor of adverse outcome following PBMV (P < 0.0001). Receiver operating characteristic analysis showed that RV‐SD4 ≥24 ms was the cutoff value which predicts the adverse outcome following PBMV. A considerable improvement of mean 6MWT with significant reduction of BNP levels after 12 months of follow‐up (P < 0.001) in subjects with RV dyssynchrony <24 ms. Conclusion Right ventricular dyssynchrony is a useful predictor of functional status, as assessed with 6MWTD and BNP level in patients with MS. Furthermore, it might be considered as an independent predictor of adverse outcome following PMBV.

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“…11,30,31 This derives mainly from delayed contraction of the basal and mid-RV free wall due to nonuniform distribution of wall stress in the dilated pressureloaded RV (Figure 3). 11,30,31 This derives mainly from delayed contraction of the basal and mid-RV free wall due to nonuniform distribution of wall stress in the dilated pressureloaded RV (Figure 3).…”

Section: Potential Role Of Rv Strain In Evaluating Cardiovascular Dmentioning

confidence: 99%

Added clinical value of applying myocardial deformation imaging to assess right ventricular function

Sokalskis¹,

Peluso

Jagodzinski³

et al. 2017

Echocardiography

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Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking-derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler-derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking-derived right atrial strain, right ventricular longitudinal strain-derived mechanical dyssynchrony, and three-dimensional echocardiography-derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use.

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Right Intraventricular Dyssynchrony in Idiopathic, Heritable, and Anorexigen-Induced Pulmonary Arterial Hypertension

Abstract: Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.

Cited by 88 publications

References 24 publications

Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension

Right ventricular dyssynchrony and functional capacity before and after percutaneous balloon mitral valvuloplasty in patients with mitral stenosis: Determinants and clinical impact

Added clinical value of applying myocardial deformation imaging to assess right ventricular function

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