The Balance between the Left and Right Ventricular Deformation Evaluated by Speckle Tracking Echocardiography Is a Great Predictor of the Major Adverse Cardiac Event in Patients with Pulmonary Hypertension

Abstract

Cardiovascular failure is one of the most relevant causes of death in pulmonary hypertension (PH). With progressive increases of right ventricular (RV) afterload in PH patients, both RV and left ventricular (LV) function impair and RV–LV dyssynchrony develop in parallel. We aimed to analyze the balance between the left and right ventricular deformation to assess the outcome of patients with pulmonary hypertension by means of speckle tracking echocardiography. In this prospective study, 54 patients with invasively diagnosed pulmonary hypertension, and 26 healthy volunteers were included and underwent a broad panel of noninvasive assessment including 2D-echocardiography, 2D speckle tracking, 6-minute walking test and BNP. Patients were followed up for 338.7 ± 131.1 (range 60 to 572) days. There were significant differences in |LVGLS/RVFLS-1| and |LASc/RASc-1| between PH patients and the control group. During the follow up, 13 patients experienced MACEs, which included 7 patients with cardiac death and 6 patients with re-admitted hospital due to right ventricular dysfunction. In the multivariate Cox model analysis, |LVGLS/RVFLS-1| remained independent prognosis of markers (HR = 4.03). Our study findings show that |LVGLS/RVFLS-1| is of high clinical and prognostic relevance in pulmonary hypertension patients and reveal the importance of the balance between the left and right ventricular deformation.

Prognostic value of right ventricular free-wall longitudinal strain in patients with pulmonary hypertension: systematic review and meta-analyses

“…Among 4048 articles retrieved from three databases, 20 articles and 21 patient groups with 2790 subjects were finally included in this meta-analysis. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Tables 1 and 2 present characteristics of included studies and patients, respectively. The pooled mean value of RVfwLS was 17.0±2.5%, reflecting impaired RV systolic function.…”

Helical structure of the ventricular myocardium. A narrative review of cardiac mechanics

“…The size, shape, and compliance of one ventricle affect the size, shape, and pressure-volume ratio of the adjacent ventricle by direct mechanical interactions, especially in the acute setting; a pressure overload on the RV circuit negatively affects the diastolic properties of the RV mechanically mediated by the increase in the curvature of the septum, we know that the AS is responsible for the phenomenon of diastolic contraction during the isovlumetric relaxation period and in the event of acute RV volume or pressure overload, elevated diastolic pressure and the dilation of the cavity will invert the position of the septum towards the LV, overloading the AS limiting its mechanics and the filling of the LV, this phenomenon will be addressed later with the interdependence of torsion-elongation-destortion. 62 A study by Xueming et al 63 (end of isovolumetric relaxation).…”

“…A study by Xueming et al 63 determined that there is a dynamic balance between the functions of the four cardiac chambers, arguing that in pulmonary hypertension the decrease in the function of the right atrium duct may result from delayed RV relaxation and diastolic dysfunction due to increased RV afterload and RV myocardial hypertrophy, which mechanically reflects what is observed in the time gap between the end of DS contraction (end of ejection) and the end of AS contraction [interpreted by the authors as a relaxation phenomenon] (end of isovolumetric relaxation).…”

Clinical Modelling of RVHF Using Pre-Operative Variables: A Direct and Inverse Feature Extraction Technique

“…Although substantial progress has been made in understanding the various pathological conditions of RVHF, effective and accurate medical assessment of these factors, as well as the benefits of RVHF diagnosis at an earlier stage, have led to a tremendous surge in the use of detectors [ 5 , 6 , 7 ]. Furthermore, Manca et al [ 8 ] reported that Titin (TTN)-related dilated cardiomyopathy (DCM) has a higher likelihood of left ventricular reverse remodelling compared with other genetic etiologies.…”