Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: Determinants and impact on pump function

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Badagliacca, Roberto¹  Poscia, Roberto¹  Pezzuto, Beatrice¹  Papa, Silvia¹  Gambardella, Cristina¹  Francone, Marco²  Mezzapesa, Mario¹  Nocioni, Martina¹  Nona, Alfred¹  Rosati, Riccardo²  Sciomer, Susanna¹  Fedele, Francesco¹  Vizza, Carmine Dario¹ 

[1] Univ Roma La Sapienza, Dept Cardiovasc & Resp Sci, I-00161 Rome, Italy

[2] Univ Roma La Sapienza, Dept Radiol Sci, I-00161 Rome, Italy

关键词: pulmonary arterial hypertension;    right ventricular function;    right ventricular dyssynchrony;    echocardiography;    2D speckle-tracking echocardiography;    right ventricular wall stress;   

DOI  :  10.1016/j.healun.2014.06.010

来源: Elsevier

【 摘 要 】

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. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free