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

JACC-CARDIOVASCULAR IMAGING

卷:8

Article

Badagliacca, Roberto¹  Reali, Manuela¹  Poscia, Roberto¹  Pezzuto, Beatrice¹  Papa, Silvia¹  Mezzapesa, Mario¹  Nocioni, Martina¹  Valli, Gabriele¹  Giannetta, Elisa²  Sciomer, Susanna¹  Iacoboni, Carlo¹  Fedele, Francesco¹  Vizza, Carmine Dario¹ 

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

[2] Univ Roma La Sapienza, Dept Expt Med, I-00161 Rome, Italy

关键词: clinical worsening;    pulmonary arterial hypertension;    right ventricular dyssynchrony;    right ventricular function;   

DOI  :  10.1016/j.jcmg.2015.02.009

来源: Elsevier

【 摘 要 】

OBJECTIVES The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension. BACKGROUND Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy. METHODS In 83 consecutive therapy-naive patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviarion of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-5D4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6MWT]), a second assessment was performed after 12 months or when clinical worsening occurred. RESULTS Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6MWT, right ventricular remodeling, and hemodynamic profile compared with patients <= 18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r(2) = 0.38; p < 0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-5D4 to clinical and hemodynamic variables (WHO IV, 6MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [Cl]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 +/- 4%). CONCLUSIONS Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments. (J Am Coll Cardiol Img 2015;8:642-52) (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

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