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Tan XL, Deng Y, Lan WF, Dai P, Hu J, Lan J. Right ventricular dyssynchrony for the prediction of prognosis in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension: a study with two-dimensional speckle tracking. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:967-979. [PMID: 38461202 DOI: 10.1007/s10554-024-03047-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/02/2024] [Indexed: 03/11/2024]
Abstract
Pulmonary arterial hypertension (PAH) is a common complication of systemic lupus erythematosus (SLE), and PAH can cause right ventricle (RV) remodel and dyssynchrony. The aim of this study was to explore the value of RV dyssynchrony in predicting adverse clinical events in patients with systemic lupus erythematosus-aaociated pulmonary arterial hypertension (SLE-PAH) using two-dimensional speckle tracking echocardiography (2D-STE). A total of 53 patients with SLE-PAH were enrolled in this study. The dyssynchrony of the RV (RV-SD6) was evaluated by 2D-STE. The clinical data of all participants were collected, and routine cardiac function parameters were measured by two-dimensional echocardiography, and analyzed for their correlation with RV-SD6. The predictive value of RV-SD6 in clinical adverse event was evaluated. RV-SD6 was negatively correlated with RV-FLS, RV-FAC, and TAPSE (r = - 0.788, r = - 0.363 and r = - 0.325, respectively, all P < 0.01), while the correlation with RV-FLS was the strongest. linear regression analysis showed that RV-FLS was an independent risk factor for RV-SD6 (β = - 1.40, 95% CI - 1.65 ~ - 1.14, P < 0.001). Cox regression analysis showed that RV-SD6 was a predictor with clinical adverse events (HR = 1.03, 95% CI 1 ~ 1.06, P < 0.05). RV-SD6 was highly discriminative in predicting clinical adverse events (AUC = 0.764), at a cutoff of 51.10 ms with a sensitivity of 83.3% and specificity of 68.3%. RV-FLS was negatively correlated with RV-SD6 and was an independent risk factor for it. RV-SD6 can serve as an indicator for predicting the occurrence of adverse clinical events in SLE-PAH patients, with high sensitivity and specificity.
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Affiliation(s)
- Xiao-Lan Tan
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Deng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
- Department of Echocardiography of Cardiovascular Disease Institute, The First Affiliated Hospital of Guangxi Medical University, 6 Shuang Yong Road, Nanning, 530021, China.
| | - Wei-Fang Lan
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ping Dai
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Hu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Lan
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Monzo L, Tupy M, Borlaug BA, Reichenbach A, Jurcova I, Benes J, Mlateckova L, Ters J, Kautzner J, Melenovsky V. Pressure overload is associated with right ventricular dyssynchrony in heart failure with reduced ejection fraction. ESC Heart Fail 2024; 11:1097-1109. [PMID: 38263857 DOI: 10.1002/ehf2.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/19/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
AIMS The determinants and relevance of right ventricular (RV) mechanical dyssynchrony in heart failure with reduced ejection fraction (HFrEF) are poorly understood. We hypothesized that increased afterload may adversely affect the synchrony of RV contraction. METHODS AND RESULTS A total of 148 patients with HFrEF and 36 controls underwent echocardiography, right heart catheterization, and gated single-photon emission computed tomography to measure RV chamber volumes and mechanical dyssynchrony (phase standard deviation of systolic displacement timing). Exams were repeated after preload (N = 135) and afterload (N = 15) modulation. Patients with HFrEF showed higher RV dyssynchrony compared with controls (40.6 ± 17.5° vs. 27.8 ± 9.1°, P < 0.001). The magnitude of RV dyssynchrony in HFrEF correlated with larger RV and left ventricular (LV) volumes, lower RV ejection fraction (RVEF) and LV ejection fraction, reduced intrinsic contractility, increased heart rate, higher pulmonary artery (PA) load, and impaired RV-PA coupling (all P ≤ 0.01). Low RVEF was the strongest predictor of RV dyssynchrony. Left bundle branch block (BBB) was associated with greater RV dyssynchrony than right BBB, regardless of QRS duration. RV afterload reduction by sildenafil improved RV dyssynchrony (P = 0.004), whereas preload change with passive leg raise had modest effect. Patients in the highest tertiles of RV dyssynchrony had an increased risk of adverse clinical events compared with those in the lower tertile [T2/T3 vs. T1: hazard ratio 1.98 (95% confidence interval 1.20-3.24), P = 0.007]. CONCLUSIONS RV dyssynchrony is associated with RV remodelling, dysfunction, adverse haemodynamics, and greater risk for adverse clinical events. RV dyssynchrony is mitigated by acute RV afterload reduction and could be a potential therapeutic target to improve RV performance in HFrEF.
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Affiliation(s)
- Luca Monzo
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique, Nancy, France
| | - Marek Tupy
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Adrian Reichenbach
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Ivana Jurcova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Benes
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Lenka Mlateckova
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jiri Ters
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Celestin BE, Bagherzadeh SP, Ichimura K, Santana EJ, Sanchez PA, Tobore T, Hemnes AR, Vonk Noordegraaf A, Salerno M, Zamanian RT, Sweatt AJ, Haddad F. Identifying consistent echocardiographic thresholds for risk stratification in pulmonary arterial hypertension. Pulm Circ 2024; 14:e12361. [PMID: 38800494 PMCID: PMC11116946 DOI: 10.1002/pul2.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/08/2024] [Indexed: 05/29/2024] Open
Abstract
Several indices of right heart remodeling and function have been associated with survival in pulmonary arterial hypertension (PAH). Outcome analysis and physiological relationships between variables may help develop a consistent grading system. Patients with Group 1 PAH followed at Stanford Hospital who underwent right heart catheterization and echocardiography within 2 weeks were considered for inclusion. Echocardiographic variables included tricuspid annular plane systolic excursion (TAPSE), right ventricular (RV) fractional area change (RVFAC), free wall strain (RVFWS), RV dimensions, and right atrial volumes. The main outcome consisted of death or lung transplantation at 5 years. Mathematical relationships between variables were determined using weighted linear regression and severity thresholds for were calibrated to a 20% 1-year mortality risk. PAH patients (n = 223) had mean (SD) age of 48.1 (14.1) years, most were female (78%), with a mean pulmonary arterial pressure of 51.6 (13.8) mmHg and pulmonary vascular resistance index of 22.5(6.3) WU/m2. Measures of right heart size and function were strongly related to each other particularly RVFWS and RVFAC (R 2 = 0.82, p < 0.001), whereas the relationship between TAPSE and RVFWS was weaker (R 2 = 0.28, p < 0.001). Death or lung transplantation at 5 years occurred in 78 patients (35%). Guided by outcome analysis, we ascertained a uniform set of parameter thresholds for grading the severity of right heart adaptation in PAH. Using these quantitative thresholds, we, then, validated the recently reported REVEAL-echo score (AUC 0.68, p < 0.001). This study proposes a consistent echocardiographic grading system for right heart adaptation in PAH guided by outcome analysis.
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Affiliation(s)
- Bettia E. Celestin
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Shadi P. Bagherzadeh
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Kenzo Ichimura
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Everton J. Santana
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
- Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular EpidemiologyUniversity of LeuvenLeuvenBelgium
| | - Pablo Amador Sanchez
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Tobore Tobore
- Pulmonary Hypertension section, Janssen and JanssenTitusvilleNew JerseyUSA
| | - Anna R. Hemnes
- Division of allergy, Pulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Anton Vonk Noordegraaf
- Pulmonary Hypertension section, Janssen and JanssenTitusvilleNew JerseyUSA
- Department of Pulmonary DiseasesVU University Medical CenterAmsterdamthe Netherlands
| | - Michael Salerno
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Roham T. Zamanian
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Andrew J. Sweatt
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Francois Haddad
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
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Nabeshima Y, Kitano T, Node K, Takeuchi M. Prognostic value of right ventricular free-wall longitudinal strain in patients with pulmonary hypertension: systematic review and meta-analyses. Open Heart 2024; 11:e002561. [PMID: 38325907 PMCID: PMC10860115 DOI: 10.1136/openhrt-2023-002561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction is associated with adverse outcomes in patients with pulmonary hypertension (PH). This systematic review and meta-analysis evaluated the prognostic value of RV free-wall longitudinal strain (RVfwLS), compared with other RV parameters in PH. METHODS We searched for articles presenting the HR of two-dimensional RVfwLS in PH. HRs were standardised using the within-study SD. The ratio of HRs of a 1 SD change in RVfwLS versus systolic pulmonary arterial pressure (SPAP), systolic tricuspid annular velocities (s'-TV), RV fractional area change (FAC) or tricuspid annular plane systolic excursion (TAPSE) was calculated for each study, after which we conducted a random model meta-analysis. Subgroup analysis regarding the type of outcome, aetiology of PH and software vendor was also performed. RESULTS Twenty articles totalling 2790 subjects were included. The pooled HR of a 1 SD decrease of RVfwLS was 1.80 (95% CI: 1.62 to 2.00, p<0.001), and there was a significant association with all-cause death (ACD) and composite endpoints (CEs). The ratio of HR analysis revealed that RVfwLS has a significant, strong association with ACD and CE per 1 SD change, compared with corresponding values of SPAP, s'-TV, RVFAC or TAPSE. RVfwLS was a significant prognostic factor regardless of the aetiology of PH. However, significant superiority of RVfwLS versus other parameters was not observed in group 1 PH. CONCLUSIONS The prognostic value of RVfwLS in patients with PH was confirmed, and RVfwLS is better than other RV parameters and SPAP. Further accumulation of evidence is needed to perform a detailed subgroup analysis for each type of PH. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry (UMIN000052679).
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Affiliation(s)
- Yosuke Nabeshima
- Department of Cardiovascular Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Tetsuji Kitano
- University of Occupational and Environmental Health Japan, Kitakyushu, Fukuoka, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Fukuoka, Japan
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Li W, Zhang XC, Qian YL, Chen XX, Quan RL, Yang T, Xiong CM, Gu Q, He JG. Biventricular intraventricular mechanical and electrical dyssynchrony in pulmonary arterial hypertension. Heliyon 2024; 10:e23352. [PMID: 38163214 PMCID: PMC10755332 DOI: 10.1016/j.heliyon.2023.e23352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background Pulmonary arterial hypertension (PAH) leads to myocardial remodeling, manifesting as mechanical dyssynchrony (M-dys) and electrical dyssynchrony (E-dys), in both right (RV) and left ventricles (LV). However, the impacts of layer-specific intraventricular M-dys on biventricular functions and its association with E-dys in PAH remain unclear. Methods Seventy-nine newly diagnosed patients with PAH undergoing cardiac magnetic resonance scanning were consecutively recruited between January 2011 and December 2017. The biventricular volumetric and layer-specific intraventricular M-dys were analyzed. The QRS duration z-scores were calculated after adjusting for age and sex. Results 77.22 % of patients were female (mean age 30.30 ± 9.79 years; median follow-up 5.53 years). Further, 29 (36.71 %) patients succumbed to all-cause mortality by the end of the study. At the baseline, LV layer-specific intraventricular M-dys had apparent transmural gradients compared with RV in the radial and circumferential directions. However, deceased patients lost the transmural gradients. The LV longitudinal strain rate time to late diastolic peak in the myocardial region (LVmyoLSRTTLDPintra) predicted long-term survival. The Kaplan-Meier curve revealed that patients with PAH with LVmyoLSRTTLDPintra <20.01 milliseconds had a worse prognosis. Larger right ventricle (RV) intraventricular M-dys resulted in worse RV ejection fraction. However, larger LV intraventricular M-dys in the late diastolic phase indicated remarkable exercise capacity and higher LV stroke volume index. E-dys and intraventricular M-dys had no direct correlations. Conclusions The layer-specific intraventricular M-dys had varying impacts on biventricular functions in PAH. PAH patients with LVmyoLSRTTLDPintra <20.01 milliseconds had a worse prognosis. LV intraventricular M-dys in the late diastolic phase needs more attention to precisely evaluate LV function.
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Affiliation(s)
- Wen Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Yu-ling Qian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-xi Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui-lin Quan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yang
- Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang-ming Xiong
- Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Gu
- Emergency Center, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Jian-guo He
- Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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6
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Crossman LM, Rajaram P, Hart CM, Pernetz MA, Sahu A, Jokhadar M, Book WM, Fisher MR, Trammell AW. Evaluation of right ventricular strain in two separate cohorts with precapillary pulmonary hypertension. Pulm Circ 2023; 13:e12204. [PMID: 36883189 PMCID: PMC9985931 DOI: 10.1002/pul2.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/20/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023] Open
Abstract
Evaluation for right ventricular (RV) dysfunction is an important part of risk assessment in care of patients with pulmonary hypertension (PH) as it is associated with morbidity and mortality. Echocardiography provides a widely available and acceptable method to assess RV function. RV global longitudinal strain (RVGLS), a measure of longitudinal shortening of RV deep muscle fibers obtained by two-dimensional echocardiography, was previously shown to predict short-term mortality in patients with PH. The purpose of the current study was to assess the performance of RVGLS in predicting 1-year outcomes in PH. We retrospectively identified 83 subjects with precapillary PH and then enrolled 50 consecutive prevalent pulmonary arterial hypertension (PAH) subjects into a prospective validation cohort. Death as well as combined morbidity and mortality events at 1 year were assessed as outcomes. In the retrospective cohort, 84% of patients had PAH and the overall 1-year mortality rate was 16%. Less negative RVGLS was marginally better than tricuspid annular plane systolic excursion (TAPSE) as a predictor for death. However, in the prospective cohort, 1-year mortality was only 2%, and RVGLS was not predictive of death or a combined morbidity and mortality outcome. This study supports that RV strain and TAPSE have similar 1-year outcome predictions but highlights that low TAPSE or less negative RV strain measures are often false-positive in a cohort with low baseline mortality risk. While RV failure is considered the final common pathway for disease progression in PAH, echocardiographic measures of RV function may be less informative of risk in serial follow-up of treated PAH patients.
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Affiliation(s)
| | | | - Charles Michael Hart
- Emory University Division of PulmonaryAllergy, Critical Care and Sleep MedicineAtlantaGeorgiaUSA
- Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | | | - Anurag Sahu
- Emory University Division of CardiologyAtlantaGeorgiaUSA
| | - Maan Jokhadar
- Emory University Division of CardiologyAtlantaGeorgiaUSA
| | - Wendy M. Book
- Emory University Division of CardiologyAtlantaGeorgiaUSA
| | - Micah R. Fisher
- Emory University Division of PulmonaryAllergy, Critical Care and Sleep MedicineAtlantaGeorgiaUSA
| | - Aaron W. Trammell
- Emory University Division of PulmonaryAllergy, Critical Care and Sleep MedicineAtlantaGeorgiaUSA
- Atlanta VA Health Care SystemDecaturGeorgiaUSA
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7
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Richter MJ, Fortuni F, Alenezi F, D'Alto M, Badagliacca R, Brunner NW, van Dijk AP, Douschan P, Gall H, Ghio S, Giudice FL, Grünig E, Haddad F, Howard L, Rajagopal S, Stens N, Stolfo D, Thijssen DHJ, Vizza CD, Zamanian RT, Zhong L, Seeger W, Ghofrani HA, Tello K. Imaging the right atrium in pulmonary hypertension: A systematic review and meta-analysis. J Heart Lung Transplant 2022; 42:433-446. [PMID: 36610927 DOI: 10.1016/j.healun.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Right atrial (RA) imaging has emerged as a promising tool for the evaluation of patients with pulmonary hypertension (PH), albeit without systematic validation. METHODS PubMed, Web of Science and the Cochrane library were searched for studies investigating the prognostic value of RA imaging assessment in patients with PH from 2000 to June 2021 (PROSPERO Identifier: CRD42020212850). An inverse variance-weighted meta-analysis of univariable hazard ratios (HRs) was performed using a random effects model. RESULTS Thirty-five studies were included (3,476 patients with PH; 74% female, 86% pulmonary arterial hypertension). Risk of bias was low/moderate (Quality of Prognosis Studies checklist). RA area (HR 1.06; 95% confidence interval [CI] 1.04-1.08), RA indexed area (HR 1.09; 95% CI 1.04-1.14), RA peak longitudinal strain (PLS; HR 0.94; 95% CI 0.91-0.97) and RA total emptying fraction (HR 0.96; 95% CI 0.94-0.98) were significantly associated with combined end-points including death, clinical worsening and/or lung transplantation; RA volume and volume index showed marginal significant associations. RA area (HR 1.06; 95% CI 1.04-1.07), RA indexed area (HR 1.12; 95% CI 1.07-1.17) and RA PLS (HR 0.98; 95% CI 0.97-0.99) showed significant associations with mortality; RA total emptying fraction showed a marginal association. CONCLUSIONS Imaging-based RA assessment qualifies as a relevant prognostic marker in PH. RA area reliably predicts composite end-points and mortality, which underscores its clinical utility. RA PLS emerged as a promising imaging measure, but is currently limited by the number of studies and different acquisition methods.
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Affiliation(s)
- Manuel J Richter
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany.
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fawaz Alenezi
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Michele D'Alto
- Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Nathan W Brunner
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arie P van Dijk
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philipp Douschan
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Henning Gall
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Lo Giudice
- National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxclinic Heidelberg GmbH at Heidelberg University Hospital, Heidelberg, Germany
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Luke Howard
- National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
| | - Sudarshan Rajagopal
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Niels Stens
- Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Davide Stolfo
- Department of Cardiology, Azienda Sanitaria Universitaria Integrata, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dick H J Thijssen
- Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Carmine Dario Vizza
- Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Italy
| | - Roham T Zamanian
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, California, USA
| | - Liang Zhong
- National Heart Centre Singapore, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; Research on Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Werner Seeger
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany
| | - Hossein A Ghofrani
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany; Department of Medicine, Imperial College London, London, UK
| | - Khodr Tello
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Cardio-Pulmonary Institute (CPI), Institute for Lung Health (ILH), Justus-Liebig University, Giessen, Germany
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Yacoub MH, Nagy M, Hosny H, Afifi A, Shehata N, Mahgoub A, El Sawy A, Sabry M, Abdullah H, Romeih S, Elafifi A. Right ventricular structure and function after novel repair of common arterial trunk. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Adachi S, Nakano Y, Furusawa K. Right Ventricular Dyssynchrony Casts New Light on the Risk Stratification and Prediction of Prognosis in Patients With Pulmonary Hypertension. Circ J 2022; 86:945-946. [DOI: 10.1253/circj.cj-22-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shiro Adachi
- Department of Cardiology, Nagoya University Hospital
| | - Yoshihisa Nakano
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Kenji Furusawa
- Department of Clinical Laboratory, Nagoya University Hospital
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10
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Yamagata Y, Ikeda S, Kojima S, Ueno Y, Nakata T, Koga S, Ohno C, Yonekura T, Yoshimuta T, Minami T, Kawano H, Maemura K. Right Ventricular Dyssynchrony in Patients With Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension. Circ J 2022; 86:936-944. [DOI: 10.1253/circj.cj-21-0849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yuki Yamagata
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Sanae Kojima
- Ultrasound Diagnostic Center, Nagasaki University Hospital
| | - Yuki Ueno
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Tomoo Nakata
- Department of Cardiology, Saiseikai Nagasaki Hospital
| | - Seiji Koga
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Chikara Ohno
- Ultrasound Diagnostic Center, Nagasaki University Hospital
| | - Tsuyoshi Yonekura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Tsuyoshi Yoshimuta
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Takako Minami
- Ultrasound Diagnostic Center, Nagasaki University Hospital
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
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11
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Demirci M, Ozben B, Sunbul M, Cincin A, Gurel YE, Bayram Guctekin T, Dogan Z, Sahinkaya Y, Direskeneli H, Tigen K, Sayar N. The evaluation of right ventricle dyssynchrony by speckle tracking echocardiography in systemic sclerosis patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:895-902. [PMID: 34259351 DOI: 10.1002/jcu.23041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Systemic sclerosis (SSc) is associated with right ventricle (RV) remodeling and dysfunction. The primary aim of this study was to evaluate RV dyssynchrony (RV-Dys) in SSc patients using two-dimensional speckle tracking echocardiography (2D-STE). METHODS Fifty-five SSc patients with functional class I-II and 45 healthy controls were consecutively included and underwent 2D-STE. RV-Dys was defined as the standard deviation of time to peak strain of mid and basal segments of RV free wall and interventricular septum. SSc group was further classified according to the presence of pulmonary arterial hypertension (PAH). Patients with tricuspid regurgitant velocity >2.8 m/s with additional echocardiographic PAH signs were defined as SSc PAH (+). RESULTS SSc patients had lower RV longitudinal strain (RV-LS) (-17.6 ± 4.6% vs. -20.8 ± 2.8%, p < 0.001) and greater RV-Dys (49.9 ± 25.4 ms vs 24.3 ± 11.8 ms, p = 0.006) than controls despite no significant difference in conventional echocardiographic variables regarding RV function. Although SSc PAH(+) patients had lower RV-LS and higher RV-Dys than SSc PAH(-) patients, the differences were not statistically significant. The only independent predictor of RV-Dys was RV-LS (β:-0.324 [-3.89- -0.45]; p = 0.014). CONCLUSION SSc patients had not only reduced RV-LS but also impaired RV synchronicity even as conventional echocardiographic variables were preserved.
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Affiliation(s)
- Murat Demirci
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Beste Ozben
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Altug Cincin
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yusuf Emre Gurel
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tuba Bayram Guctekin
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Zekeriya Dogan
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin Sahinkaya
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kursat Tigen
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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12
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Clinical Significance of Right Ventricular Function in Pulmonary Hypertension. Keio J Med 2021; 70:60-67. [PMID: 33456013 DOI: 10.2302/kjm.2020-0015-ir] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease characterized by increased pulmonary vascular resistance that leads to right ventricular (RV) failure, a condition that determines its prognosis. This review focuses on the clinical value of the evaluation of RV function in PH. First, the pathophysiology of PH, including hemodynamics, RV function, and their interaction (known as ventriculoarterial coupling), are summarized. Next, non-invasive imaging modalities and the parameters of RV function, mainly assessed by echocardiography, are reviewed. Finally, the clinical impacts of RV function in PH are described. This review will compare the techniques that yield comprehensive information on RV function and their roles in the assessment of PH.
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13
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Zhong SW, Zhang YQ, Chen LJ, Zhang ZF, Wu LP, Hong WJ. Ventricular function and dyssynchrony in children with a functional single right ventricle using real time three-dimensional echocardiography after fontan operation. Echocardiography 2021; 38:1218-1227. [PMID: 34156720 DOI: 10.1111/echo.15148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and clinical value of real time three-dimensional echocardiography (RT-3DE) for assessing ventricular systolic dysfunction and dyssynchrony in children with an functional single right ventricle (FSRV) having undergone the Fontan procedure. METHODS Twenty-five children with an FSRV and 25 healthy children were enrolled in our study. RV volume analysis was performed compared with magnetic resonance imaging (MRI) as the reference standard in FSRV patients. The patients were divided into wide and narrow QRS interval groups. Global and regional functions of the RV in three compartments (inflow, body, and outflow) were compared between FSRV and control subjects, including RV systolic dyssynchrony indices of maximal difference of time to minimal volume (Tmsv-Dif), standard deviation of time to minimal volume (Tmsv-SD), maximal difference of time to minimal volume corrected by R-R interval (Tmsv-Dif%), and standard deviation of time to minimal volume corrected by R-R interval (Tmsv-SD%). RESULTS RT-3DE measurements were significantly lower than MRI measurements for RV-EDV, RV-ESV, RV-SV, and RVEF (p < 0.01).Compared with controls, patients with an FRSV had significantly higher dyssynchrony indices and significantly lower global EF in both narrow QRS interval and wide QRS interval groups. Tmsv-SD% was shown to be most strongly correlated with MRI-RVEF (r = -.570, p = 0.003). CONCLUSIONS RT-3DE tended to underestimate RV ventricular volume in children with FSRV. Children with an FSRV and either a wide or narrow QRS interval had reduced ventricular function and higher dyssynchrony than normal subjects. Worsening RV dyssynchrony is associated with overall decline in function after the Fontan operation.
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Affiliation(s)
- Shu-Wen Zhong
- International Department, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Qi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Jun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Fang Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan-Ping Wu
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Jing Hong
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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14
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Lai J, Guo X, Zhao J, Wang H, Tian Z, Wang Q, Li M, Fang Q, Fang L, Liu Y, Zeng X. Interventricular systolic asynchrony predicts prognosis in patients with systemic sclerosis-associated pulmonary arterial hypertension. Rheumatology (Oxford) 2021; 61:983-991. [PMID: 34057459 DOI: 10.1093/rheumatology/keab465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a serious complication of systemic sclerosis (SSc) with high mortality. Interventricular systolic asynchrony (IVSA) is observed in PAH patients, but the effect of IVSA and its association with long-term mortality and clinical events in SSc-associated PAH are unclear. This study aimed to investigate the impact of IVSA on the prognosis of SSc-associated PAH. METHODS Between March 2010 and July 2018, a total of 60 consecutive patients with SSc-associated PAH were enrolled. The end point was a composite of all-cause mortality and clinical worsening. Asynchrony was assessed by colour-coded tissue Doppler imaging (TDI) echocardiography. The myocardial sustained systole curves (Sm) of the basal portion of the right ventricular (RV) free wall and left ventricular (LV) lateral wall were obtained. IVSA was defined as the time difference from the onset of the QRS complex to the end of Sm between LV and RV. RESULTS Patients with greater IVSA time differences presented with advanced pulmonary vascular resistance (PVR). The IVSA time difference was an independent predictive factor (HR = 1.018, 95% CI 1.005-1.031, p = 0.005) for the composite end point and was significantly associated with PVR (r = 0.399, R2=0.092, p = 0.002). Kaplan-Meier survival curves showed that patients with greater IVSA had worse prognoses (log-rank p = 0.001). CONCLUSION In conclusion, IVSA analyzed by colour-coded TDI echocardiography provided added value as a noninvasive, easy-to-use approach for assessing the prognosis of patients with SSc-associated PAH. A significant IVSA time difference identifies the subgroup of patients at high risk of a poor prognosis.
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Affiliation(s)
- Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Hui Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Ligang Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
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15
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Fraser AG, Bijnens BH, Friedberg MK. Understanding right ventricular dyssynchrony: Its myriad determinants and clinical relevance. Exp Physiol 2021; 106:797-800. [PMID: 33599973 DOI: 10.1113/ep089366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/11/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Alan G Fraser
- School of Medicine, Cardiff University, Cardiff, UK.,Department of Cardiology, University Hospital of Wales, Cardiff, UK.,Cardiovascular Imaging and Dynamics, Catholic University of Leuven, Leuven, Belgium
| | - Bart H Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Mark K Friedberg
- Labatt Family Heart Centre, Division of Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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16
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Baba M, Yoshida K, Hanaki Y, Yamamoto M, Shinoda Y, Takeyasu N, Nogami A. Upgrade of cardiac resynchronization therapy by utilizing additional His-bundle pacing in patients with inotrope-dependent end-stage heart failure: a case series. Eur Heart J Case Rep 2021; 4:1-9. [PMID: 33447714 PMCID: PMC7793217 DOI: 10.1093/ehjcr/ytaa303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/30/2019] [Accepted: 08/11/2020] [Indexed: 11/13/2022]
Abstract
Background His-bundle pacing (HBP) alone may become an alternative to conventional cardiac resynchronization therapy (CRT) utilizing right ventricular apical (RVA) and left ventricular (LV) pacing (BiVRVA+LV) in selected patients, but the effects of CRT utilizing HBP and LV pacing (BiVHB+LV) on cardiac resynchronization and heart failure (HF) are unclear. Case summary We presented two patients with inotrope-dependent end-stage HF in whom the upgrade from conventional BiVRVA+LV to BiVHB+LV pacing by the addition of a lead for HBP improved their HF status. Patient 1 was a 32-year-old man with lamin A/C cardiomyopathy, atrial fibrillation, and complete atrioventricular (AV) block. Patient 2 was a 70-year-old man with ischaemic cardiomyopathy complicated by AV block and worsening of HF resulting from ablation for ventricular tachycardia storm. The HF status of both patients improved dramatically following the upgrade from BiVRVA+LV to BiVHB+LV pacing. Discussion End-stage HF patients suffer from diffuse intraventricular conduction defect not only in the LV but also in the right ventricle (RV). The resulting dyssynchrony may not be sufficiently corrected by conventional BiVRVA+LV pacing or HBP alone. Right ventricular apical pacing itself may also impair RV synchrony. An upgrade to BiVHB+LV pacing could be beneficial in patients who become non-responsive to conventional BiV pacing as the His–Purkinje conduction defect progresses.
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Affiliation(s)
- Masako Baba
- Department of Cardiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yuichi Hanaki
- Department of Cardiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yasutoshi Shinoda
- Department of Cardiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.,Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Noriyuki Takeyasu
- Department of Cardiology, Ibaraki Prefectural Central Hospital, 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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17
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Ewalts M, Dawkins T, Boulet LM, Thijssen D, Stembridge M. The influence of increased venous return on right ventricular dyssynchrony during acute and sustained hypoxaemia. Exp Physiol 2020; 106:925-937. [PMID: 33369788 DOI: 10.1113/ep088657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Right ventricular dyssynchrony is a marker of function that is elevated in healthy individuals exposed to acute hypoxia, but does it remain elevated during sustained exposure to high altitude hypoxia, and can it be normalised by augmenting venous return? What is the main finding and its importance? For the first time it is demonstrated that (i) increasing venous return in acute hypoxia restores the synchrony of right ventricular contraction and (ii) dyssynchrony is evident after acclimatisation to high altitude, and remains sensitive to changes in venous return. Therefore, the interpretation of right ventricular dyssynchrony requires consideration the prevailing haemodynamic state. ABSTRACT Regional heterogeneity in timing of right ventricular (RV) contraction (RV dyssynchrony; RVD) occurs when pulmonary artery systolic pressure (PASP) is increased during acute hypoxia. Interestingly, RVD is not observed during exercise, a stimulus that increases both PASP and venous return. Therefore, we hypothesised that RVD in healthy humans is sensitive to changes in venous return, and examined whether (i) increasing venous return in acute hypoxia lowers RVD and (ii) if RVD is further exaggerated in sustained hypoxia, given increased PASP is accompanied by decreased ventricular filling at high altitude. RVD, PASP and right ventricular end-diastolic area (RVEDA) were assessed using transthoracic two-dimensional and speckle-tracking echocardiography during acute normobaric hypoxia ( F i O 2 = 0.12) and sustained exposure (5-10 days) to hypobaric hypoxia (3800 m). Venous return was augmented with lower body positive pressure at sea level (LBPP; +10 mmHg) and saline infusion at high altitude. PASP was increased in acute hypoxia (20 ± 6 vs. 28 ± 7, P < 0.001) concomitant to an increase in RVD (18 ± 7 vs. 38 ± 10, P < 0.001); however, the addition of LBPP during hypoxia decreased RVD (38 ± 0 vs. 26 ± 10, P < 0.001). Sustained hypoxia increased PASP (20 ± 4 vs. 26 ± 5, P = 0.008) and decreased RVEDA (24 ± 4 vs. 21 ± 2, P = 0.042), with RVD augmented (14 ± 5 vs. 31 ± 12, P = 0.001). Saline infusion increased RVEDA (21 ± 2 vs. 23 ± 3, P = 0.008) and reduced RVD (31 ± 12 vs. 20 ± 9, P = 0.001). In summary, an increase in PASP secondary to acute and sustained exposure to hypoxia augments RVD, which can be at least partly reduced via increased venous return.
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Affiliation(s)
- Michiel Ewalts
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.,Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - Tony Dawkins
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Lindsey M Boulet
- Centre for Heart Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | - Dick Thijssen
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - Mike Stembridge
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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18
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Murata M, Kawakami T, Kataoka M, Moriyama H, Hiraide T, Kimura M, Endo J, Kohno T, Itabashi Y, Fukuda K. Clinical Significance of Guanylate Cyclase Stimulator, Riociguat, on Right Ventricular Functional Improvement in Patients with Pulmonary Hypertension. Cardiology 2020; 146:130-136. [PMID: 33238268 DOI: 10.1159/000510860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Riociguat is a soluble guanylate cyclase stimulator that improves hemodynamics in patients with pulmonary hypertension (PH). Accumulating evidence implicates the additional effect of riociguat on the increase in cardiac output. However, its mechanisms have not been fully understood. This study aimed to investigate whether riociguat could ameliorate right ventricular (RV) contraction as well as hemodynamics. METHODS We studied 45 patients with pulmonary arterial hypertension (14) or chronic thromboembolic pulmonary hypertension (31) and evaluated hemodynamics, using right-sided heart catheterization, before and after the administration of riociguat. RV function was assessed by echocardiography, including speckle-tracking echocardiography. RESULTS Riociguat significantly improved the WHO functional class and reduced the mean pulmonary arterial pressure and vascular resistance. In addition, the cardiac index increased. RV remodeling was ameliorated after riociguat administration as assessed by the echocardiographic parameters, such as RV diameter and RV area index. RV function, including RV fractional area change and RV global longitudinal strain, also significantly improved, and their improvement was even observed in patients with mild PH after pulmonary endarterectomy or balloon pulmonary angioplasty. Furthermore, covariance analysis revealed that RV global longitudinal strain and RV fractional area change improved after riociguat administration, even with the same mean pulmonary arterial pressure, implicating the improvement of RV contractile function by riociguat, regardless of RV loading. CONCLUSIONS Riociguat not only improved the hemodynamics of patients with PH but also ameliorated the echocardiographic parameters with RV function. RV strain could detect the subtle improvement in mild PH, and riociguat may have a benefit even after intervention, as assessed by speckle-tracking echocardiography.
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Affiliation(s)
- Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan, .,Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan,
| | - Takashi Kawakami
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Masaharu Kataoka
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hidenori Moriyama
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takahiro Hiraide
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Mai Kimura
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Jin Endo
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, Kyorin University, School of Medicine, Tokyo, Japan
| | - Yuji Itabashi
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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19
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Acute effects of intravenous pimobendan administration in dog models of chronic precapillary pulmonary hypertension. J Vet Cardiol 2020; 32:16-27. [PMID: 33080489 DOI: 10.1016/j.jvc.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Pulmonary hypertension (PH) is a progressive and potentially life-threatening disease. Several drugs are used for the treatment of dogs with precapillary PH. Pimobendan is an inotropic drug with phosphodiesterase 3 inhibitory and calcium-sensitizing effects. Pimobendan administration improved right ventricular (RV) function and lowered pulmonary arterial pressure in some human patients with precapillary PH. However, the efficacy of pimobendan in dogs with precapillary PH is unknown. ANIMALS, MATERIAL, AND METHODS An implantable port device was percutaneously placed in the cranial vena cava of five laboratory beagles. Chronic embolic precapillary PH was induced via the repeated injection of microspheres every 1-2 days. Microsphere injection was continued until systolic pulmonary arterial pressure reached 50 mmHg. Right heart catheterization and echocardiography were performed at baseline and after injections of placebo and pimobendan (0.15 mg/kg). RESULTS Repeated injections of microspheres caused an increase in pulmonary vascular resistance, a decrease in stroke volume, RV dilation, left ventricular (LV) and RV dysfunction, and RV dyssynchrony as assessed using echocardiography. Compared with placebo, pimobendan improved LV and RV function based on the LV Tei index from 0.48 to 0.38 (p=0.002) and the RV Tei index from 0.76 to 0.61 (p=0.008), as well as the stroke volume index from 29.4 to 36.7 ml/m2 (p=0.012), respectively. CONCLUSIONS In dog models of chronic PH, intravenous pimobendan effectively improved RV and LV function and increased stroke volume. However, pimobendan administration did not decrease pulmonary arterial pressure or produce hypotension.
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20
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Yang Y, Liu C, Tian J, Ding X, Yu S, Bian S, Yang J, Qin Z, Zhang J, Ke J, Yuan F, Zhang C, Rao R, Huang L. Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts. Front Physiol 2020; 11:703. [PMID: 32714205 PMCID: PMC7343894 DOI: 10.3389/fphys.2020.00703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/28/2020] [Indexed: 01/29/2023] Open
Abstract
The aims of this study were to explore the effect of high-altitude (HA) exposure on the incidence, determinants, and impacts of right ventricular dyssynchrony (RVD). In our study, 108 healthy young men were enrolled, and physiological and echocardiographic variables were recorded at both sea level and 4,100 m. By using two-dimensional speckle-tracking echocardiography, RVD was evaluated by calculating the R–R interval-corrected standard deviation of the time-to-peak systolic strain for the four mid-basal RV segments (RVSD4) and defined by RVSD4 > 18.7 ms. After HA exposure, RVSD4 was significantly increased, and the incidence of RVD was approximately 32.4%. Subjects with RVD showed lower oxygen saturation (SaO2) and RV global longitudinal strain and higher systolic pulmonary artery pressure than those without RVD. Moreover, myocardial acceleration during isovolumic contraction was increased in all subjects and those without RVD, but not in those with RVD. Multivariate logistic regression revealed that SaO2 is an independent determinant of RVD at HA (odds ratio: 0.72, 95% CI: 0.56–0.92; P = 0.009). However, the mean pulmonary artery pressure was linearly correlated with the magnitude of RVD in the presence of Notch. No changes were found in RV fractional area change, tricuspid annular motion, or tricuspid s’ velocity between subjects with and without RVD. Collectively, we demonstrated for the first time that HA exposure could induce RVD in healthy subjects, which may be mainly attributed to the decline in SaO2 as well as RV overload; the incidence of RVD was associated with reduced RV regional function and blunted myocardial acceleration.
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Affiliation(s)
- Yuanqi Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingdu Tian
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaohan Ding
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Shiyong Yu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shizhu Bian
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhexue Qin
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jihang Zhang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbin Ke
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fangzhengyuan Yuan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chen Zhang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Rongsheng Rao
- Department of Medical Ultrasonics, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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21
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Cheng XL, Liu BY, Wu WC, Li W, Huang L, Yang T, Liu ZH, Wang H, He JG, Xiong CM. Impact of right ventricular dyssynchrony on prognosis of patients with idiopathic pulmonary arterial hypertension. Pulm Circ 2019; 9:2045894019883609. [PMID: 31692686 PMCID: PMC6811764 DOI: 10.1177/2045894019883609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/29/2019] [Indexed: 02/05/2023] Open
Abstract
Idiopathic pulmonary arterial hypertension is a progressive disease with high mortality with an increasing burden of right ventricular. Right ventricular dyssynchrony was observed in idiopathic pulmonary arterial hypertension, but the association with mortality is unclear. This study aimed to investigate the impact of right ventricular dyssynchrony on the survival of idiopathic pulmonary arterial hypertension. A total of 116 patients with idiopathic pulmonary arterial hypertension were enrolled in this study. All these patients underwent comprehensive clinical evaluation. Right ventricular dyssynchrony was assessed by two-dimensional speckle-tracking echocardiography. The time to peak strain (Tpeak) of right ventricular segments were obtained. Right ventricular dyssynchrony was quantified by the standard deviation of the heart rate-corrected Tpeak of right ventricular four segments. All patients were followed up and the primary endpoint was all cause of death. Results found patients with significant right ventricular dyssynchrony present with advanced World Health Organization functional class, worse hemodynamic status and right ventricular function. Right ventricular dyssynchrony was an independent predictive factor for the survival of idiopathic pulmonary arterial hypertension. Kaplan–Meier survival curves showed patients with right ventricular dyssynchrony had worse prognosis. In conclusion, right ventricular dyssynchrony analyzed by speckle-tracking echocardiography provided added value to hemodynamic and echocardiographic parameters in evaluating the survival of patients with idiopathic pulmonary arterial hypertension.
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Affiliation(s)
- Xiao-Ling Cheng
- Department of Internal Medicine (General Medicine), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bing-Yang Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Chun Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Hong Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Guo He
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang-Ming Xiong
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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22
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Right Ventricular Mechanical Dyssynchrony in Hypoplastic Left Heart Syndrome: Correlation with Systolic Function and QRS Duration. Pediatr Cardiol 2019; 40:934-942. [PMID: 30895330 DOI: 10.1007/s00246-019-02091-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
The single right ventricle (RV) in hypoplastic left heart syndrome (HLHS) often develops systolic dysfunction with time and this affects prognosis. Mechanical dyssynchrony has been reported in HLHS but has not consistently correlated with systolic function or electrical dyssynchrony. The aims of this study were to assess the relationship between RV mechanical dyssynchrony, RV systolic function, and QRS duration on surface electrocardiography. We hypothesized that surface QRS duration would not be an adequate indicator of mechanical dyssynchrony compared with dyssynchrony parameters. Retrospective analysis of echocardiograms of patients with HLHS divided into preserved vs reduced RV function. We measured two RV function parameters: (1) fractional area change (FAC) and (2) global longitudinal strain (RVGLS). We measured two dyssynchrony parameters: (1) the standard deviation of the time to peak strain for 9 segments (tPS-9) and (2) time difference between the earliest and latest time to peak strain (RV dyssynchrony index or RVDI) both corrected for R-R interval. We also measured the QRS duration from surface EKG. Mechanical dyssynchrony parameters were compared to both RV systolic function and to QRS duration. 41 patients with HLHS were identified: 21 had preserved function and 20 had reduced function defined by a FAC < 35%. The reduced function group had a significantly lower mean FAC and RVGLS. RVDI was higher in the dysfunction group and had a modest correlation with FAC (r = 0.48) and RVGLS (r = 0.57). tPS-9 was longer in the dysfunction group and had a modest correlation with FAC (r = 0.45) and RVGLS (r = 0.57). QRS duration was longer in the dysfunction group and had a modest correlation with FAC (r = 0.56) and RVGLS (r = 0.56). The weakest correlations were between QRS duration and tPS-9 (r = 0.32) and QRS duration and RVDI (r = 0.10). RV dysfunction measured by FAC was associated with mechanical dyssynchrony measured by increased RVDI and tPS-9. QRS duration was longer in the group with dysfunction but did not correlate with directly measured mechanical dyssynchrony. This may have potential implications for cardiac resynchronization therapy in univentricular patients as assessed by mechanical dyssynchrony parameters rather than QRS duration alone.
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23
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Right ventricular function and dyssynchrony measured by echocardiography in dogs with precapillary pulmonary hypertension. J Vet Cardiol 2019; 23:1-14. [PMID: 31174719 DOI: 10.1016/j.jvc.2018.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 11/27/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Assessment of the right ventricular (RV) function by echocardiography is important in dogs with pulmonary hypertension (PH). Few reports are available on RV function and dyssynchrony in dogs, especially in the context of precapillary PH. ANIMALS The study included 79 client-owned dogs: 25 dogs with precapillary PH and 54 control dogs. METHODS Dogs with precapillary PH were prospectively enrolled between December 2013 and February 2017. The echocardiographic indices of RV function, including RV strain and the dyssynchrony index by speckle-tracking echocardiography, were measured. Multivariate analysis was used to determine independent predictors of the RV dyssynchrony index. RESULTS Dogs with precapillary PH showed RV dilation, hypertrophy and right atrial dilation. Impaired echocardiographic indices of RV function, including RV strain, were observed. In addition, RV dyssynchrony occurred in dogs with precapillary PH. Multivariate analysis revealed that tricuspid regurgitation velocity and RV dilation were independent predictors of the RV dyssynchrony index. CONCLUSIONS Echocardiographic RV function indices are impaired in dogs with precapillary PH. In addition, RV dilation and elevated systolic pulmonary arterial pressure estimated by echocardiography are associated with RV dyssynchrony.
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24
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Massolo AC, Paria A, Hunter L, Finlay E, Davis CF, Patel N. Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia. Neonatology 2019; 116:68-75. [PMID: 31085915 DOI: 10.1159/000499347] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is an important cause of mortality and morbidity in the neonatal period. Pulmonary hypertension and pulmonary hypoplasia are key pathological findings. Cardiac function may also be an important determinant of disease severity, prognostic indicator, and therapeutic target in CDH. OBJECTIVE The aim of this study was to assess ventricular mechanics and synchrony in infants with CDH and controls using speckle tracking echocardiography (STE). METHODS Retrospective analysis was performed of echocardiograms obtained in the first 48 h of life in 27 infants with CDH and 20 controls. STE-derived longitudinal strain (LS) was measured in the right and left ventricles (RV, LV). Circumferential strain (CS) and radial strain (RS) were additionally measured in the LV. Mechanical dispersion (MD), a measure of synchrony, was assessed by calculation of the standard deviation of time to peak systolic strain in six ventricular segments. RESULTS RV LS and LV LS, LV CS, and LV RS were significantly reduced in CDH compared to controls. In the LV free wall, LS and RS were significantly reduced in CDH. LV LS correlated significantly with RV LS in CDH cases (r2 = 0.37, p = 0.002), but not controls (r2 = 0.19, p = 0.06). LV LS also correlated with LV MD in CDH (r2 = 0.25, p = 0.01) but not controls (r2 = 0.02, p = 0.54). CONCLUSIONS Global impairment of RV and LV systolic function are present in newborn infants with CDH and are associated with primary left ventricular dysfunction, ventricular interdependence, and MD.
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Affiliation(s)
- Anna Claudia Massolo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy,
| | - Anshuman Paria
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Lindsey Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Emma Finlay
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Carl F Davis
- Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, United Kingdom
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
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25
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Morita T, Nakamura K, Osuga T, Yokoyama N, Morishita K, Sasaki N, Ohta H, Takiguchi M. Effect of acute volume overload on echocardiographic indices of right ventricular function and dyssynchrony assessed by use of speckle tracking echocardiography in healthy dogs. Am J Vet Res 2019; 80:51-60. [DOI: 10.2460/ajvr.80.1.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Hulshof HG, Eijsvogels TMH, Kleinnibbelink G, van Dijk AP, George KP, Oxborough DL, Thijssen DHJ. Prognostic value of right ventricular longitudinal strain in patients with pulmonary hypertension: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2018; 20:475-484. [DOI: 10.1093/ehjci/jey120] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/04/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hugo G Hulshof
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Phililps van Leijdenlaan 15, EX Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Phililps van Leijdenlaan 15, EX Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 3 Byrom Street, Liverpool, UK
| | - Geert Kleinnibbelink
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Phililps van Leijdenlaan 15, EX Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 3 Byrom Street, Liverpool, UK
| | - Arie P van Dijk
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Phililps van Leijdenlaan 15, EX Nijmegen, The Netherlands
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 3 Byrom Street, Liverpool, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 3 Byrom Street, Liverpool, UK
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Phililps van Leijdenlaan 15, EX Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 3 Byrom Street, Liverpool, UK
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27
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Pezzuto B, Forton K, Badagliacca R, Motoji Y, Faoro V, Naeije R. Right ventricular dyssynchrony during hypoxic breathing but not during exercise in healthy subjects: a speckle tracking echocardiography study. Exp Physiol 2018; 103:1338-1346. [PMID: 30055062 DOI: 10.1113/ep087027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/27/2018] [Indexed: 12/31/2022]
Abstract
NEW FINDINGS What is the central question of this study? Right ventricular dyssynchrony in severe pulmonary hypertension is associated with a poor prognosis. However, it has recently been observed in patients with lung or connective tissue disease and pulmonary artery pressure at the upper limits of normal. The mechanisms of right ventricular dyssynchrony in pulmonary hypertension remain uncertain. What is the main finding and its importance? Acute hypoxic breathing, but not normoxic exercise, induces an increase in right ventricular dyssynchrony detected by speckle tracking echocardiography in healthy subjects. These results add new insights into the determinants of right ventricular dyssynchrony, suggesting a role for systemic factors added to afterload in the pathophysiology of right ventricular inhomogeneity of contraction. ABSTRACT Pulmonary hypertension (PH) has been shown to be associated with regional inhomogeneity (or dyssynchrony) of right ventricular (RV) contraction. Right ventricular dyssynchrony is an independent predictor of decreased survival in advanced PH, but has also been reported in patients with only mildly elevated pulmonary artery pressure (PAP). The mechanisms of RV dyssynchrony in PH remain uncertain. Our aim was to evaluate RV regional function in healthy subjects during acute hypoxia and during exercise. Seventeen healthy subjects (24 ± 6 years) underwent a speckle tracking echocardiography of the RV at rest in normoxia and every 15 min during a 60 min exposure to hypoxic breathing ( F I O 2 12%). Ten of the subjects also underwent an incremental cycle ergometry in normoxia to 100 W, with the same echocardiographic measurements. Dyssynchrony was measured as the SD of the times to peak systolic strain of the four basal and mid RV segments corrected for the heart rate (RV-SD4). RV-SD4 increased during hypoxia from 12 ± 7 to 22 ± 11 ms in spite of mild increases in mean PAP (mPAP) from 15 ± 2 to 20 ± 2 mmHg and pulmonary vascular resistance (PVR) from 1.18 ± 0.15 to 1.4 ± 0.15 Wood units (WU). During exercise RV-SD4 did not significantly change (from 12 ± 6 ms to 14 ± 6 ms), while mPAP increased to 25 ± 2 mmHg and PVR was unchanged. These data show that in healthy subjects, RV contraction is inhomogeneous in hypoxia but not during exercise. Since PAP increases more during exercise, RV dyssynchrony in hypoxia may be explained by a combination of mechanical (RV afterload) and systemic (hypoxia) factors.
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Affiliation(s)
- Beatrice Pezzuto
- Department of Exercise Physiology; Faculty of Motor Sciences, Université Libre de Bruxelles; Route de Lennik 808 Bruxelles Belgium
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome; Rome Italy
| | - Kevin Forton
- Department of Exercise Physiology; Faculty of Motor Sciences, Université Libre de Bruxelles; Route de Lennik 808 Bruxelles Belgium
| | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Sciences, Sapienza University of Rome; Rome Italy
| | - Yoshiki Motoji
- Department of Exercise Physiology; Faculty of Motor Sciences, Université Libre de Bruxelles; Route de Lennik 808 Bruxelles Belgium
| | - Vitalie Faoro
- Department of Exercise Physiology; Faculty of Motor Sciences, Université Libre de Bruxelles; Route de Lennik 808 Bruxelles Belgium
| | - Robert Naeije
- Department of Exercise Physiology; Faculty of Motor Sciences, Université Libre de Bruxelles; Route de Lennik 808 Bruxelles Belgium
- Department of Cardiology, Erasme University Hospital of Brussels; Route de Lennik 808 Bruxelles Belgium
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28
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Kamimura Y, Okumura N, Adachi S, Shimokata S, Tajima F, Nakano Y, Hirashiki A, Murohara T, Kondo T. Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension. Heart Vessels 2018; 33:1220-1228. [PMID: 29704099 PMCID: PMC6133067 DOI: 10.1007/s00380-018-1168-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/20/2018] [Indexed: 12/12/2022]
Abstract
Right ventricular (RV) function is associated with prognosis in chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to establish an RV dysfunction score using RV echocardiographic parameters to clarify the clinical characteristics in patients with CTEPH and to compare RV dysfunction score with parameters such as World Health Organization (WHO) functional class, hemodynamics, exercise capacity, and plasma BNP level. We enrolled 35 inpatients with CTEPH (mean age, 62 ± 15 years, 15 males). We constructed ‘an RV dysfunction score’ calculated as the summation of each point awarded for the presence of four parameters: tricuspid annular plane systolic excursion (TAPSE) < 16 mm, 1 point; tissue Doppler-derived tricuspid lateral annular systolic velocity (S′) < 10 cm/s, 1 point; right ventricular fractional area change (RVFAC) < 35%, 1 point; and right ventricular myocardial performance index (RV-MPI) > 0.4, 1 point. TAPSE, S′, RVFAC, and RV-MPI was 18.7 ± 4.8 mm, 11.9 ± 3.1 cm/s, 33.5 ± 13.9%, and 0.39 ± 0.2, respectively. The RV dysfunction score was associated with symptom [WHO functional class (p = 0.026)], hemodynamics [mean PAP (p = 0.01), cardiac index (p = 0.009), pulmonary vascular resistance (p = 0.001), and SvO2 (p = 0.039)], exercise capacity [6-min walk distance (p = 0.046), peakVO2 (p = 0.016), and VE/VCO2 slope (p = 0.031)], and plasma BNP level (p = 0.005). This RV dysfunction score using the four RV echocardiographic parameters could be a simple and useful scoring system to evaluate prognostic factors in patients with CTEPH.
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Affiliation(s)
- Yoshihiro Kamimura
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Naoki Okumura
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan
| | - Shiro Adachi
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan
| | - Shigetake Shimokata
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Fumitaka Tajima
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Yoshihisa Nakano
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Akihiro Hirashiki
- Department of Cardiology, National Center for Geriatrics and Gerontology, Morioka-cho 7-430, Obu, 474-8511, Japan
| | - Toyoaki Murohara
- Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan
| | - Takahisa Kondo
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8560, Japan.
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29
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Dandel M, Hetzer R. Evaluation of the right ventricle by echocardiography: particularities and major challenges. Expert Rev Cardiovasc Ther 2018. [PMID: 29521112 DOI: 10.1080/14779072.2018.1449646] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Compared with the left ventricle (LV), the right ventricle (RV) is less suited for evaluation by echocardiography (ECHO). Nevertheless, RV ECHO-assessment has currently emerged as an important diagnostic tool with meaningful prognostic value and essential contribution to therapeutic decisions. Although significant progress has been made, including generation of higher-quality normative data, validation of several two-dimensional measurements and improvements in three-dimensional ECHO-techniques, many challenges in RV ECHO-assessment still persist. Areas covered: This review discusses the particular challenges and limits in obtaining accurate measurements of RV anatomical and functional parameters and focuses primarily on the difficulties in proper interpretation of the highly load dependent RV ECHO-parameters which complicates the use of this valuable diagnostic and surveillance technique. Expert commentary: There is increasing evidence that RV assessment in relation with its actual loading conditions by ECHO-derived composite variables, which either incorporate a certain functional parameter and load, or incorporate measures which reflect the relationship between RV dilation and RV load, considering also the right atrial pressure (i.e. 'load adaptation index'), is particularly suited for clinical decision-making. Load dependency of RV ECHO-parameters must be taken into consideration especially in patients with advanced RV dysfunction scheduled for LV assist device implantation or lung transplantation.
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Affiliation(s)
- Michael Dandel
- a German Centre for Heart and Circulatory Research (DZHK) , Partner site Berlin , Germany.,b Deutsches Herzzentrum Berlin , Germany
| | - Roland Hetzer
- b Deutsches Herzzentrum Berlin , Germany.,c Cardio Centrum Berlin , Germany
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30
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Murata M, Kawakami T, Kataoka M, Kohno T, Itabashi Y, Fukuda K. Riociguat, a soluble guanylate cyclase stimulator, ameliorates right ventricular contraction in pulmonary arterial hypertension. Pulm Circ 2017; 8:2045893217746111. [PMID: 29251547 PMCID: PMC5753926 DOI: 10.1177/2045893217746111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Riociguat is a soluble guanylate cyclase stimulator used for pulmonary hypertension (PH) treatment. We evaluated right ventricular (RV) contractile function in 27 PH patients receiving riociguat. A comparison of pre- and post-administration echocardiographic studies demonstrated significantly improved RV strain after riociguat treatment, even after adjusting for RV afterload.
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Affiliation(s)
- Mitsushige Murata
- 1 Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kawakami
- 2 Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Masaharu Kataoka
- 2 Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takashi Kohno
- 2 Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Yuji Itabashi
- 2 Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Fukuda
- 2 Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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31
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Letter to the editor about the paper “Right ventricular dyssynchrony predicts clinical outcomes in patients with pulmonary hypertension” by Murata et al. Int J Cardiol 2017; 234:128. [DOI: 10.1016/j.ijcard.2017.01.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/10/2017] [Indexed: 11/24/2022]
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32
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Sokalskis V, Peluso D, Jagodzinski A, Sinning C. Added clinical value of applying myocardial deformation imaging to assess right ventricular function. Echocardiography 2017; 34:919-927. [PMID: 28317170 DOI: 10.1111/echo.13521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Vladislavs Sokalskis
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Diletta Peluso
- Department of Cardiac, Thoracic and Vascular Sciences, Ospedale dell'Angelo, Venice Mestre, Italy
| | - Annika Jagodzinski
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christoph Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
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