Altered synchrony of right ventricular contraction in borderline pulmonary hypertension

Abstract

Imaging studies have shown that pulmonary hypertension (PH) is associated with inhomogenous right ventricular (RV) regional contraction, or dyssynchrony, and that this is of prognostic relevance. This study aimed at the identification and functional significance of RV dyssynchrony in borderline PH defined by a mean pulmonary artery pressure between (mPAP) 20 and 25 mmHg. RV dyssynchrony was measured by 2-dimensional speckle tracking echocardiography in 17 patients with pulmonary arterial hypertension (PAH), 13 patients with borderline PH and 14 controls. Dyssynchrony was defined as the R-R interval-corrected standard deviation of the times to peak-systolic strain for the basal and medium segments of the RV. All the PH patients underwent a right heart catheterization. RV dyssynchrony amounted to 69 ± 34 ms in PAH, 47 ± 23 ms in borderline PH and 8 ± 6 ms in controls, all different from each other (p < 0.05). RV dyssynchrony in borderline PH was the only parameter of RV systolic dysfunction in 11 of 13 (85%) of the patients. RV dyssynchrony was accompanied by postsystolic shortening and correlated to RV fractional area change, not to mPAP or pulmonary vascular resistance. RV dyssynchrony occurs in borderline PH and may reflect early RV-arterial uncoupling.

Right ventricular dyssynchrony during hypoxic breathing but not during exercise in healthy subjects: a speckle tracking echocardiography study

“…Typical reported values for RV-SD4 are of 12 ± 6 ms in healthy subjects, 47 ± 33 ms in patients with borderline PH and 69 ± 34 ms in patients with pulmonary arterial hypertension (Lamia et al, 2017).…”

“…However, while the interobserver and intraobserver variabilities of RV-SD4 assessment are quite satisfactory in experienced hands (Badagliacca et al, 2015b;Lamia et al, 2017), as they were in the present study, the measurement shows variability as also indicated by large SDs in this study and in previously reports (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017bKalogeropoulos et al, 2008;Lamia et al, 2017;Murata et al, 2017). Actually RV-SD4 may be higher than the upper limit of normal, taken as 20-22 ms, in no more than 50-60% of patients and stabilize around 27-30 ms in severe PH (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017a.…”

“…However, RV dyssynchrony has been recently reported in patients with 'borderline' PH (mean PAP (mPAP) between 20 and 25 mmHg; Lamia et al, 2017) and thus with only marginally increased wall stress. However, RV dyssynchrony has been recently reported in patients with 'borderline' PH (mean PAP (mPAP) between 20 and 25 mmHg; Lamia et al, 2017) and thus with only marginally increased wall stress.…”

Ventricular Dysfunction, Interdependence, and Mechanical Dispersion in Newborn Infants with Congenital Diaphragmatic Hernia

“…Altered RV and LV MD has been observed in adults with PAH [11, 12, 24]. In CDH patients LV MD correlated with impaired LV LS in CDH, but not in controls.…”

“…To assess MD, we calculated the standard deviation of the time to peak systolic strain in all six segments (in each plane), and corrected for the R-R interval [11]. Longitudinal MD was also assessed in the four non-apical segments only (MD4), in view of previous reports of high interobserver variability and manufacturer recommendations [12]. …”