Electrical and mechanical dyssynchrony in pediatric pulmonary hypertension

Hill, Allison C.; Maxey, Dawn; Rosenthal, David N.; Siehr, Stephanie L.; Hollander, Seth A.; Feinstein, Jeffrey A.; Dubin, Anne M.

doi:10.1016/j.healun.2012.04.004

Cited by 16 publications

(15 citation statements)

References 36 publications

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“…Although data from PAH patients showed that RVD was strongly correlated with impaired RV function and adverse RV remodeling (Hill et al, 2012), we did not find any additional changes in the decreased FAC and TAM in subjects with RVD. However, subjects with RVD showed lower values of RVGLS than subjects without RVD, which was mainly attributed to the decline in RV strain at basal segments, suggesting that regional RV function was more affected by RVD.…”

Section: Rv Functioncontrasting

confidence: 94%

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

et al. 2020

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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 intervalcorrected 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 (SaO 2) 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 SaO 2 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 SaO 2 as well as RV overload; the incidence of RVD was associated with reduced RV regional function and blunted myocardial acceleration.

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Section: Rv Functioncontrasting

confidence: 94%

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

et al. 2020

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“…Ventricular dyssynchrony describes uncoordinated contraction reducing effective pump function. RV dyssynchrony has been described in PAH patients resulting in compromised Qp and might be the result of mechanical (RV structural adaptation) or electrical delay (right bundle branch block) . Patients with more severe RV dyssynchrony have poorer exercise capacity and a higher WHO‐FC (World Health Organization Functional Class) level .…”

Section: Cardiac Factors and Ventriculoarterial Uncouplingmentioning

confidence: 99%

“…RV dyssynchrony has been described in PAH patients resulting in compromised Qp and might be the result of mechanical (RV structural adaptation) 41 or electrical delay (right bundle branch block). 42 Patients with more severe RV dyssynchrony have poorer exercise capacity and a higher WHO-FC (World Health Organization Functional Class) level. 43 Badagliacca et al 44 suggested that resting RV dyssynchrony is an independent predictor of peak VO 2 and postulated it is an important contributor to exercise intolerance.…”

Section: Right Ventricular Dyssynchronymentioning

confidence: 99%

Pathophysiology of exercise intolerance in pulmonary arterial hypertension

et al. 2017

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Pulmonary arterial hypertension (PAH) is a chronic disease with poor prognosis and important exercise limitation despite the proliferation of treatment options in the last decade. Chronically increased right ventricular (RV) afterload results in right heart failure and without treatment, rapid clinical deterioration is common. Exercise intolerance is the cardinal feature of the disease impacting upon quality of life and clinical outcome. The pathophysiological mechanisms that lead to reduced exercise capacity in this population are complex with ventriculoarterial uncoupling likely to be the predominant feature. The relative contributions of additional factors that contribute to exercise limitation beyond ventriculoarterial uncoupling have not been characterized. This review addresses these factors with a focus on recent developments and uncertainties. RV maladaptation and the intricate interplay between the heart, abnormal pulmonary vascular bed and peripheral factors such as dysfunction of the respiratory and peripheral muscles are discussed in detail.

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“…Electromechanical dyssynchrony is increasingly appreciated in patients with complex congenital heart disease and long-term disease processes associated with major myocardial remodeling such as pulmonary hypertension. [8][9][10][11][12][13] This is of particular interest considering that responsiveness to cardiac resynchronization therapy in patients with congenital heart disease is associated with immediate improvement in ventricular mechanics. 14,15 The presence of a bundle branch block and prolonged QRS duration, which serve as primary guideline determinants for cardiac resynchronization, are present on longitudinal follow-up in 13% to 30% of patients after Ross and Ross-Konno procedures, respectively.…”

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confidence: 99%

Ventricular interactions and electromechanical dyssynchrony after Ross and Ross-Konno operations

Schäfer

Browne

Alvensleben

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: Ross and Ross-Konno operations are associated with the inherent risk of residual ventricular septal dysfunction and injury to the conduction system. However, comprehensive biventricular functional outcomes on magnetic resonance imaging after Ross and Ross-Konno procedures are unknown. The purpose of this study was to evaluate and compare the degree of electrical and mechanical dyssynchrony using cardiac magnetic resonance imaging in patients late after Ross and Ross-Konno operations.Methods: Patients following Ross operation (n ¼ 16), Ross-Konno operation (n ¼ 13), and healthy controls (n ¼ 12) underwent cardiac magnetic resonance imaging strain deformation analysis to quantify left ventricular (LV) intraventricular dyssynchrony and right ventricular (RV)-LV interventricular dyssynchrony. Mechanical dyssynchrony indices were correlated with the degree of electrical dyssynchrony as assessed by QRS duration, as well as with magnetic resonance imaging-derived biventricular and autograft regurgitation parameters.Results: Patients in the Ross and Ross-Konno groups had reduced LV global longitudinal strain when compared with controls (both P values < .01). Both Ross (P<.05) and Ross-Konno (P<.01) groups demonstrated increased RV-LV interventricular dyssynchrony compared with controls. Patients in the Ross-Konno group also had increased septal LV intraventricular dyssynchrony when compared with control and Ross groups (both P values<.01). The global LV intramechanical dyssynchrony strongly correlated with QRS duration (R ¼ 0.716; P <.001). There was no association between mechanical dyssynchrony and aortic regurgitation fraction.Conclusions: Long-term follow-up of patients who underwent Ross and Ross-Konno operations demonstrates reduced LV global longitudinal strain suggestive of chronically increased afterload independent of autograft function. Additionally, Ross-Konno operation is associated with impaired LV intraventricular mechanics and electrical dyssynchrony.

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Electrical and mechanical dyssynchrony in pediatric pulmonary hypertension

Cited by 16 publications

References 36 publications

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

Preliminary Study of Right Ventricular Dyssynchrony Under High-Altitude Exposure: Determinants and Impacts

Pathophysiology of exercise intolerance in pulmonary arterial hypertension

Ventricular interactions and electromechanical dyssynchrony after Ross and Ross-Konno operations

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