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

Badagliacca, Roberto; Poscia, Roberto; Pezzuto, Beatrice; Papa, Silvia; Gambardella, Cristina; Francone, Marco; Mezzapesa, Mario; Nocioni, Martina; Nona, Alfred; Rosati, Riccardo; Sciomer, Susanna; Fedele, Francesco; Vizza, Carmine Dario

doi:10.1016/j.healun.2014.06.010

Cited by 55 publications

(66 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 77%

“…An increased RV-SD4 at rest has been previously reported to predict a decreased exercise capacity in severe PH (Badagliacca et al, 2017a) in relation to altered RV pump function (Badagliacca et al, 2015a;Kalogeropoulos et al, 2008). An increased RV-SD4 at rest has been previously reported to predict a decreased exercise capacity in severe PH (Badagliacca et al, 2017a) in relation to altered RV pump function (Badagliacca et al, 2015a;Kalogeropoulos et al, 2008).…”

Section: Discussionmentioning

confidence: 96%

“…Magnetic resonance imaging (MRI), tissue Doppler imaging and speckle tracking echocardiography studies have shown that severe PH is associated not only with a prolonged RV contraction resulting in 'post-systolic shortening' Marcus et al, 2008), but also with regional heterogeneity of RV contraction, or 'dyssynchrony' (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aKalogeropoulos et al, 2008;Meris et al, 2010;Murata et al, 2017;Smith et al, 2014). Magnetic resonance imaging (MRI), tissue Doppler imaging and speckle tracking echocardiography studies have shown that severe PH is associated not only with a prolonged RV contraction resulting in 'post-systolic shortening' Marcus et al, 2008), but also with regional heterogeneity of RV contraction, or 'dyssynchrony' (Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017aKalogeropoulos et al, 2008;Meris et al, 2010;Murata et al, 2017;Smith et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Thus we considered longitudinal strain and calculatedthe standard deviation (SD) of the times to peak-systolic strain for the four mid-basal RV segments corrected to the R-R interval between two QRS complexes, according to Bazett's formula, and called RV-SD4(Badagliacca et al, 2015a(Badagliacca et al, , 2015b(Badagliacca et al, , 2017bLamia et al, 2017). The software then automatically divided the RV long axis image into six standard segments and generated individual strain-time waveforms for basal, mid and apical septum, and basal, mid and apical free wall segments.…”

mentioning

confidence: 99%

“…Badagliacca et al, 2015a;Kalogeropoulos et al, 2008;Lamia et al, 2017). This may be understandable in view of the interindividual adaptation of RV to increased afterload in PH patients I G U R E 2 Speckle tracking echocardiography of the right ventricle with strain-time curves in a subject at rest and during exercise.…”

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confidence: 99%

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

Pezzuto

Forton

Badagliacca

et al. 2018

Experimental Physiology

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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 ( 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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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Pezzuto

Forton

Badagliacca

et al. 2018

Experimental Physiology

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The evaluation of right ventricle dyssynchrony by speckle tracking echocardiography in systemic sclerosis patients

Demirci

Özben

Sünbül

et al. 2021

J of Clinical Ultrasound

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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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Right Ventricular Normal Function

Balahura

Bartos

Bădilă

2018

Right Heart Pathology

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

Cited by 55 publications

References 29 publications

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

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

The evaluation of right ventricle dyssynchrony by speckle tracking echocardiography in systemic sclerosis patients

Right Ventricular Normal Function

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