Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Mukherjee, Monica; Chung, Shang En; Ton, Von Khue; Tedford, Ryan J.; Hummers, Laura K.; Wigley, Fredrick M.; Abraham, Theodore P.; Shah, Ami A.

doi:10.1161/circimaging.115.003792

Cited by 73 publications

(71 citation statements)

References 40 publications

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“…We previously demonstrated a heterogeneous pattern of RVLSS in a large cohort of SSc patients in which there was increased contractility of the basal RV free wall and diminished contractility of the midventricular and apical segments [8]. Here, we similarly demonstrated regional heterogeneity in which midventricular and apical segments had decreased RVLSS compared with the basal RV segment.…”

Section: To the Editorsupporting

confidence: 62%

“…Speckle-tracking echocardiography (STE), an echo-based imaging modality used in conjunction with 2DE, allows offline calculation of myocardial velocities and deformation parameters in the assessment of regional myocardial contractility [7]. Our group recently demonstrated a heterogeneous pattern of RV longitudinal systolic strain (RVLSS) utilising STE in SSc patients with variable afterloads, which was not appreciable by 2DE alone [8]. Our findings, however, were shown in a cross-sectional analysis of asymptomatic SSc patients without symptomatic RV failure, right heart catheterisation (RHC)-confirmed PAH or with echocardiographic evidence of RV dilatation.…”

Section: To the Editormentioning

confidence: 99%

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Right ventricular longitudinal strain is diminished in systemic sclerosis compared with idiopathic pulmonary arterial hypertension

et al. 2017

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Section: To the Editorsupporting

confidence: 62%

Section: To the Editormentioning

confidence: 99%

Right ventricular longitudinal strain is diminished in systemic sclerosis compared with idiopathic pulmonary arterial hypertension

et al. 2017

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“…To date, different ultrasound Right Ventricular Strain in Systemic Sclerosis manufacturers and software developers have used different approaches (ie, definitions of the region of interest and of strain parameters) to 2DE image postprocessing to obtain strain and strain-rate values. The RVFWLS values reported by Mukherjee et al 3 in their control subjects are significantly lower than those reported in the literature. 5,9 However, they used a novel vendor-independent software package (EchoInsight, Epsilon Imaging, Ann Arbor, MI) to measure RVFWLS, whereas the large majority of investigators who applied RVFWLS for RV analysis used a different software (EchoPac, GE Vingmed, Horten, Norway).…”

Section: See Article By Mukherjee Et Alcontrasting

confidence: 70%

Subclinical Right Ventricular Dysfunction by Strain Analysis

Badano

Muraru

2016

Circ: Cardiovascular Imaging

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T he peculiar shape of the right ventricle (RV), its position within the chest, and the thinness of its free wall have always represented a formidable challenge for the assessment of RV size and function by conventional 2-dimensional echocardiography. Over time, a large number of 2D echocardiography and Doppler parameters have been proposed to describe RV geometry and function.1,2 However, most of them are limited by geometric assumptions about RV shape, load dependency, or suboptimal reproducibility, resulting in a limited contribution of conventional echocardiography to the understanding of the role played by the RV in many clinical conditions. See Article by Mukherjee et alIn the last decade, the advent of 2D speckle-tracking echocardiography (2DSTE) has fueled the application of strain imaging to measure the RV myocardial deformation, particularly for an early detection of subclinical myocardial dysfunction, when global ventricular function indices are still normal. The possibility to derive strain parameters from conventional gray-scale images with excellent reproducibility and the relative ease of use of the technique have encouraged researchers to apply 2DSTE for elucidating the extent of RV involvement in a wide variety of cardiac and noncardiac conditions. A PubMed search found >800 articles published on RV strain imaging by echocardiography since 2008.In this issue of Circulation: Cardiovascular Imaging, Mukherjee et al 3 from the Johns Hopkins University School of Medicine report on the ability of 2DSTE longitudinal strain to detect occult abnormalities in regional and global myocardial function of RV free wall in patients with systemic sclerosis (SSc). Conventional 2DE parameters of RV function (eg, tricuspid annular plane systolic excursion and fractional area change) were similar in patients with SSc versus age-and sexmatched controls, whereas RV free wall longitudinal strain (RVFWLS) was found to be significantly impaired in patients with SSc, regardless of pulmonary systolic pressure and SSc phenotype. Moreover, the investigators identified a peculiar regional strain pattern in SSc group, with decreased strain magnitude in the apical and mid segments and increased strain magnitude in the basal segments of the RV free wall. Thus, RVFWLS seems promising in allowing clinicians to identify subclinical RV myocardial impairment in patients with SSc. If these results are confirmed by future studies, evidence of occult RV dysfunction by RVFWLS assessment may prompt for a more intense cardiological follow-up or early treatment of patients with SSc, to avoid or delay the development of overt RV failure.However, the anatomic substrate and the pathophysiology of impaired RVFWLS with altered regional pattern in patients with SSc remain to be clarified. One may hypothesize 2 major contributions to RV impaired performance in patients with SSc: higher pulmonary load because of vessel stiffness/sclerosis or primary intrinsic myocardial dysfunction. Mukherjee et al 3 deserve credit for evaluating RVFWLS together w...

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“…Mechanical dispersion was expressed by the standard deviation of the time from R on ECG to peak strain in 16 LV segments . Measurements from the RV included proximal RVOT diameter from the parasternal short‐axis view, basal RV diameter, tricuspid annular plane systolic excursion, and RV longitudinal strain (RVLS) calculated from three free wall RV segments …”

Section: Methodsmentioning

confidence: 99%

Lower than expected burden of premature ventricular contractions impairs myocardial function

et al. 2017

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AimsWe aimed to explore the burden of frequent premature ventricular contractions (PVCs) associated with myocardial dysfunction in patients with outflow tract arrhythmia (OTA). We hypothesized that this threshold is lower than the previously suggested threshold of 24 000 PVCs/24 h (24%PVC) when systolic function is assessed by strain echocardiography. Furthermore, we aimed to characterize OTA patients with malignant arrhythmic events.Methods and resultsWe included 52 patients referred for OTA ablation (46 ± 12 years, 58% female). Left ventricular global longitudinal strain (GLS) and mechanical dispersion were assessed by speckle tracking echocardiography. A subset underwent cardiac magnetic resonance imaging. PVC burden (%PVC) was assessed by Holter recording. Sinus rhythm QRS duration and PVC QRS duration were recorded from electrocardiogram, and the ratio was calculated (PVC QRS duration / sinus rhythm QRS duration). Median %PVC was 7.2 (0.2–60.0%). %PVC correlated with GLS (R = 0.44, P = 0.002) and with mechanical dispersion (R = 0.48, P < 0.001), but not with ejection fraction (R = 0.22, P = 0.12). %PVC was higher in patients with impaired systolic function by GLS (worse than −18%) compared with patients with normal function (22% vs. 5%, P = 0.001). Greater than 8%PVC optimally identified patients with abnormal GLS (area under the curve 0.79). Serious arrhythmic events occurred in 11/52 (21%) patients characterized by high QRS ratios (1.56 vs. 1.91, P < 0.001).ConclusionsMore than 8%PVC was associated with impaired systolic function by GLS, which is a lower threshold than previously reported. Patients with serious arrhythmic events had higher QRS ratios, which may represent a more malignant phenotype of OTA.

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Unique Abnormalities in Right Ventricular Longitudinal Strain in Systemic Sclerosis Patients

Cited by 73 publications

References 40 publications

Right ventricular longitudinal strain is diminished in systemic sclerosis compared with idiopathic pulmonary arterial hypertension

Right ventricular longitudinal strain is diminished in systemic sclerosis compared with idiopathic pulmonary arterial hypertension

Subclinical Right Ventricular Dysfunction by Strain Analysis

Lower than expected burden of premature ventricular contractions impairs myocardial function

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