TY - JOUR
T1 - Right ventricular dyssynchrony predicts clinical outcomes in patients with pulmonary hypertension
AU - Murata, Mitsushige
AU - Tsugu, Toshimitsu
AU - Kawakami, Takashi
AU - Kataoka, Masaharu
AU - Minakata, Yugo
AU - Endo, Jin
AU - Tsuruta, Hikaru
AU - Itabashi, Yuji
AU - Maekawa, Yuichiro
AU - Fukuda, Keiichi
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background RV dyssynchrony has been described in patients with pulmonary hypertension (PH) and is an independent predictor of clinical worsening; however, the optimal method for measuring RV dyssynchrony has not been fully established. This study aimed to investigate whether RV dyssynchrony is correlated with hemodynamics and prognosis in PH patients and to identify the best parameter for evaluating RV dyssynchrony. Methods This study assessed 100 PH patients, measuring mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index (CI) by right heart catheterization (RHC). RV strain curves were obtained using two-dimensional speckle-tracking echocardiography (2DSTE), and time from QRS onset to maximum peak longitudinal strain (Tmax) or time to first peak (Tfirst) was measured. Difference in time between the earliest and the latest segment (TD) and standard deviation (SD) of T in 6 segments with RV apex (− SD6) and 4 segments without RV apex (− SD4) were also assessed. Results Among all RV dyssynchrony parameters, Tmax-SD6 showed the strongest correlation with RV hemodynamics such as mPAP (R2 = 0.27, P < 0.0001) and PVR (R2 = 0.22, P < 0.0001). Univariate and multivariate Cox proportional hazard analyses showed that Tmax-SD6 significantly correlated with and independently predicted event-free survival in patients with PH. Conclusions RV dyssynchrony is a useful index for RV function and an independent predictor of clinical outcomes in patients with PH. In addition, the inclusion of apical motion is essential for the optimal assessment of RV dyssynchrony.
AB - Background RV dyssynchrony has been described in patients with pulmonary hypertension (PH) and is an independent predictor of clinical worsening; however, the optimal method for measuring RV dyssynchrony has not been fully established. This study aimed to investigate whether RV dyssynchrony is correlated with hemodynamics and prognosis in PH patients and to identify the best parameter for evaluating RV dyssynchrony. Methods This study assessed 100 PH patients, measuring mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index (CI) by right heart catheterization (RHC). RV strain curves were obtained using two-dimensional speckle-tracking echocardiography (2DSTE), and time from QRS onset to maximum peak longitudinal strain (Tmax) or time to first peak (Tfirst) was measured. Difference in time between the earliest and the latest segment (TD) and standard deviation (SD) of T in 6 segments with RV apex (− SD6) and 4 segments without RV apex (− SD4) were also assessed. Results Among all RV dyssynchrony parameters, Tmax-SD6 showed the strongest correlation with RV hemodynamics such as mPAP (R2 = 0.27, P < 0.0001) and PVR (R2 = 0.22, P < 0.0001). Univariate and multivariate Cox proportional hazard analyses showed that Tmax-SD6 significantly correlated with and independently predicted event-free survival in patients with PH. Conclusions RV dyssynchrony is a useful index for RV function and an independent predictor of clinical outcomes in patients with PH. In addition, the inclusion of apical motion is essential for the optimal assessment of RV dyssynchrony.
KW - Dyssynchrony
KW - Pulmonary hypertension
KW - Right ventricle
KW - Strain
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U2 - 10.1016/j.ijcard.2016.11.244
DO - 10.1016/j.ijcard.2016.11.244
M3 - Article
C2 - 27912199
AN - SCOPUS:84998996715
SN - 0167-5273
VL - 228
SP - 912
EP - 918
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -