Clinical Investigation
Ventricular and Atrial Function
Right Ventricular Regional Systolic Function and Dyssynchrony in Patients with Pulmonary Hypertension Evaluated by Three-Dimensional Echocardiography

https://doi.org/10.1016/j.echo.2013.03.007Get rights and content

Background

The aim of this study was to evaluate right ventricular (RV) regional systolic function and dyssynchrony in patients with pulmonary hypertension (PH) using real-time three-dimensional echocardiography.

Methods

Real-time three-dimensional echocardiographic images were acquired to obtain RV regional (inflow, body, and outflow) ejection fraction (EF) and time to minimum systolic volume in 70 patients with PH and 26 normal controls. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance measured by echocardiography in all subjects and by right heart catheterization in 17 patients were recorded.

Results

Inflow EF and global EF were significantly lower in patients with PH than in controls (P < .05). Body EF was significantly decreased in patients with moderate (PASP, 50–69mm Hg) and severe (PASP ≥ 70 mm Hg) PH (P < .05). Outflow EF was significantly lowered in patients with severe PH (P < .001). The standard deviation of regional time to minimum systolic volume corrected by heart rate was significantly prolonged in patients with severe PH (P < .05). Inflow EF and global EF were negatively correlated with PASP (r = −0.731 and r = −0.769, respectively, P < .001) and with pulmonary vascular resistance (r = −0.789 and r = −0.801, P < .001).

Conclusions

In patients with PH, RV inflow and global systolic function was impaired in inverse relationship with PASP and pulmonary vascular resistance. RV systolic synchronicity was impaired in patients with severe PH. Evaluation of RV regional systolic function using real-time three-dimensional echocardiography may play a potential role in the noninvasive assessment of the severity of PH.

Section snippets

Study Population

A total of 70 consecutive patients with PH (22 men; mean age, 41 ± 15 years) were enrolled in this study. Patients were admitted to the Division of Cardiology or the Division of Cardiac Surgery at Zhongshan Hospital of Fudan University from December 2010 to April 2011. Forty-seven patients were diagnosed with pulmonary arterial hypertension (six idiopathic, 27 with atrial septal defects, eight with ventricular septal defects, and six with patent ductus arteriosus), and 23 patients were

Clinical and Conventional Echocardiographic Characteristics

Conventional echocardiographic images were successfully obtained and analyzed in all subjects. Clinical and conventional echocardiographic characteristics of the study population are summarized in Table 1. There were no significant differences in age, gender, peak tissue Doppler systolic velocity of the tricuspid annulus, and left ventricular EF between the PH groups and the control group. Heart rates in the moderate and severe PH groups were higher than in the control group. RV end-diastolic

Discussion

The present study demonstrated regional characteristics of RV systolic function evaluated by RT3DE in patients with PH. We found that RV inflow and global systolic function were impaired in inverse relationship with PASP and PVR in patients with PH and that RV systolic synchronicity was impaired in severe PH. These findings suggest that the evaluation of RV regional systolic function using RT3DE may play a potential role in the noninvasive assessment of the severity of PH. To our knowledge,

Conclusions

The present study demonstrated that the use of RT3DE is feasible in the quantification of RV regional systolic function and dyssynchrony in patients with PH. We found that the early impairment of RV regional systolic function could be detected by RT3DE. RV inflow and global systolic function were impaired in inverse relationship with PASP and PVR in patients with PH, and RV systolic synchronicity was impaired in patients with severe PH. These findings suggest that the evaluation of RV regional

References (32)

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This study was supported by grants 81000614 and 30972812 from National Natural Science Foundation of China, grant XYQ2011056 from the Shanghai Outstanding Young Scientist Project, grant 416 from the Youth Foundation of Zhongshan Hospital, and grant Y-2013-15 from the Youth Foundation of Shanghai Institute of Medical Imaging.

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