Right intraventricular dyssynchrony in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension: Clinical impact and reversibility

Roberto Badagliacca, Manuela Reali, Roberto Poscia, Beatrice Pezzuto, Silvia Papa, Mario Mezzapesa, Martina Nocioni, Gabriele Valli, Elisa Giannetta, Susanna Sciomer, Carlo Iacoboni, Francesco Fedele, Carmine Dario Vizza

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Abstract

Objectives The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension. Background Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy. Methods In 83 consecutive therapy-naïve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6MWT]), a second assessment was performed after 12 months or when clinical worsening occurred. Results Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r = 0.38; p <0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4%). Conclusions Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.

Original languageEnglish
Pages (from-to)642-652
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume8
Issue number6
DOIs
Publication statusPublished - Jun 1 2015

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Pulmonary Hypertension
Hemodynamics
Patient Rights
Vascular Resistance
Ventricular Remodeling
ROC Curve
Echocardiography
Therapeutics
Confidence Intervals
Lung
Walk Test

Keywords

  • clinical worsening
  • pulmonary arterial hypertension
  • right ventricular dyssynchrony
  • right ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Right intraventricular dyssynchrony in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension : Clinical impact and reversibility. / Badagliacca, Roberto; Reali, Manuela; Poscia, Roberto; Pezzuto, Beatrice; Papa, Silvia; Mezzapesa, Mario; Nocioni, Martina; Valli, Gabriele; Giannetta, Elisa; Sciomer, Susanna; Iacoboni, Carlo; Fedele, Francesco; Vizza, Carmine Dario.

In: JACC: Cardiovascular Imaging, Vol. 8, No. 6, 01.06.2015, p. 642-652.

Research output: Contribution to journalArticle

Badagliacca, R, Reali, M, Poscia, R, Pezzuto, B, Papa, S, Mezzapesa, M, Nocioni, M, Valli, G, Giannetta, E, Sciomer, S, Iacoboni, C, Fedele, F & Vizza, CD 2015, 'Right intraventricular dyssynchrony in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension: Clinical impact and reversibility', JACC: Cardiovascular Imaging, vol. 8, no. 6, pp. 642-652. https://doi.org/10.1016/j.jcmg.2015.02.009
Badagliacca, Roberto ; Reali, Manuela ; Poscia, Roberto ; Pezzuto, Beatrice ; Papa, Silvia ; Mezzapesa, Mario ; Nocioni, Martina ; Valli, Gabriele ; Giannetta, Elisa ; Sciomer, Susanna ; Iacoboni, Carlo ; Fedele, Francesco ; Vizza, Carmine Dario. / Right intraventricular dyssynchrony in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension : Clinical impact and reversibility. In: JACC: Cardiovascular Imaging. 2015 ; Vol. 8, No. 6. pp. 642-652.
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abstract = "Objectives The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension. Background Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy. Methods In 83 consecutive therapy-na{\"i}ve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6MWT]), a second assessment was performed after 12 months or when clinical worsening occurred. Results Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r = 0.38; p <0.000001). At 12 months, 32.5{\%} of patients presented clinical worsening (actuarial rates: 19{\%} at 6 months, 31{\%} at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95{\%} confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95{\%} negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4{\%}). Conclusions Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.",
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AU - Badagliacca, Roberto

AU - Reali, Manuela

AU - Poscia, Roberto

AU - Pezzuto, Beatrice

AU - Papa, Silvia

AU - Mezzapesa, Mario

AU - Nocioni, Martina

AU - Valli, Gabriele

AU - Giannetta, Elisa

AU - Sciomer, Susanna

AU - Iacoboni, Carlo

AU - Fedele, Francesco

AU - Vizza, Carmine Dario

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N2 - Objectives The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension. Background Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy. Methods In 83 consecutive therapy-naïve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6MWT]), a second assessment was performed after 12 months or when clinical worsening occurred. Results Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r = 0.38; p <0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4%). Conclusions Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.

AB - Objectives The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension. Background Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy. Methods In 83 consecutive therapy-naïve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6MWT]), a second assessment was performed after 12 months or when clinical worsening occurred. Results Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r = 0.38; p <0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4%). Conclusions Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.

KW - clinical worsening

KW - pulmonary arterial hypertension

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KW - right ventricular function

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