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Differences in right ventricular dysfunction in patients with idiopathic pulmonary hypertension versus secondary pulmonary hypertension
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Abstract
Introduction: Right ventricular (RV) function in the setting of pulmonary hypertension based on different etiologies has not been well studied. In this study, we evaluated the RV function in patients with idiopathic pulmonary hypertension (IPH) versus secon-dary pulmonary hypertension (SPH) due to congestive heart failure.
Material and method: Forty-five patients with pulmonary hypertension and New York Heart Association (NYHA) functional class II or III were enrolled. Of these, 22 were diagnosed with IPH and 23 with SPH. Echocardiographic data, including Doppler and Doppler based strain, were assessed according to the American Society of Echocardiography (ASE) guidelines for detailed evaluation of RV function in these two groups.
Results: Mean PAP was 60 ± 14.5 mm Hg in patients with IPH versus 43 ± 11.5 mm Hg in patients with SPH (p = 0.001). Considering conventional indexes of RV function, only Sm and dp/dt were significantly better in the first group compared with the second group (p-value for Sm = 0.042 and for dp/dt = 0.039). RV end diastolic dimension was significantly higher in the IPH group (p = 0.013). Using deformation indexes of RV function, the basal and mid portion of RV free wall strain and basal RV strain rates were significantly worse in the chronic systolic heart failure (PH-HF) group in comparison to the IPH group (p < 0.001 in basal RV strain, p = 0.034 in mid RV strain and p = 0.046 in basal RV strain rate respectively).
Conclusion: IPH has less impact on RV function in comparison to PH-HF. Considering both entities are in the category of RV pressure overload, we conclude that the etiology of pulmonary hypertension also plays an important role in RV function in addition to pressure overload.
Abstract
Introduction: Right ventricular (RV) function in the setting of pulmonary hypertension based on different etiologies has not been well studied. In this study, we evaluated the RV function in patients with idiopathic pulmonary hypertension (IPH) versus secon-dary pulmonary hypertension (SPH) due to congestive heart failure.
Material and method: Forty-five patients with pulmonary hypertension and New York Heart Association (NYHA) functional class II or III were enrolled. Of these, 22 were diagnosed with IPH and 23 with SPH. Echocardiographic data, including Doppler and Doppler based strain, were assessed according to the American Society of Echocardiography (ASE) guidelines for detailed evaluation of RV function in these two groups.
Results: Mean PAP was 60 ± 14.5 mm Hg in patients with IPH versus 43 ± 11.5 mm Hg in patients with SPH (p = 0.001). Considering conventional indexes of RV function, only Sm and dp/dt were significantly better in the first group compared with the second group (p-value for Sm = 0.042 and for dp/dt = 0.039). RV end diastolic dimension was significantly higher in the IPH group (p = 0.013). Using deformation indexes of RV function, the basal and mid portion of RV free wall strain and basal RV strain rates were significantly worse in the chronic systolic heart failure (PH-HF) group in comparison to the IPH group (p < 0.001 in basal RV strain, p = 0.034 in mid RV strain and p = 0.046 in basal RV strain rate respectively).
Conclusion: IPH has less impact on RV function in comparison to PH-HF. Considering both entities are in the category of RV pressure overload, we conclude that the etiology of pulmonary hypertension also plays an important role in RV function in addition to pressure overload.
Keywords
pulmonary artery hypertension; pulmonary hypertension; right ventricular function; Doppler echocardiography; myocardial strain
About this articleTitle
Differences in right ventricular dysfunction in patients with idiopathic pulmonary hypertension versus secondary pulmonary hypertension
Journal
Advances in Respiratory Medicine
Issue
Article type
Research paper
Pages
1-5
Published online
2020-02-28
DOI
10.5603/ARM.2020.0071
Pubmed
Bibliographic record
Adv Respir Med 2020;88(1):1-5.
Keywords
pulmonary artery hypertension
pulmonary hypertension
right ventricular function
Doppler echocardiography
myocardial strain
Authors
Sepideh Emami
Niloufar Samiei
Ahamd Amin
Sepideh Taghavi
Mozhghan Parsaee
Nasim Naderi
Alireza Serati
Mohammad Reza Movahed
References (17)- Dias CA, Assad RS, Caneo LF, et al. Reversible pulmonary trunk banding. II. An experimental model for rapid pulmonary ventricular hypertrophy. J Thorac Cardiovasc Surg. 2002; 124(5): 999–1006.
- Chen EP, Craig DM, Bittner HB, et al. Pharmacological strategies for improving diastolic dysfunction in the setting of chronic pulmonary hypertension. Circulation. 1998; 97(16): 1606–1612.
- Chin KM, Kim NHS, Rubin LJ. The right ventricle in pulmonary hypertension. Coron Artery Dis. 2005; 16(1): 13–18.
- Hsiao SH, Wang WC, Yang SH, et al. Myocardial tissue Doppler-based indexes to distinguish right ventricular volume overload from right ventricular pressure overload. Am J Cardiol. 2008; 101(4): 536–541.
- Samiei N, Hadizadeh N, Borji M, et al. Which type of right ventricular pressure overload is worse? An echocardiographic comparison between pulmonary stenosis and pulmonary arterial hypertension. Archives of Cardiovascular Imaging. 2014; 2(4).
- Naderi N, Ojaghi Haghighi Z, Amin A, et al. Utility of right ventricular strain imaging in predicting pulmonary vascular resistance in patients with pulmonary hypertension. Congest Heart Fail. 2013; 19(3): 116–122.
- Kaul S, Tei C, Hopkins JM, et al. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984; 107(3): 526–531.
- Anconina J, Danchin N, Selton-Suty C, et al. Noninvasive estimation of right ventricular dP/dt in patients with tricuspid valve regurgitation. Am J Cardiol. 1993; 71(16): 1495–1497.
- Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr. 1996; 9(6): 838–847.
- Meluzín J, Spinarová L, Bakala J, et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J. 2001; 22(4): 340–348.
- Fan TH, Liang CS, Kawashima S, et al. Alterations in cardiac beta-adrenoceptor responsiveness and adenylate cyclase system by congestive heart failure in dogs. Eur J Pharmacol. 1987; 140(2): 123–132.
- Nootens M, Kaufmann E, Rector T, et al. Neurohormonal activation in patients with right ventricular failure from pulmonary hypertension: relation to hemodynamic variables and endothelin levels. J Am Coll Cardiol. 1995; 26(7): 1581–1585.
- Fan TH, Liang Cs, Kawashima S, et al. Alterations in cardiac β-adrenoceptor responsiveness and adenylate cyclase system by congestive heart failure in dogs. European Journal of Pharmacology. 1987; 140(2): 123–132.
- Quaife RA, Chen MY, Lynch D, et al. Importance of right ventricular end-systolic regional wall stress in idiopathic pulmonary arterial hypertension: a new method for estimation of right ventricular wall stress. Eur J Med Res. 2006; 11(5): 214–220.
- Abraham WT, Raynolds MV, Badesch DB, et al. Angiotensin-converting enzyme DD genotype in patients with primary pulmonary hypertension: increased frequency and association with preserved haemodynamics. J Renin Angiotensin Aldosterone Syst. 2003; 4(1): 27–30.
- Raza F, Dillane C, Mirza A, et al. Differences in right ventricular morphology, not function, indicate the nature of increased afterload in pulmonary hypertensive subjects with normal left ventricular function. Echocardiography. 2017; 34(11): 1584–1592.
- Schwaiger JP, Knight DS, Kaier T, et al. Two-dimensional knowledge-based volumetric reconstruction of the right ventricle documents short-term improvement in pulmonary hypertension. Echocardiography. 2017; 34(6): 817–824.