Right ventricular dyssynchrony predicts clinical outcomes in patients with pulmonary hypertension

Mitsushige Murata, Toshimitsu Tsugu, Takashi Kawakami, Masaharu Kataoka, Yugo Minakata, Jin Endo, Hikaru Tsuruta, Yuji Itabashi, Yuichiro Maekawa, Keiichi Fukuda

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)912-918
Number of pages7
JournalInternational Journal of Cardiology
Volume228
DOIs
Publication statusPublished - 2017 Feb 1

Fingerprint

Pulmonary Hypertension
Vascular Resistance
Pulmonary Artery
Hemodynamics
Pressure
Cardiac Catheterization
Disease-Free Survival
Echocardiography

Keywords

  • Dyssynchrony
  • Pulmonary hypertension
  • Right ventricle
  • Strain

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Right ventricular dyssynchrony predicts clinical outcomes in patients with pulmonary hypertension. / Murata, Mitsushige; Tsugu, Toshimitsu; Kawakami, Takashi; Kataoka, Masaharu; Minakata, Yugo; Endo, Jin; Tsuruta, Hikaru; Itabashi, Yuji; Maekawa, Yuichiro; Fukuda, Keiichi.

In: International Journal of Cardiology, Vol. 228, 01.02.2017, p. 912-918.

Research output: Contribution to journalArticle

Murata, Mitsushige ; Tsugu, Toshimitsu ; Kawakami, Takashi ; Kataoka, Masaharu ; Minakata, Yugo ; Endo, Jin ; Tsuruta, Hikaru ; Itabashi, Yuji ; Maekawa, Yuichiro ; Fukuda, Keiichi. / Right ventricular dyssynchrony predicts clinical outcomes in patients with pulmonary hypertension. In: International Journal of Cardiology. 2017 ; Vol. 228. pp. 912-918.
@article{ebb0505b78dc4ed69c92b08f0e64f715,
title = "Right ventricular dyssynchrony predicts clinical outcomes in patients with pulmonary hypertension",
abstract = "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.",
keywords = "Dyssynchrony, Pulmonary hypertension, Right ventricle, Strain",
author = "Mitsushige Murata and Toshimitsu Tsugu and Takashi Kawakami and Masaharu Kataoka and Yugo Minakata and Jin Endo and Hikaru Tsuruta and Yuji Itabashi and Yuichiro Maekawa and Keiichi Fukuda",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.ijcard.2016.11.244",
language = "English",
volume = "228",
pages = "912--918",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

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

UR - http://www.scopus.com/inward/record.url?scp=84998996715&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84998996715&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2016.11.244

DO - 10.1016/j.ijcard.2016.11.244

M3 - Article

VL - 228

SP - 912

EP - 918

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -