Journal of the American Society of Echocardiography
Evaluation of Right Intraventricular Dyssynchrony by Two-Dimensional Strain Echocardiography in Patients With Pulmonary Arterial Hypertension
Section snippets
Patients
Forty stable outpatients with PAH were selected according to the following criteria: (1) PAH defined according to the World Health Organization's Revised Nomenclature and Classification of Pulmonary Hypertension (Category 1)12, 13 and (2) clinically stable for ≥1 month before evaluation. Patients with (1) congenital heart disease, (2) bundle branch block or paced rhythm, (3) atrial fibrillation or flutter, or (4) LV ejection fraction ≤45% by the modified Simpson's rule were excluded from the
Baseline Characteristics and Standard Echocardiography
Optimal tracking of all RV segments was possible in 36 of 40 patients with PAH (90.0%) and 39 of 40 controls (97.5%). Only these patients were included in subsequent analyses. The baseline characteristics and standard echocardiographic parameters of the study groups are presented in Table 1. Of the 36 patients with PAH included in the study, 6 had underlying autoimmune diseases (2 with systemic lupus erythematosus, 1 with scleroderma, 1 with mixed connective tissue disease, 1 with Sjögren's
Discussion
We found a considerable degree of mechanical intraventricular dyssynchrony in the right ventricles of patients with PAH. This was clearly demonstrated by the comparative analyses of the segmental ts in patients with PAH and controls in our 6-segment RV model and was effectively described by the proposed RV-SD6 parameter (63 ± 21 ms in patients with PAH vs 25 ± 15 ms in controls). We identified the mid and basal free wall as the main regions causing intraventricular delay; our findings are in
Conclusion
In summary, our findings suggest that right intraventricular dyssynchrony can be effectively described by a feasible and reproducible 2DS echocardiographically derived measure, the RV-SD6. On the basis of this metric, we found that RV dyssynchrony was present in a substantial proportion of patients with PAH and that this dyssynchrony adversely affected RV function. It is unclear at this point, however, whether this dyssynchrony is merely a synonym for RV dysfunction or represents an independent
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