Abstract 11486: Impact of Right Ventricular Dyssynchrony on Left Ventricular Performance in Patients with Pulmonary Hypertension
Background: Pulmonary hypertension has been associated with right ventricular (RV) dyssynchrony, which may induce left ventricular (LV) dysfunction and dyssynchrony through ventriculo-ventricular interaction. The aim of the present study was to evaluate the influence of RV dyssynchrony on LV performance in patients with pulmonary hypertension.
Methods:One hundred and six patients with pulmonary hypertension and LV ejection fraction (EF) ≥ 35% (age 63±13 years, systolic pulmonary arterial pressure 61±18 mmHg) were evaluated. Ventricular dyssynchrony was assessed with speckle tracking echocardiography and defined as the standard deviation of the time to peak longitudinal strain of 6 segments of the RV (RV-SD) and the LV (LV-SD) in the apical 4 chamber view.
Results:Mean RV-SD and LV-SD assessed with longitudinal strain speckle tracking were 51.9±22 ms and 54±28.2 ms, respectively. The patient population was divided according to the median RV-SD value of 50 ms. Patients with RV-SD > 50 ms had significantly worse NYHA functional class (2.3±0.7 vs. 2.7±0.7, p=0.01), RV function (TAPSE: 16±4 mm vs. 18±5 mm, p=0.008), LV ejection fraction (51±9 % vs. 55±8 %, p=0.02), and larger LV-SD (61±22 ms vs. 43±18 ms, p<0.001). RV-SD was significantly correlated with LV ejection fraction (r=-0.21, p=0.03, figure a) and LV-SD (r=0.44, p<0.001, figure b). Multiple linear regression analysis showed an independent association between RV-SD and LV-SD (B 0.28, 95% CI 0.14 - 0.42, p<0.001).
Conclusion:RV dyssynchrony is significantly associated with LV dyssynchrony and reduced LV ejection fraction in patients with pulmonary hypertension. Whether device therapies such as cardiac resynchronization therapy may improve the clinical status and halt the progression of the disease in these patients needs to be confirmed in additional studies.
- © 2012 by American Heart Association, Inc.