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Impact of right ventricular dyssynchrony on left ventricular performance in patients with pulmonary hypertension

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Abstract

Pulmonary hypertension has been associated with right ventricular (RV) dyssynchrony which may induce left ventricular (LV) dysfunction and dyssynchrony through ventricular interdependence. The present study evaluated the influence of RV dyssynchrony on LV performance in patients with pulmonary hypertension. One hundred and seven patients with pulmonary hypertension (age 63 ± 14 years, systolic pulmonary arterial pressure 60 ± 19 mmHg) and LV ejection fraction (EF) >35 % were evaluated. Ventricular dyssynchrony was assessed with speckle tracking echocardiography and defined as the standard deviation of the time to peak longitudinal strain of six segments of the RV (RV-SD) and the LV (LV-SD) in the apical 4-chamber view. Mean RV-SD and LV-SD assessed with longitudinal strain speckle tracking echocardiography were 51 ± 28 and 47 ± 21 ms, respectively. The patient population was divided according to the median RV-SD value of 49 ms. Patients with RV-SD ≥49 ms had significantly worse NYHA functional class (2.7 ± 0.7 vs. 2.3 ± 0.7, p = 0.004), RV function (tricuspid annular plane systolic excursion: 16 ± 4 vs. 19 ± 4 mm, p < 0.001), LVEF (50 ± 10 vs. 55 ± 8 %, p = 0.001), and larger LV-SD (57 ± 18 vs. 36 ± 18 ms, p < 0.001). RV-SD significantly correlated with LV-SD (r = 0.55, p < 0.001) and LVEF (r = −0.23, p = 0.02). Multiple linear regression analysis showed an independent association between RV-SD and LV-SD (β = 0.35, 95 %CI 0.21–0.49, p < 0.001). RV dyssynchrony is significantly associated with LV dyssynchrony and reduced LVEF in patients with pulmonary hypertension.

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Abbreviations

EF:

Ejection fraction

LV:

Left ventricle

LV-SD:

Left ventricular dyssynchrony

MPAP:

Mean pulmonary artery pressure

NYHA:

New York Heart Association

PH:

Pulmonary hypertension

RV:

Right ventricle

RV-SD:

Right ventricular dyssynchrony

SPAP:

Systolic pulmonary artery pressure

TAPSE:

Tricuspid annular plane systolic excursion

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Acknowledgments

The department of Cardiology received research Grants from General Electric Healthcare, Medtronic, Boston Scientific, St. Jude Medical, Biotronik and Actelion Pharmaceuticals. Dr. V. Delgado received consulting fees from St. Jude Medical and Medtronic.

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None.

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Authors and Affiliations

  1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Marlieke L. A. Haeck, Ulas Höke, Nina Ajmone Marsan, Eduard R. Holman, Jeroen J. Bax, Martin J. Schalij, Hubert W. Vliegen & Victoria Delgado

  2. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands

    Ron Wolterbeek

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  1. Marlieke L. A. Haeck
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  2. Ulas Höke
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  3. Nina Ajmone Marsan
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  8. Hubert W. Vliegen
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  9. Victoria Delgado
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Correspondence to Victoria Delgado.

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Haeck, M.L.A., Höke, U., Marsan, N.A. et al. Impact of right ventricular dyssynchrony on left ventricular performance in patients with pulmonary hypertension. Int J Cardiovasc Imaging 30, 713–720 (2014). https://doi.org/10.1007/s10554-014-0384-1

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  • DOI: https://doi.org/10.1007/s10554-014-0384-1

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