title: Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class.
abstract: BACKGROUND
  Abnormalities in right ventricular function are known to occur in patients with pulmonary arterial hypertension.
  
  
  OBJECTIVE
  Test the hypothesis that chronic elevation in pulmonary artery systolic pressure delays mechanical activation of the right ventricle, termed dyssynchrony, and is associated with both symptoms and right ventricular dysfunction.
  
  
  METHODS
  Fifty-two patients (mean age 46 +/- 15 years, 24 patients with chronic pulmonary hypertension) were prospectively evaluated using several echocardiographic parameters to assess right ventricular size and function. In addition, tissue Doppler imaging was also obtained to assess longitudinal strain of the right ventricular wall, interventricular septum, and lateral wall of the left ventricle and examined with regards to right ventricular size and function as well as clinical variables.
  
  
  RESULTS
  In this study, patients with chronic pulmonary hypertension had statistically different right ventricular fractional area change (35 +/- 13 percent), right ventricular end-systolic area (21 +/- 10 cm2), right ventricular Myocardial Performance Index (0.72 +/- 0.34), and Eccentricity Index (1.34 +/- 0.37) than individuals without pulmonary hypertension (51 +/- 5 percent, 9 +/- 2 cm2, 0.27 +/- 0.09, and 0.97 +/- 0.06, p < 0.005, respectively). Furthermore, peak longitudinal right ventricular wall strain in chronic pulmonary hypertension was also different -20.8 +/- 9.0 percent versus -28.0 +/- 4.1 percent, p < 0.01). Right ventricular dyssynchrony correlated very well with right ventricular end-systolic area (r = 0.79, p < 0.001) and Eccentricity Index (r = 0.83, p < 0.001). Furthermore, right ventricular dyssynchrony correlates with pulmonary hypertension severity index (p < 0.0001), World Health Organization class (p < 0.0001), and number of hospitalizations (p < 0.0001).
  
  
  CONCLUSIONS
  Lower peak longitudinal right ventricular wall strain and significantly delayed time-to-peak strain values, consistent with right ventricular dyssynchrony, were found in a small heterogeneous group of patients with chronic pulmonary hypertension when compared to individuals without pulmonary hypertension. Furthermore, right ventricular dyssynchrony was associated with disease severity and compromised functional class.
authors.affiliation: Cardiovascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA. lopezcandalesa@upmc.edu
authors.forename: Angel
authors.initials: A
authors.lastname: López-Candales
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.forename: Navin
authors.initials: N
authors.lastname: Rajagopalan
authors.forename: Matthew
authors.initials: M
authors.lastname: Suffoletto
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murali
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.forename: Kathy
authors.initials: K
authors.lastname: Edelman
mesh_terms: D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013223:Statistics as Topic; D018497:Ventricular Dysfunction, Right / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology