title: Right Intraventricular Dyssynchrony in Idiopathic, Heritable, and Anorexigen-Induced Pulmonary Arterial Hypertension: Clinical Impact and Reversibility.
abstract: OBJECTIVE
  The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension.
  
  
  BACKGROUND
  Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy.
  
  
  METHODS
  In 83 consecutive therapy-naïve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6 MWT]), a second assessment was performed after 12 months or when clinical worsening occurred.
  
  
  RESULTS
  Patients with right ventricular dyssynchrony (RV-SD4 >18 ms) had advanced WHO class, worse 6 MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤ 18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r(2) = 0.38; p < 0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6 MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4%).
  
  
  CONCLUSIONS
  Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy. Electronic address: roberto.badagliacca@uniroma1.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Badagliacca
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Reali
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Poscia
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pezzuto
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Papa
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Mezzapesa
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Nocioni
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Valli
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Giannetta
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Sciomer
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Iacoboni
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
authors.affiliation: Department of Cardiovascular and Respiratory Science, Sapienza University of Rome, Rome, Italy.
authors.forename: Carmine Dario
authors.initials: CD
authors.lastname: Vizza
mesh_terms: D001067:Appetite Depressants / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors; D014655:Vascular Resistance; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
chemical_list: D001067:Appetite Depressants
keywords: clinical worsening; pulmonary arterial hypertension; right ventricular dyssynchrony; right ventricular function