title: Right Ventricular Structure and Function in Idiopathic Pulmonary Fibrosis with or without Pulmonary Hypertension.
abstract: OBJECTIVE
  To elucidate right ventricular (RV) function in patients with idiopathic pulmonary fibrosis (IPF) with and without pulmonary hypertension (PH) and its relation to other features of the disease.
  
  
  RESULTS
  Clinical evaluation, standard Doppler echo, Doppler myocardial imaging (DMI), and 2D strain echocardiography (STE) of RV septal and lateral walls were performed in 52 IPF patients (66.5 ± 8.5 years; 27 males) and in 45 age- and sex-comparable controls using a commercial US system (MyLab Alpha, Esaote). Pulmonary artery mean pressure (mPAP) was estimated by standard echo Doppler. RV global longitudinal strain (RV GLS) was calculated by averaging RV local strains. The IPF patients were divided into 2 groups by noninvasive assessment of PH: no PH (mPAP<25 mmHg; 36 pts) and PH (mPAP ≥25 mmHg; 16 pts). Left ventricular diameters and ejection fraction were comparable between controls and IPF, while GLS was impaired in IPF (P < 0.01). RV end-diastolic diameters, wall thickness andmPAP were increased in IPF patients with PH. In addition, pulsed DMI detected in PH IPF impaired myocardial RV early diastolic (Em) peak velocity. Also peak systolic RV strain was reduced in basal and middle RV lateral free walls in IPF, as well as RV GLS (P < 0.0001). The impairment in RV wall strain was more evident when comparing controls with the no PH group than comparing the no PH group with the PH group. By multivariate analysis, independent association of RV strain with both six-minute walking test distance (P < 0.001), mPAP (P < 0.0001), as well as with forced vital capacity (FVC) % (P < 0.005) in IPF patients were observed.
  
  
  CONCLUSIONS
  Impaired RV diastolic and systolic myocardial function were present even in IPF patients without PH, which indicates an early impact on RV function and structure in patients with IPF.
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Division of Pneumology, Federico II University, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Stanziola
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Enza
authors.initials: E
authors.lastname: Di Palma
authors.affiliation: Division of Pneumology, Federico II University, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Martino
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.affiliation: Cardiology, "Villa dei Fiori" Clinic, Naples, Italy.
authors.forename: Santo
authors.initials: S
authors.lastname: Dellegrottaglie
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Cocchia
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Riegler
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Meredyth Vanessa
authors.initials: MV
authors.lastname: Betancourt Cordido
authors.affiliation: Division of Pneumology, Federico II University, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Maurizia
authors.initials: M
authors.lastname: Lanza
authors.affiliation: Global Marketing US Cardio - Esaote Ultrasound Technology, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Maglione
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Diana
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli - Monaldi" Hospitals, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Department of Cardiovascular Medicine, Piedmont Heart Institute, Atlanta, Georgia.
authors.forename: Mani
authors.initials: M
authors.lastname: Vannan
authors.affiliation: Department of Cardiology and Cardiac Surgery, "San Giovanni di Dio e Ruggi d'Aragona" University Hospital, Salern, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged
keywords: Doppler myocardial imaging; echocardiography; idiopathic pulmonary fibrosis; pulmonary hypertension; right ventricle; speckle tracking strain