Right ventricular diastolic dysfunction in patients with left ventricular hypertrophy: analysis of right ventricular myocardial relaxation using two-dimensional speckle tracking imaging
Tóm tắt
Although several previous studies have suggested the presence of right ventricular (RV) diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM) and those with hypertensive left ventricular hypertrophy (HT-LVH), the mechanisms are still unclear. This study aimed to clarify the relationship between the RV global diastolic dysfunction in these patients and the regional myocardial diastolic function, including synchronicity of the interventricular septum and RV free wall. In 20 age-matched patients with HT-LVH, 20 patients with HCM and 22 control subjects without pulmonary hypertension, RV isovolumic relaxation time (IRTR) was measured using continuous-wave Doppler echocardiography. The early diastolic peak strain rate (E
SR) and time from QRS to E
SR (T–E
SR) were measured in the apical, mid-ventricular and basal segments of the interventricular septum and RV free wall using two-dimensional speckle tracking imaging (2DST). IRTR was more prolonged both in HT-LVH and in HCM than in the controls. The averaged septal E
SR was reduced both in HT-LVH and in HCM (P < 0.0001, respectively), but the averaged RV free wall E
SR was decreased only in HCM (P = 0.0007). E
SR averaged for six septal and RV free wall segments was correlated with IRTR (r = −0.46, P = 0.0001). Neither intergroup difference nor correlation with IRTR was observed in a coefficient of variation of T–E
SR for the six segments. RV global diastolic function is impaired in patients with HT-LVH and HCM due to relaxation abnormalities, not an asynchrony, of the myocardium surrounding the RV cavity. The detection of RV free wall relaxation abnormality using 2DST may be useful to differentiate HCM from HT-LVH.
Tài liệu tham khảo
Suzuki J, Chang JM, Caputo GR, Higgins CB. Evaluation of right ventricular early diastolic filling by cine nuclear magnetic resonance imaging in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1991;18:120–6.
Maeda M, Yamakado T, Nakano T. Right ventricular diastolic function in patients with hypertrophic cardiomyopathy—an invasive study. Jpn Circ J. 1999;63:681–7. doi:10.1253/jcj.63.681.
Severino S, Caso P, Cicala S, Galderisi M, de Simone L, D’Andrea A, et al. Involvement of right ventricle in left ventricular hypertrophic cardiomyopathy: analysis by pulsed Doppler tissue imaging. Eur J Echocardiogr. 2000;1:281–8. doi:10.1053/euje.2000.0043.
Chakko S, de Marchena E, Kessler KM, Materson BJ, Myerburg RJ. Right ventricular diastolic function in systemic hypertension. Am J Cardiol. 1990;65:1117–20. doi:10.1016/0002-9149(90)90324-T.
Cicala S, Galderisi M, Caso P, Petrocelli A, D’Errico A, de Divitiis O, et al. Right ventricular diastolic dysfunction in arterial systemic hypertension: analysis by pulsed tissue Doppler. Eur J Echocardiogr. 2002;3:135–42. doi:10.1053/euje.2001.0124.
Larrazet F, Pellerin D, Fournier C, Witchitz S, Veyrat C. Right and left isovolumic ventricular relaxation time intervals compared in patients by means of a single-pulsed Doppler method. J Am Soc Echocardiogr. 1997;10:699–706. doi:10.1016/S0894-7317(97)70111-1.
Helle-Valle T, Crosby J, Edvardsen T, Lyseggen E, Amundsen BH, Smith HJ, et al. New noninvasive method for assessment of left ventricular rotation: speckle tracking echocardiography. Circulation. 2005;112:3149–56. doi:10.1161/CIRCULATIONAHA.104.531558.
Tops LF, Suffoletto MS, Bleeker GB, Boersma E, van der Wall EE, Gorcsan J 3rd, et al. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. J Am Coll Cardiol. 2007;50:1180–8. doi:10.1016/j.jacc.2007.06.011.
Pirat B, McCulloch ML, Zoghbi WA. Evaluation of global and regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol. 2006;98:699–704. doi:10.1016/j.amjcard.2006.03.056.
Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–8.
Aessopos A, Farmakis D, Taktikou H, Loukopoulos D. Doppler-determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation. J Am Soc Echocardiogr. 2000;13:645–9. doi:10.1067/mje.2000.104535.
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285(26):1441–6.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography: American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.
Takatsuji H, Mikami T, Urasawa K, Teranishi J, Onozuka H, Takagi C, et al. A new approach for evaluation of left ventricular diastolic function: spatial and temporal analysis of left ventricular filling flow propagation by color M-mode Doppler echocardiography. J Am Coll Cardiol. 1996;27:365–71. doi:10.1016/0735-1097(96)81240-X.
D’Andrea A, Caso P, Severino S, Cuomo S, Capozzi G, Calabro P, et al. Prognostic value of intra-left ventricular electromechanical asynchrony in patients with hypertrophic cardiomyopathy. Eur Heart J. 2006;27:1311–8. doi:10.1093/eurheartj/ehi688.
Kato TS, Noda A, Izawa H, Yamada A, Obata K, Nagata K, et al. Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography. Circulation. 2004;110:3808–14. doi:10.1161/01.CIR.0000150334.69355.00.
Goto K, Mikami T, Onozuka H, Kaga S, Inoue M, Komatsu H, et al. Role of left ventricular regional diastolic abnormalities for global diastolic dysfunction in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2006;19:857–64. doi:10.1016/j.echo.2006.02.013.
Betocchi S, Hess OM, Losi MA, Nonogi H, Krayenbuehl HP. Regional left ventricular mechanics in hypertrophic cardiomyopathy. Circulation. 1993;88(5 Pt 1):2206–14
De Marchi SF, Allemann Y, Seiler C. Relaxation in hypertrophic cardiomyopathy and hypertensive heart disease: relations between hypertrophy and diastolic function. Heart. 2000;83:678–84. doi:10.1136/heart.83.6.678.
Kuribayashi T, Roberts WC. Myocardial disarray at junction of ventricular septum and left and right ventricular free walls in hypertrophic cardiomyopathy. Am J Cardiol. 1992;70:1333–40. doi:10.1016/0002-9149(92)90771-P.
Suzuki J, Sakamoto T, Takenaka K, Kawakubo K, Amano K, Takahashi H, et al. Assessment of the thickness of the right ventricular free wall by magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Br Heart J. 1988;60:440–5. doi:10.1136/hrt.60.5.440.
Mckenna WJ, Kleinebenne A, Nihoyannopolos P, Foale R. Echocardiographic measurement of right ventricular wall thickness in hypertrophic cardiomyopathy: relation to clinical and prognostic features. J Am Coll Cardiol. 1988;11:351–8.
Gottdiener JS, Gay JA, Maron BJ, Fletcher RD. Increased right ventricular wall thickness in left ventricular pressure overload: echocardiographic determination of hypertrophic response of the “nonstressed” ventricle. J Am Coll Cardiol. 1985;6:550–5.
Nunez BD, Messerli FH, Amodeo C, Garavaglia GE, Schmieder RE, Frohlich ED. Biventricular cardiac hypertrophy in essential hypertension. Am Heart J. 1987;114(4 Pt 1):813–8. doi:10.1016/0002-8703(87)90792-7.
Lindqvist P, Waldenstrom A, Henein M, Morner S, Kazzam E. Regional and global right ventricular function in healthy individuals aged 20–90 years: a pulsed Doppler tissue imaging study: Umea General Population Heart Study. Echocardiography. 2005;22:305–14. doi:10.1111/j.1540-8175.2005.04023.x.
Van de Veire NR, De Backer J, Ascoop AK, Middernacht B, Velghe A, Sutter JD. Echocardiographically estimated left ventricular end-diastolic and right ventricular systolic pressure in normotensive healthy individuals. Int J Cardiovasc Imaging. 2006;22:633–41. doi:10.1007/s10554-006-9082-y.
Lindqvist P, Calcutteea A, Henein M. Echocardiography in the assessment of right heart function. Eur J Echocardiogr. 2008;9:225–34.