Right ventricular systolic echocardiographic parameters in dilated cardiomyopathy and prognosis

##plugins.themes.academic_pro.article.sidebar##

Published Nov 14, 2017
Download
pdf
Vol. 95 No. 2 (2017): Issue Feb 2017

##plugins.themes.academic_pro.article.main##

Ihsen Zairi
Khadija Mzoughi
Mariem Jabeur
Zouhaier Jnifene
Sana Fennira
Sondos Kraiem
Sofiène Kamoun
Fethia Ben Moussa

Abstract

Background: Right ventricular (RV) dysfunction is associated with poor prognosis in patients with non-ischemic dilated cardiomyopathy. Several RV echocardiographic parameters have been proposed as sensitive markers to detect patients at risk.

Objective: To compare the predictive value of echographic parameters of RV systolic function for adverse outcomes in patients with non-ischemic dilated cardiomyopathy.
 
Methods:   Forty patients with non-ischemic dilated cardiomyopathy were included. Right ventricular systolic function assessed by Doppler echocardiography standard (RV fractional area change, Tei index, TAPSE and dp/dt), tissue Doppler (peak systolic velocity (Sa)) and Strain 2D of the RV. The primary endpoint was the occurrence of a major cardiovascular event. The follow-up extended for 6.2 months ± 2,49.

Results: Eighteen patients reached the primary endpoint. TAPSE (HR 0.86 [0.74-0.99], p=0.04), Sa (HR 0.77 [0.62-0.95], p=0.01), Tei index (HR 1.06 [1.01-1.12], p=0.02) and strain of the lateral wall of the RV (HR 1.13 [1.04-1.23], p=0.004) were found to be independent predictors of major cardiovascular event.
The cut-off thresholds for TAPSE, Sa, Tei index and strain of the lateral wall of th RV, defined using ROC curves were respectively 12,5mm ; 8,5cm/s ; 0,55 et -12.

Conclusion: TAPSE, Sa, Tei index and strain of the lateral wall of the RV are independent predictors of major cardiovascular event in non ischemic dilated cardiomyopathy.

Keywords:

Dilated cardiomyopathy, right ventricle, echocardiography, strain, prognosis

##plugins.themes.academic_pro.article.details##

References

  1. Jefferies JL, Towbin JA: Dilated cardiomyopathy. Lancet 2010, 375(9716):752-762.
  2. Solomon SD, Anavekar N, Skali H, McMurray JJ, Swedberg K, Yusuf S, et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 2005;112:3738-44
  3. MR, Hasselblad V, Gheorghiade M, Adams Jr KF, Swedberg K, Califf RM, et al. Prognostic usefulness of the sixminute walk in patients with advanced congestive heart failure secondary to ischemic or nonischemic cardiomyopathy. Am J Cardiol 2001;88:987-93.
  4. Ghio S, Gavazzi A, Campana C, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure.J Am Coll Cardiol. 2001; 37: 183-188.
  5. Karatasakis GT, Karagounis LA, Kalyvas PA, et al. Prognostic significance of echocardiographically estimated right ventricular shortening in advanced heart failure. Am J Cardiol.1998; 82: 329-334.
  6. Ghio S, Recusani F, Klersy C, et al. Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 2000; 85: 837-842.
  7. Thomas DE, Wheeler R, Youssef ZR, Masani ND. The role of echocardiography in guiding management in dilated cardiomyopathy. Eur J Echocardiogr, 2009, 10 : 15-21.
  8. Rigolin VH, Robiolio PA, Wilson JS, Harrison JK, Bashore TM. The forgotten chamber: The importance of the right ventricle. CathetCardiovasc Diagn 1995; 35:18-28.
  9. Tulevski II, Romkes H, Dodge-Khatami A, van der Wall EE,Groenink M, van Veldhuisen DJ, Mulder B. Quantitative assessment of the pressure and volume overloaded right ventricle: Imaging is a real challenge. Int J Cardiovasc Imaging 2002; 18:41-51.
  10. Tulevski II, Romkes H, Dodge-Khatami A, van der Wall EE,Groenink M, van Veldhuisen DJ, Mulder B. Quantitative assessment of the pressure and volume overloaded right ventricle: Imaging is a real challenge. Int J Cardiovasc Imaging 2002; 18:41-51.
  11. Andrea A, Salerno G, Scarafile R et al. Right Ventricular Myocardial Function in Patients with Either Idiopathic or Ischemic Dilated Cardiomyopathy Without Clinical Sign of Right Heart Failure: Effects of Cardiac Resynchronization Therapy. Pacing Clin Electrophysiol. 2009 Aug;32(8):1017-29.
  12. Vizzardi E, D'Aloia A, Caretta G, et al. Long-Term Prognostic Value of Longitudinal Strain of Right Ventricle in Patients with Moderate Heart Failure. Hellenic J Cardiol 2014; 55: 150-155.
  13. Polak JF, Holman BL, Wynne J, Colucci WS. Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease. J Am Coll Cardiol 1983; 2:217-224.
  14. Baker BJ, Wilen MM, Boyd CM, Dinh H, Franciosa JA. Relation of right ventricular ejection fraction to exercise capacity in chronic left ventricular failure. Am J Cardiol 1984; 54:596-599.
  15. López-Candales A, Rajagopalan N, Saxena N, Gulyasy B, Edelman K, Bazaz R. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol. 2006; 98: 973-977.
  16. Gupta S, Khan F, Shapiro M, Weeks SG, Litwin SE, Michaels AD. The associations between tricuspid annular plane systolic excursion (TAPSE), ventricular dyssynchrony, and ventricular interaction in heart failure patients. Eur J Echocardiogr. 2008; 9: 766-771.
  17. Donal E, Roulaud M, Raud-Raynier P, et al. Echocardiographic right ventricular strain analysis in chronic heart failure. Eur J Echocardiogr. 2007; 8: 449-456.
  18. Meluzín J, Spinarová L, Bakala J, et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function. Eur Heart J. 2001; 22: 340-348.
  19. Damy T, Viallet C, Lairez O, Deswarte G, Pavlino A, Maison P, et al. Comparison of four right ventricular systolic echocardiographic parameters to predict adverse outcomes in chronic heart failure. Eur J Heart Fail 2009; 11:818-24.
  20. Thèse de doctorat en medicine soutenue par Hadi Khachab en Septembre 2011: Interêt pronostique de l'échographie cardiaque dans la cardiomyopathie dilatée. Université Henri Poincare, Nancy 1.
  21. Missant C, Rex S, Claus P, Mertens L, Wouters PF. Loadsensitivity of regional tissue deformation in the right ventricle: isovolumic versus ejection-phase indices of contractility. Heart. 2008; 94: e15.
  22. Vogel M, Schmidt MR, Kristiansen SB, et al. Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure-volume relations in an animal model. Circulation. 2002; 105: 1693-1699.