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Right Ventricular Structure and Function in Idiopathic Pulmonary Fibrosis with or without Pulmonary Hypertension
Author(s) -
D'Andrea Antonello,
Stanziola Anna,
Di Palma Enza,
Martino Maria,
D'Alto Michele,
Dellegrottaglie Santo,
Cocchia Rosangela,
Riegler Lucia,
Betancourt Cordido Meredyth Vanessa,
Lanza Maurizia,
Maglione Marco,
Diana Veronica,
Calabrò Raffaele,
Russo Maria Giovanna,
Vannan Mani,
Bossone Eduardo
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12992
Subject(s) - pulmonary hypertension , medicine , cardiology , pulmonary artery , diastole , ejection fraction , idiopathic pulmonary fibrosis , doppler echocardiography , doppler imaging , blood pressure , lung , heart failure
Aims 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. Methods and 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 andm PAP 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 .