2016

150.00 rub.
Buy article
2016/№6

Right ventricular damage under diastolic dysfunction of different severity in patients with ischemic heart disease

Arkhipov O.G.1, Sumin A.N.2
1 – Federal Budgetary Institution, Rehabilitation Center "Topaz" of the RF Social Insurance Fund, Leskhoznaya 1, Myski 652840, Kemerovo Region
2 – Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Federal Agency for Scientific Organizations, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: diastolic function, left ventricle, right ventricle, coronary heart disease

DOI: 10.18087/rhfj.2016.6.2207

Background. Functional condition of the right ventricle (RV) in coronary heart disease (CHD) is understudied although lesions of the right heart are not uncommon. It is unclear how progression of LV diastolic dysfunction can affect the right heart. Aim. To study EchoCG parameters of RV filling in CHD patients with LV diastolic dysfunction of different severity. Materials and methods. The study included 633 patients with CHD (350 men) aged 36 to 85. Patients were divided into 4 groups: patients with preserved LV diastolic function (n=283); grade 1 LV diastolic dysfunction (n=141); pseudonormal diastolic function (n=145); and restrictive filling pattern (n=64). EchoCG with evaluation of LV and RV diastolic function in modes of pulsed-wave Doppler for atrioventricular flows, spectral tissue Doppler of mitral and tricuspid annuli, and colored M-mode imaging was performed for all study patients. Results. Data from pulsed-wave Doppler of transmitral flows differed in groups consistent with changes in the type of LV diastolic filling. In patients with the restrictive type of LV filling, ET was increased by 8% (Z=–2.51; p=0.012); the atrial systolic velocity, AT, was reduced by 10% (Н=19.5; p=0.0002); the Ет/Ат ratio was increased by 9.7% (Н=39.3; р<0.0001) compared to group 1; and the early tricuspid flow deceleration time, B3ET, was significantly decreased compared to other groups (Н=14.5; p=0.0023). The tricuspid flow propagation velocity (TFPV) was significantly decreased (by 9% in groups 2 and 3 and by 12% in the last group, Н=35.3; p<0.0001). In the latter two groups, е’t was increased by one quarter compared to patients of group 2 (Н=34.1; p<0.0001). In patients with different types of diastolic dysfunction, а’t decreased linearly (Н=44.8; p<0.0001). The е’t/а’t ratio was significantly greater for patients with the restrictive type of diastolic dysfunction than for patients of the first three groups (Н=48.3; p<0.0001). The Еt/е’t ratio was significantly increased by 12% only in group 2 (Н=15.0; p=0.018). The correlation analysis showed significant correlations of LV and RV diastolic function parameters. Stronger correlations were found for Ет/Ат with parameters of LV diastolic function, Е/А (r=0.41; p=0.001), е’/а’ (r=0.32; p=0.001), е’sept/а’sept (r=0.39; p=0.001), and for tricuspid flow propagation velocity (TFPV) with MFPV (r=0.41; p=0.001). The early diastolic tricuspid annulus motion velocity, е’t, was correlated with е’sept (r=0.49; p=0.001) and е’sept/а’sept (r=0.28; p=0.01). The е’t/а’t ratio was correlated with Е/А (r=0.58; p=0.001), е’ (r=0.29; p=0.01), е’/а’ (r=0.53; p=0.001), and е’sept/а’sept (r=0.55; p=0.001). Conclusion. Parameters of RV filling changed in different directions; only the early RV filling flow propagation velocity significantly decreased with progression of LV diastolic dysfunction. Other parameters of RV diastolic function were less impaired by the process of LV diastolic dysfunction progression. This category of CHD patients need comprehensive evaluation of RV diastolic function parameters.
  1. Cuspidi C, Facchetti R , Bombelli M, Sala C, Tadic M, Grassi G, Mancia G. Risk of mortality in relation to an updated classification of left ventricular geometric abnormalities in a general population: the Pamela study. J Hypertens. 2015 Oct;33 (10):2133–40.
  2. Нарциссова Г.П. Роль правого желудочка в патологии сердечно-сосудистой системы. Патология кровообращения и кардиохирургия. 2014;1:32–6 [Narczissova G.P. Rol` pravogo zheludochka v patologii serdechno-sosudistoj sistemy`. Patologiya krovoobrashheniya i kardioxirurgiya. 2014;1:32–6].
  3. Fenster BE, Holm KE, Weinberger HD, Moreau KL, Meschede K, Crapo JD et al. Right ventricular diastolic function and exercise capacity in COPD. Respir Med. 2015 Oct;109 (10):1287–92.
  4. Grapsa J, Pereira Nunes MC, Tan TC, Cabrita IZ, Coulter T, Smith BC et al. Echocardiographic and hemodynamic predictors of survival in precapillary pulmonary hypertension: seven-year follow-up. Circ Cardiovasc Imaging. 2015 Jun;8 (6):pii:e002107.
  5. Peyrou J, Parsaï C, Chauvel C, Simon M, Dehant P, Abergel E. Echocardiographic assessment of right ventricular systolic function in a population of unselected patients before cardiac surgery: a multiparametric approach is necessary. Arch Cardiovasc Dis. 2014 Oct;107 (10):529–39.
  6. Сумин А.Н., Шушунова О.В., Архипов О.Г. Диастолическая дисфункция правого желудочка у больных артериальной гипертензией: клинико-эхокардиографические корреляции. Журнал Сердечная Недостаточность. 2015;16 (1):22–30 [Sumin A.N., Shushunova O.V., Arxipov O.G. Diastolicheskaya disfunkcziya pravogo zheludochka u bol`ny`x arterial`noj gipertenziej: kliniko-e`xokardiograficheskie korrelyaczii. Zhurnal Serdechnaya Nedostatochnost`. 2015;16 (1):22–30].
  7. Zakeri R , Mohammed SF. Epidemiology of right ventricular dysfunction in heart failure with preserved ejection fraction. Curr Heart Fail Rep. 2015 Oct;12 (5):295–301.
  8. Cenkerova K, Dubrava J, Pokorna V, Kaluzay J, Jurkovicova O. Right ventricular systolic dysfunction and its prognostic value in heart failure with preserved ejection fraction. Acta Cardiol. 2015 Aug;70 (4):387–93.
  9. Mohammed SF, Hussain I, AbouEzzeddine OF, Takahama H, Kwon SH, Forfia P et al. Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation. 2014 Dec 23;130 (25):2310–20.
  10. Piccolo R , Niglio T, Spinelli L, Capuano E, Strisciuglio T, D'Anna C et al. Reperfusion correlates and clinical outcomes of right ventricular dysfunction in patients with inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol. 2014 Jul 15;114 (2):243–9.
  11. Di Bella G, Siciliano V, Aquaro GD, De Marchi D, Rovai D, Carerj S et al. Right ventricular dysfunction: an independent and incremental predictor of cardiac deaths late after acute myocardial infarction. Int J Cardiovasc Imaging. 2015 Feb;31 (2):379–87.
  12. Сумин А.Н., Архипов О.Г. Показатели диастолической функции правого желудочка при различной выраженности легочной гипертензии у больных хроническим легочным сердцем. Журнал Сердечная Недостаточность. 2012;13 (1):13–8 [Sumin A.N., Arxipov O.G. Pokazateli diastolicheskoj funkczii pravogo zheludochka pri razlichnoj vy`razhennosti legochnoj gipertenzii u bol`ny`x xronicheskim legochny`m serdczem. Zhurnal Serdechnaya Nedostatochnost`. 2012;13 (1):13–8].
  13. Lopez-Candales A, Palm DS, Lopez FR , Perez R , Candales MD. Importance of end-diastolic rather than end-systolic right atrial size in chronic pulmonary hypertension. Echocardiography. 2015 Dec;32 (12):1762–70.
  14. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al.  Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009 Mar;10 (2):165–93.
  15. Агеев Ф.Т., Овчинников А.Г. Давление наполнения левого желудочка: механизмы развития и ультразвуковая оценка. Журнал Сердечная Недостаточность. 2012;13 (5):287–309 [Ageev F.T., Ovchinnikov A.G. Davlenie napolneniya levogo zheludochka: mexanizmy` razvitiya i ul`trazvukovaya oczenka. Zhurnal Serdechnaya Nedostatochnost`. 2012;13 (5):287–309].
  16. Bourji KI, Hassoun PM. Right ventricle dysfunction in pulmonary hypertension: mechanisms and modes of detection. Curr Opin Pulm Med. 2015 Sep;21 (5):446–53.
  17. Murch SD, La Gerche A, Roberts TJ, Prior DL, MacIsaac AI, Burns AT. Abnormal right ventricular relaxation in pulmonary hypertension. Pulm Circ. 2015 Jun;5 (2):370–5.
  18. Fredriksson AG, Svalbring E, Eriksson J, Dyverfeldt P, Alehagen U, Engvall J et al. 4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease. J Magn Reson Imaging. 2016 Mar;43 (3):558–65.
  19. Nikdoust F, Tabatabaei SA, Shafiee A, Mostafavi A, Mohamadi M, Mohammadi S. The effect of elective percutaneous coronary intervention of the right coronary artery on right ventricular function. Int Cardiovasc Res J. 2014 Dec;8 (4):148–51.
  20. Кузнецов В.А., Ярославская Е.И., Пушкарев Г.С., Горбатенко Е.А. Факторы, ассоциированные с дилатацией правого желудочка у больных ишемической болезнью сердца с перенесенным крупноочаговым инфарктом миокарда. Патология кровообращения и кардиохирургия. 2014;1:37–41 [Kuzneczov V.A., Yaroslavskaya E.I., Pushkarev G.S., Gorbatenko E.A. Faktory`, assocziirovanny`e s dilatacziej pravogo zheludochka u bol`ny`x ishemicheskoj bolezn`yu serdcza s perenesenny`m krupnoochagovy`m infarktom miokarda. Patologiya krovoobrashheniya i kardioxirurgiya. 2014;1:37–41].
  21. Кузнецов В.А., Ярославская Е.И., Пушкарев Г.С., Криночкин Д.В., Бессонов И.С., Горбатенко Е.А. Дилатация правого желудочка у больных ишемической болезнью сердца без инфаркта миокарда (по данным «Регистра проведенных операций коронарографии»). Терапевтический архив. 2015;87 (9):34–8 [Kuzneczov V.A., Yaroslavskaya E.I., Pushkarev G.S., Krinochkin D.V., Bessonov I.S., Gorbatenko E.A. Dilatacziya pravogo zheludochka u bol`ny`x ishemicheskoj bolezn`yu serdcza bez infarkta miokarda (po danny`m «Registra provedenny`x operaczij koronarografii»). Terapevticheskij arxiv. 2015;87 (9):34–8].
  22. Jin Y, Wang H, Wang Z, Jiang H, Tao D, Wu H. The evaluation of preoperative right ventricular diastolic dysfunction on coronary artery disease patients with left ventricular dysfunction. Echocardiography. 2014 Nov;31 (10):1259–64.
  23. Rodriguez Muñoz D, Markl M, Moya Mur JL, Barker A, Fernández-Golfín C, Lancellotti P, Zamorano Gomez JL. Intracardiac flow visualization: current status and future directions. Eur Heart J Cardiovasc Imaging. 2013 Nov;14 (11):1029–38.
Arkhipov O.G., Sumin A.N. Right ventricular damage under diastolic dysfunction of different severity in patients with ischemic heart disease. Russian Heart Failure Journal. 2016;17 (6):443–453

To access this material please log in or register

Register Authorize
Ru En