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- Lisi, Matteo, et al.
(författare)
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Right ventricular longitudinal deformation correlates closely with right ventricular myocardial fibrosis in patients with end-stage heart failure
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34, s. 780-780
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Right ventricular (RV) longitudinal strain (LS) plays a key role in the evaluation of its systolic performance and clinical outcomein patients with refractory heart failure (HF). This study sought to determine the value of RVLS for prediction of RV myocardial fibrosis inpatients with severe HF undergoing heart transplantation (HTx).Methods: The cohort we studied consists of 24 patients with severe systolic HF (left ventricular ejection fraction ≤ 25%; NYHA class IV) referred between 2009 and 2013 for a simultaneous right heartcatheterization and echocardiographic evaluation before HTx.RVLS by Speckle Tracking Echocardiography (STE) was used to assess free-wall RVLS, global cavity RVLS (including all segments in the apical 4 chamber view and right atrial LS (RALS), RV fractional area change (RVFAC), RV sphericity index (RVSI) and tricuspid annular plane systolic excursion (TAPSE) were also measured. All patients underwent HTx 12±34 days afterwards. From the explanted hearts a 1 x 0,5 cmmyocardial sample of the RV lateral free wall was obtained and stainedwith hematoxylin-eosin and Masson's trichrome. The ratio of the fibrotic area to the total surface area of each section was used to estimate the extent of RV myocardial fibrosis (percentage) as (fibrotis area-total area) x 100.Results: A good correlation was found between the extent of RVmyocardial fibrosis and free-wall RVLS (r=0.72; p<0.0001), global RVLS (r=0.49; p<0.0001), RVSI (r=0.47; p<0.0001), and RALS (r= -0.46; p=0.005), with a poorer correlation with TAPSE (r= -0.32; p=0.01) and RVFAC (r= -0.25; p=ns). Of these indeces, free-wall RVLS had the strongest diagnostic accuracy for detecting severe RV myocardialfibrosis (AUC = 0.87).Conclusions: In late stage HF patients, right ventricular free wallmyocardial deformation is the best functional measure that correlateswith the extent of myocardial fibrosis. These findings should have clinical implications when interpreting other RV measurements.
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