Key result
Left ventricular wall motion abnormalities were associated with significantly lower right ventricular systolic performance (TAPSE) at rest (20.5 vs 24.9 mm) and after dobutamine stress (21.5 vs 27.65 mm).
Why the study?
Does the presence of left ventricular wall motion abnormalities affect right ventricular systolic function and reserve during dobutamine stress echocardiography?
Cross-Sectional (n=59)
No
Does the presence of left ventricular wall motion abnormalities affect right ventricular systolic function and reserve during dobutamine stress echocardiography?
Left ventricular wall motion abnormalities are associated with reduced right ventricular longitudinal systolic function at rest and an impaired right ventricular response to dobutamine stress, highlighting ventricular interdependence.
May indicate biventricular involvement; leaves open whether RV reserve assessment refines risk stratification in stress echocardiography.
BACKGROUND: Right ventricular (RV) systolic performance is more difficult for evaluation compared to the left ventricle (LV). Despite differences in structure, RV myocardial fibers are in continuity with those of LV. The aim is assessment of the effects of LV wall motion abnormalities (WMA) on RV systolic function at rest and after stress. METHODS: Fifty nine subjects, 15 with LV-WMA underwent dobuatmine stress echocardiography (DSE) studies using the usual protocol. Measurement of tricuspid annular plane systolic excursion (TAPSE), velocity (TASV), mitral annular plane systolic excursion (MAPSE) and velocity (MASV), were performed before and immediately after DSE studies. RESULTS: TAPSE was lower, in those with LV-WMA than in those without, both at rest 20.5 ± 4.8 mm versus 24.9 ± 4.7 mm, P = 0.015 and after DSE studies, 21.5 ± 5.6 mm versus 27.65 ± 5.7 mm, P = 0.005. DSE studies did not change TAPSE significantly in the presence of LV-WMA. TASV at rest in those with LV-WMA was 16.5 ± 2.7 cm/sec and similar to that in those without, 17.6 ± 3 cm/sec. In both groups the velocity increased after DSE studies, 23.25 ± 7.5 cm/sec, P = 0.01 with LV-WMA, and 27.5 ± 6 cm/sec, P = 0.0005, without LV-WMA. Despite similar TASV at rest, the TAPSE/TASV ratio, indicating duration of shortening, was lower (124 ± 21 msec) in subjects with of LV-WMA, than in those without (145 ± 27 msec), P = 0.0065, implying increased after load for RV longitudinal shortening in the presence of LV-WMA. CONCLUSIONS: TAPSE is lower at rest and after DSE studies in subjects with LV-WMA than in subjects without; however, DSE studies increase TPASE only in the absence of LV-WMA. TASV increases after DSE studies and is similar at rest in both groups with or without LV-WMA. It seems that LV-WMA increases after load to RV longitudinal motion.
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Dawod Sharif (2013) conducted a cross-sectional in Coronary artery disease (n=59). Left ventricular wall motion abnormalities (LV-WMA) vs. No left ventricular wall motion abnormalities was evaluated on Tricuspid annular plane systolic excursion (TAPSE) at rest (p=0.015). Left ventricular wall motion abnormalities were associated with significantly lower right ventricular systolic performance (TAPSE) at rest (20.5 vs 24.9 mm) and after dobutamine stress (21.5 vs 27.65 mm).
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