Does right ventricular dyssynchrony evaluated by 2D speckle-tracking echocardiography predict clinical worsening in patients with connective tissue disease-associated pulmonary arterial hypertension?
Right ventricular dyssynchrony assessed by 2D speckle-tracking echocardiography is significantly impaired in CTD-PAH and serves as an independent predictor of clinical worsening.
OBJECTIVES: Numerous studies have demonstrated impaired right ventricular (RV) synchronicity in pulmonary arterial hypertension (PAH). However, few studies have focused on connective tissue disease (CTD)-associated PAH. This study evaluates RV dyssynchrony and its prognostic value in CTD-associated PAH. METHODS: One hundred thirteen CTD patients and 32 healthy controls were consecutively recruited. The patients were further divided into two groups: the CTD-nonPAH group (sPAP ˂ 36 mmHg, n = 60) and the CTD-PAH group (sPAP ≥ 36 mm Hg, n = 53). RV dyssynchrony was evaluated by determining the standard deviation of the heart rate-corrected intervals from QRS onset to peak strain for the four segments (RV-SD4) using 2D speckle-tracking echocardiography (2D-STE). All patients were followed up, and the primary endpoint was clinical worsening. RESULTS: Compared to the health control, the CTD patients exhibited obviously prolonged RV-SD4 (13.3 ± 6.8 ms vs. 41.2 ± 36.5 ms, p 60.6 ms predicted clinical worsening with 91.3% sensitivity and 66.7% specificity (AUC = 0.891, p < 0.001). Multivariate Cox analysis showed that TAPSE (HR = 0.739; 95% CI 0.623-0.878; p = 0.001) and RV-SD4 (HR = 6.148; 95% CI 1.718-22.000; p = 0.005) were independent predictive parameters of clinical worsening. CONCLUSION: CTD patients exhibit impaired RV synchronicity, which is linked to RV function and pulmonary artery pressure. RV dyssynchrony could predict clinical worsening in CTD-PAH.
Ma et al. (Mon,) studied this question.