Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary  Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study.

D'Andrea, Antonello; Stanziola, Anna Agnese; Saggar, Rajan; Saggar, Rajeev; Sperlongano, Simona; Conte, Marianna; D'Alto, Michele; Ferrara, Francesco; Gargani, Luna; LANCELLOTTI, Patrizio; Bossone, Eduardo; RIGHT Heart International NETwork (RIGHT-NET), Investigators

doi:10.1016/j.chest.2018.11.015

Article (Scientific journals)

Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study.

D'Andrea, Antonello; Stanziola, Anna Agnese; Saggar, Rajan et al.

2019 • In CHEST, 155 (2), p. 297-306

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/291264

DOI
10.1016/j.chest.2018.11.015

PubMed
30543808

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Keywords :

Adaptation, Physiological; Adult; Blood Gas Analysis; Case-Control Studies; Disease Progression; Echocardiography, Doppler/methods; Echocardiography, Stress/methods; Female; Functional Residual Capacity; Hemodynamics; Humans; Hypertension, Pulmonary/etiology/physiopathology; Idiopathic Pulmonary Fibrosis/complications/diagnostic imaging/mortality/physiopathology; Image Interpretation, Computer-Assisted; Italy; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Proportional Hazards Models; Risk Assessment; Severity of Illness Index; Survival Analysis; Vascular Resistance; Ventricular Dysfunction, Right/diagnostic imaging/etiology/mortality; 2D speckle tracking echocardiography; idiopathic pulmonary fibrosis; right ventricle; stress echocardiography

Abstract :

[en] BACKGROUND: The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF. METHODS: Fifty early-stage patients with IPF and 50 healthy control patients underwent rest and stress echocardiography, including RV two-dimensional speckle tracking echocardiography. At peak exertion, blood gas analysis and spirometry were also assessed. RESULTS: At rest, RV diameters were mildly increased in IPF; however, although RV conventional systolic function indexes were similar between the IPF and control groups, RV global longitudinal strain and RV lateral wall longitudinal strain (LWLS) were significantly reduced in the IPF cohort. During physical exercise, patients with IPF showed a reduced exercise tolerance with lower maximal workload (P < .01), level of oxygen saturation (P < .001), and peak heart rate (P < .01). Systolic and diastolic BP values were similar in both groups. Systolic pulmonary artery pressure (PAPs) increase (ΔPAPs) during exertion was higher in IPF vs healthy subjects (P < .0001); RV LWLS increase (ΔRV LWLS) during exercise was lower in patients with IPF vs control patients (P < .00001). By multivariable analysis, RV LWLS at rest and ΔRV LWLS were directly related to peak exertion capacity, PAPs, and blood oxygen saturation level (Spo(2); P < .0001). Δ RV LWLS was directly related to diffusion lung carbon monoxide (P < .0001). CONCLUSIONS: RV myocardial dysfunction is already present at rest in early-stage IPF and worsens during exertion as detected by two-dimensional speckle-tracking echocardiography. The RV altered contractile reserve appears to be related to reduced exercise tolerability and impaired pulmonary hemodynamic.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

D'Andrea, Antonello; Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences,

Stanziola, Anna Agnese; Section of Respiratory Diseases, Department of Clinical Medicine and Surgery,

Saggar, Rajan; Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy,

Saggar, Rajeev; Department of Medicine, University of Arizona, Phoenix, AZ.

Sperlongano, Simona; Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences,

Conte, Marianna; Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences,

D'Alto, Michele; Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences,

Ferrara, Francesco; Division of Cardiology, Heart Department, 'Cava de' Tirreni and Amalfi Coast'

Gargani, Luna; Institute of Clinical Physiology, National Research Council, Pisa, Italy.

LANCELLOTTI, Patrizio ; Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie

Bossone, Eduardo; Division of Cardiology, Heart Department, 'Cava de' Tirreni and Amalfi Coast'

RIGHT Heart International NETwork (RIGHT-NET), Investigators

Other collaborator :

Bossone, Eduardo

Gargani, Luna

Naeije, Robert

Ferrara, Francesco

Armstrong, William F

Kolias, Theodore John

Bossone, Eduardo

Ferrara, Francesco

Caliendo, Luigi

Cocchia, Rosangela

More authors (53 more)

Language :

English

Title :

Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis: An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study.

Publication date :

February 2019

Journal title :

CHEST

ISSN :

0012-3692

eISSN :

1931-3543

Publisher :

Elsevier, Us il

Volume :

155

Issue :

Pages :

297-306

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 24 May 2022

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