TY - JOUR
T1 - Right Ventricular Functional Reserve in Early-Stage Idiopathic Pulmonary Fibrosis
T2 - An Exercise Two-Dimensional Speckle Tracking Doppler Echocardiography Study
AU - D'Andrea, Antonello
AU - Bossone, Eduardo
AU - RIGHT Heart International NETwork (RIGHT-NET) Investigators
A2 - Ostenfeld, Ellen
N1 - Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - 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 (Spo2; 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.
AB - 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 (Spo2; 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.
KW - Adaptation, Physiological
KW - Adult
KW - Blood Gas Analysis
KW - Case-Control Studies
KW - Disease Progression
KW - Echocardiography, Doppler/methods
KW - Echocardiography, Stress/methods
KW - Female
KW - Functional Residual Capacity
KW - Hemodynamics
KW - Humans
KW - Hypertension, Pulmonary/etiology
KW - Idiopathic Pulmonary Fibrosis/complications
KW - Image Interpretation, Computer-Assisted
KW - Italy
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Proportional Hazards Models
KW - Risk Assessment
KW - Severity of Illness Index
KW - Survival Analysis
KW - Vascular Resistance
KW - Ventricular Dysfunction, Right/diagnostic imaging
U2 - 10.1016/j.chest.2018.11.015
DO - 10.1016/j.chest.2018.11.015
M3 - Article
C2 - 30543808
SN - 1931-3543
VL - 155
SP - 297
EP - 306
JO - Chest
JF - Chest
IS - 2
ER -