Determinación de parámetros de deformación bidimensionales y tridimensionales en cavidades derechas en pacientes con diferentes tipos de hipertensión pulmonar precapilar
- Autores: Esther Cambronero Cortinas
- Directores de la Tesis: Petros Nihoyannopoulos (dir. tes.), Francisco Ridocci Soriano (codir. tes.), María del Mar Arroyo Jiménez (tut. tes.)
- Lectura: En la Universidad de Castilla-La Mancha ( España ) en 2022
- Idioma: español
- Tribunal Calificador de la Tesis: José María Oliver Ruiz (presid.), José A. Urbano (secret.), María Lázaro Salvador (voc.)
- Programa de doctorado: Programa de Doctorado en Ciencias de la Salud por la Universidad de Castilla-La Mancha
- Materias:
- Enlaces
- Tesis en acceso abierto en: RUIdeRA
- Resumen
Background and objectives: Precapillary pulmonary hypertension (PPH) pathologies are a group of progressive pathophysiological disorders with poor prognosis that affects both the pulmonary vasculature and secondary the heart. Right chambers’s function are affected and right ventricular failure (RVF) is the main determinant of survival and quality of life of these group of patients. Moreover, it’s known that deterioration of right ventricle (RV) function is associated with significant morbidity and mortality. However, despite advancement in echocardiographic and other imaging techniques, the RV assessment remains challenging in comparison to the LV. So, the aim of this study was to assess changes in RV and right atrial (RA) function determined by 2-dimensional (2D) and 3-dimensional (3D) speckle-tracking echocardiography (STE) in order to assess right chambers function in patients with different types of PPH.
Methods: A prospective study of cases and controls in adult patients with PPH was performed. We have included consecutively 80 patients with PPH and 80 controls matched by gender and age. Medical records, electrocardiograms and echocardiograms were reviewed. RV and RA dimensiones, RV fractional area change, tricuspid annular plane systolic excursion, systolic wave by TDI and myocardial performance index were determined. RV systolic pressure was assessed using continuous-wave Doppler echocardiography. 3D RV ejection fraction was calculated. 2D and 3D STE of RA and RV parameters were measured. Correlation analysis of echocardiography parameters was performed. Multivariate analysis of the risk factor (logistic regression) and analysis of adverse cardiovascular events (ACE; dead, change of treatment, heart failure and hospitalization; Kaplan-Meier) were performed. The patients were followed-up during nearly 36 months.
Results: The majority of patients (P) were female (48 P; 60%) and the mean age was 51.6 ± 12 years. Among the 80 P, 37.5% (30 P) were diagnosed with IPAH, 5% (4 P) heritable PAH, 2,5% (2 P) secondary to drug and toxin-induced PAH, 5% (4 P) PAH secondary to connective tissue disease, 5% (4 P) secondary to human immunodeficiency virus, 2.5 % (2 P) secondary to portal hypertension, 16.3% (13 P) secondary to congenital heart disease, 24% (19 P) were classified as chronic thromboembolic pulmonary hypertension, 2.5% (2 P) pulmonary hypertension with multifactorial mechanisms. Patients with PPH displayed significantly affected all parameters of RV systolic function compared with controls. The best echocardiography parameters associated with severely reduced RV ejection fraction were 3D RV longitudinal strain (Hazard Ratio HR’, 1.6; 95% Confidence interval CI, 1.2-2.2; p<0.001) and 2D RA conduit SR (HR’, 16; 95% CI, 1.5-175; p<0.022). ACE occurred in 51 patients (64%). 26 patients (32.5%) died; 1 had massive haemoptysis, 1 sudden death, 24 P secondary to right heart failure (RHF). 11 patients (14%) had RHF, 32 P (40%) need updated their treatment and 6 patients (7.5%) were admitted to the hospital. Factors associated with ACE in the multivariable analysis were RA reservoir strain < 24.6 % (HR’: 2.3; 95% CI, 1.1-4.7; p=0.033) and RA active SR < -1.7/s (HR’: 3.4; %CI, 2.9-4.2; p=0.037). In a mean follow-up of 3 years, ACE was detected in 17 P (33%) with one parameter and 22 P (42 %) with both parameters’ vs 23% (12 P) without these parameters. After a mean follow-up 2 of years, 70% patients with both parameters remained free of ACE vs 90% with one o non-parameters. However, after a mean follow-up of almost 5 years, all groups have a high ACE rate (100% patients with both parameters vs 80% patients without parameters; p=0.008).
Conclusions: In summary, 2D and 3D deformation parameters are useful and reproducible tools for assessing RV and RA function in different types of PPH. RVEF is correlated with longitudinal strain, circumferential strain and area strain of the RV and deformation parameters of the RA. But, the best ecochardiography parameters associated with severely reduced RV ejection fraction were 3D RV longitudinal strain and 2D RA conduit SR, and RA reservoir strain and RA active strain rate parameters were the best variables in order to identificate patients with worse prognosis. Although RA STE is not routinely used in our clinical practice, its evaluation may enhance non-invasive risk stratification of right heart chambers in precapillary pulmonary hypertension patients. Further multicentre studies are needed to investigate how the affectation of RV and RA mechanics can affect RV-PA coupling.
