Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study

Abstract Background Pulmonary hypertension worsens the prognosis of idiopathic pulmonary fibrosis (IPF) and is associated with chronic respiratory failure in advanced disease. However, little is known about the occurrence of pulmonary hypertension and subsequent right ventricular dysfunction in non-advanced IPF patients without hypoxemia at rest. We evaluated right ventricular dysfunction in non-advanced IPF patients and examined the association of right ventricular dysfunction with mean pulmonary artery pressure (mPAP) at rest and during exercise.Methods This cross-sectional study included patients with blood oxygen saturation levels ≥92% at rest, Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea scale score ≤3, and no history of oxygen therapy. Patients underwent transthoracic echocardiography at rest and during cardiopulmonary exercise. Ventricular function was analyzed by measuring conventional parameters and right ventricular global longitudinal strain using two-dimensional speckle-tracking echocardiography. Means were compared using t-test for independent samples. Results Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular dysfunction (mean mPAP: 21.6 ± 5.5 mmHg at rest, 42.2 ± 14.1 mmHg during maximal exercise). Significant differences in mPAP were observed between patients with right ventricular dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). Right ventricular dysfunction was detected in 37% of non-advanced IPF patients and was associated with increased mPAP at rest and during exercise. Early recognition was only possible using speckle-tracking echocardiography. Conclusions Right ventricular dysfunction was detected in 37% of non-advanced IPF patients and was associated with increased mPAP at rest and during exercise. Special attention should be given to these patients; as right ventricular dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.

Download Full-text

Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study

10.21203/rs.2.15809/v3 ◽

2020 ◽

Author(s):

Sandra de Barros Cobra ◽

Marcelo Palmeira Rodrigues ◽

Felipe Xavier de Melo ◽

Nathali Mireise Costa Ferreira ◽

Viviane Vieira Passini Soares ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Right Ventricular ◽

Speckle Tracking ◽

Oxygen Therapy ◽

Ventricular Dysfunction ◽

Speckle Tracking Echocardiography ◽

Right Ventricular Dysfunction ◽

Cross Sectional

Abstract Background Pulmonary hypertension worsens the prognosis of idiopathic pulmonary fibrosis (IPF) and is associated with chronic respiratory failure in advanced disease. However, little is known about the occurrence of pulmonary hypertension and subsequent right ventricular dysfunction in non-advanced IPF patients without hypoxemia at rest. We evaluated right ventricular dysfunction in non-advanced IPF patients and examined the association of right ventricular dysfunction with mean pulmonary artery pressure (mPAP) at rest and during exercise. Methods This cross-sectional study included patients with blood oxygen saturation levels ≥92% at rest, Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea scale score ≤3, and no history of oxygen therapy. Patients underwent transthoracic echocardiography at rest and during cardiopulmonary exercise. Ventricular function was analyzed by measuring conventional parameters and right ventricular global longitudinal strain using two-dimensional speckle-tracking echocardiography. Means were compared using the t-test for independent samples.Results Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular dysfunction (mean mPAP: 21.6 ± 5.5 mmHg at rest, 42.2 ± 14.1 mmHg during maximal exercise). Significant differences in mPAP were observed between patients with right ventricular dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). Right ventricular dysfunction was detected in 37% of non-advanced IPF patients and was associated with increased mPAP at rest and during exercise. Early recognition was only possible using speckle-tracking echocardiography.Conclusions Right ventricular dysfunction was detected in 37% of non-advanced IPF patients and was associated with increased mPAP at rest and during exercise. Special attention should be given to these patients as right ventricular dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.

Download Full-text

Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study

10.21203/rs.2.15809/v1 ◽

2019 ◽

Author(s):

Sandra de Barros Cobra ◽

Marcelo Palmeira Rodrigues ◽

Felipe Xavier de Melo ◽

Nathali Mireise Costa Ferreira ◽

Viviane Vieira Passini Soares ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Right Ventricular ◽

Speckle Tracking ◽

Oxygen Therapy ◽

Ventricular Dysfunction ◽

Speckle Tracking Echocardiography ◽

Right Ventricular Dysfunction ◽

Cross Sectional

Abstract Background: Pulmonary hypertension worsens the prognosis of idiopathic pulmonary fibrosis (IPF) and is associated with chronic respiratory failure in advanced disease. However, little is known about the occurrence of pulmonary hypertension and subsequent right ventricular dysfunction in non-advanced IPF patients without hypoxemia at rest. We evaluated right ventricular dysfunction in non-advanced IPF patients and examined the association of right ventricular dysfunction with mean pulmonary artery pressure (mPAP) at rest and during exercise. Methods: This cross-sectional study included patients with blood oxygen saturation levels ≥92% at rest, Gender-Age-Physiology Index ≤5, modified Medical Research Council scale score ≤3, and no history of oxygen therapy. Patients underwent transthoracic echocardiography at rest and during cardiopulmonary exercise. Ventricular function was analyzed by measuring conventional parameters and right ventricular global longitudinal strain using two-dimensional speckle-tracking echocardiography. The t-test was used to compare means of independent samples. Results: Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular dysfunction (mean mPAP: 21.6 ± 5.5 mmHg at rest, 42.2 ± 14.1 mmHg during maximal exercise). Significant differences in mPAP were observed between patients with right ventricular dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002). Right ventricular dysfunction was detected in 37% of non-advanced IPF patients and was associated with increased mPAP at rest and during exercise. Early recognition was only possible using speckle-tracking echocardiography. Conclusions: Right ventricular dysfunction was detected in 37% of non-advanced IPF patients and was associated with increased mPAP at rest and during exercise. Special attention should be given to these patients, as right ventricular dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.

Download Full-text

Prognostic Factors in the Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Retrospective Single-center Study

Internal Medicine ◽

10.2169/internalmedicine.9331-17 ◽

2018 ◽

Vol 57 (5) ◽

pp. 655-661 ◽

Cited By ~ 9

Author(s):

Kenichiro Atsumi ◽

Yoshinobu Saito ◽

Naoyuki Kuse ◽

Kenichi Kobayashi ◽

Toru Tanaka ◽

...

Keyword(s):

Prognostic Factors ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Acute Exacerbation ◽

Single Center ◽

Single Center Study ◽

Center Study

Download Full-text

Idiopathic pulmonary fibrosis (IPF) in upper Egypt, a single center study

Egyptian Journal of Chest Diseases and Tuberculosis ◽

10.1016/j.ejcdt.2015.05.007 ◽

2015 ◽

Vol 64 (4) ◽

pp. 915-919 ◽

Cited By ~ 1

Author(s):

M. Alaa Rashad ◽

Ahmed K. Ibrahim

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Single Center ◽

Upper Egypt ◽

Single Center Study ◽

Center Study

Download Full-text

Right ventricular contractility decreases during exercise in patients with non-advanced idiopathic pulmonary fibrosis

10.1101/2020.05.14.20098327 ◽

2020 ◽

Author(s):

Sandra Barros Cobra ◽

Marcelo Palmeira Rodrigues ◽

Felipe Xavier Melo ◽

Nathali Mireise Costa Ferreira ◽

Cesar Augusto Melo Silva

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Right Ventricular ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Ventricular Dysfunction ◽

Global Longitudinal Strain ◽

Right Ventricular Dysfunction ◽

Peak Exercise ◽

Ventricular Contractility

Introduction: Early right ventricular dysfunction in non-advanced patients with idiopathic pulmonary fibrosis has not been fully elucidated. Thus, we aimed to assess right ventricular functions in idiopathic pulmonary fibrosis patients and controls by speckle-tracking strain echocardiography at rest and peak exercise. Methods: We conducted a cross-sectional study in 20 idiopathic pulmonary fibrosis patients without oxygen use, blood oxygen saturation levels ≥92% at rest, and modified Medical Research Council score ≤3 and enrolled 10 matched controls. Transthoracic echocardiography images were acquired at rest and during a cardiopulmonary exercise test. We analyzed two-dimensional echocardiographic parameters and right ventricular function using the global longitudinal strain assessed by the two-dimensional speckle-tracking technique. Results: In the control group, we found normal values of global longitudinal strain (GLS) at rest and at peak exercise, the latter being much more negative (-23.6&plusmn2.2% and -26.8&plusmn3.1%, respectively; p<0.001). By contrast, GLS values in the idiopathic pulmonary fibrosis group increased from -21.1&plusmn3.8% at rest to -17.0&plusmn4.5% at peak exercise (p<0.001). The exercise revealed a difference between the two groups as the mean GLS values moved during peak exercise in opposite directions. Patients with idiopathic pulmonary fibrosis got worse, whereas control patients presented improved right ventricular contractility. Conclusions: Right ventricular dysfunction was unveiled by speckle-tracking echocardiography during exercise in non-advanced idiopathic pulmonary fibrosis patients. We suggest that this reflects an inadequate right ventricular-arterial coupling decreasing the right ventricular longitudinal contraction during exercise in these patients. This parameter may be useful as an early index of suspected pulmonary hypertension.

Download Full-text