Correlation between right ventricular dyssynchrony and early ventricular dysfunction

Miguel Ayala-León, Terapia Intensiva Cardiovascular, Hospital Beneficencia Española, Puebla, Pue., México
Daniela A. Macías-Hernández, Terapia Intensiva Cardiovascular, Hospital Beneficencia Española, Puebla, Pue., México
Carla C. Conde-García, Terapia Intensiva Cardiovascular, Hospital Beneficencia Española, Puebla, Pue., México
Consuelo Orihuela-Sandoval, Departamento de Cardiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
Paula Z. Serrano-Jova, Departamento de Medicina Interna, Unidad Médica de Alta Especialidad, Hospital de Especialidades San José Puebla, Puebla, Pue., México

Objective: To assess the association between right ventricular dyssynchrony and systolic dysfunction in patients with pulmonary hypertension, considering the distinct pathophysiological mechanisms from those affecting the left ventricle. Method: Prospective observational study including patients with pulmonary hypertension (groups 1, 3, 4, and 5). Right ventricular dyssynchrony was evaluated using speckle tracking, tissue Doppler imaging, and 3D echocardiography, measuring time-to-peak strain and systolic dyssynchrony index. Results: A strong correlation was found between increased dyssynchrony and impaired right ventricular systolic function on 3D echocardiography (systolic dyssynchrony index and ejection fraction: R = -0.77; p = 0.000045). No significant association was observed with pulmonary artery systolic pressure or right bundle branch block. Dyssynchrony showed a moderate correlation with left ventricular eccentricity indices and paradoxical septal motion. Conclusions: Right ventricular dyssynchrony is an independent marker of systolic dysfunction and is not related to afterload. Advanced imaging techniques are required for detection, as dyssynchrony may appear early and is not identifiable with conventional 2D echocardiography. Incorporating dyssynchrony assessment may improve diagnosis and prognosis in pulmonary hypertension.

Keywords: Right ventricular dyssynchrony. Pulmonary hypertension. Advanced echocardiography. Right ventricular systolic function.