Electrical-mechanical dyssynchrony in pre-capillary pulmonary hypertension.

Abstract

Background: This study focused on exploring the correlation between the electrical and mechanical dyssynchrony of the right ventricle (RV) in patients with pre-capillary pulmonary hypertension (PcPH). It also aimed to compare the predictive capabilities of these dyssynchronies for risk stratification.

Methods: From April 2017 to March 2018, PcPH patients at Fuwai Hospital were consecutively enrolled. They were divided into low-risk and non-low-risk groups according to the 2015 European Society of Cardiology Guidelines. Off-line software (GE EchoPAC version 201) was used to measure RV mechanical dyssynchrony (standard deviation of the time from QRS onset to peak strain for the six RV segments [RV-SD6]), while QRS duration representing electrical dyssynchrony was measured manually.

Results: In total, 66 PcPH patients (average 35 years, 19 males and 47 females) were enrolled, 37 in the low-risk group and 29 in the non-low-risk group. QRS duration was significantly correlated with RV-SD6 (r = 0.25, p = 0.047). Both RV-SD6 and QRS duration were significantly correlated with N‑terminal pro-brain natriuretic peptide levels (r = 0.44, p < 0.001 vs. r = 0.26, p = 0.039). Furthermore, RV-SD6 (area under the curve [AUC]: 0.75, 95% confidence interval [CI]: 0.64-0.87, p < 0.001) and QRS duration (AUC: 0.65, 95% CI: 0.52-0.78, p = 0.036) had the potential to predict non-low-risk stratification. Multivariate logistic regression analyses identified RV-SD6 (odds ratio [OR]: 1.02, 95% CI: 1.01-1.03, p = 0.009) and QRS duration (OR: 1.07, 95% CI: 1.00-1.15, p = 0.045) as independent predictors of non-low-risk PcPH.

Conclusion: Mechanical dyssynchrony presented by RV-SD6 correlates with QRS duration and better predicts risk stratification in PcPH patients without complete bundle branch block.