Early Impairment of Right Ventricular Functions in Patients with Moderate Asthma and the Role of Isovolumic Acceleration

Yıl 2022, Cilt: 25 Sayı: 2, 157 - 164, 20.08.2022

Betül Banu Karasu Hüseyin Ayhan

Öz

Introduction: Asthma is a common chronic lung disease that affects people all over the world. Pulmonary hypertension and right ventricular (RV) dysfunction are possible complications that may develop in the advanced stages of asthma. However, the number of studies investigating asthma and its implications on new RV parameters are very rare. This study aims to evaluate the RV functions in patients with moderate asthma before the development of pulmonary hypertension.

Patients and Methods: Forty-one patients with moderate asthma and 40 healthy individuals were enrolled in this case-control study. All participants underwent a detailed two-dimensional echocardiographic examination. RV functions were measured through RV isovolumic acceleration (IVA) index in addition to conventional parameters. RV IVA, a tissue doppler derived parameter, was calculated as the ratio between maximum isovolumic myocardial velocity during isovolumic contraction and the time interval from the onset of this wave to the time at its maximum velocity.

Results: There were no significant differences between the two groups in terms of baseline clinical characteristics, laboratory findings and echocardiographic parameters measuring left ventricular functions (p> 0.05). In asthmatic patients, RV isovolumic relaxation time and RV myocardial performance index were higher (p= 0.027 and p< 0.001 respectively), while RV fractional area change, tricuspid annular plane systolic excursion (TAPSE) and RV IVA values were all lower (p< 0.001). RV IVA was found to be inversely proportional to asthma duration. TAPSE [β= 0.632, 95% CI= (0.121) - (0.225), p< 0.001] and pulmonary artery systolic pressure [β= -0.188, 95% CI= (-0.057) - (-0.003), p= 0.032] were shown as independent predictors of RV IVA.

Conclusion: Asthma is an important disease that may result in subclinical RV dysfunction even before the development of pulmonary hypertension. RV IVA, an easily obtained and load-independent parameter, may be a useful and reliable index that sensitively analyzes subtle deteriorations in the contractile function of RV in asthmatic patients. RV IVA may also correlate with asthma duration.

Anahtar Kelimeler

Asthma, echocardiography, ventricular function, right ventricular dysfunction, pulmonary hypertension

Kaynakça

• 1. Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V, et al. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol 2013;62(25 Suppl):D109-16. [Crossref]
• 2. Zangiabadi A, De Pasquale CG, Sajkov D. Pulmonary hypertension and right heart dysfunction in chronic lung disease. Biomed Res Int 2014;2014:739674. [Crossref]
• 3. The Global Initiative for Asthma (GINA) guidelines. Global strategy for asthma management and prevention; Updated 2019. Available from: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf.
• 4. Rehman A, Amin F, Sadeeqa S. Prevalence of asthma and its management: A review. J Pak Med Assoc 2018;68(12):1823-7.
• 5. Li S, Ma X, Xie J, Yan X, Sun W. MicroRNA-206, IL-4, IL-13, and INF-γ levels in lung tissue and plasma are increased by the stimulation of particulate matter with a diameter of ≤2.5μm, and are associated with the poor prognosis of asthma induced pulmonary arterial hypertension patients. Clin Exp Hypertens 2021;43(2):181-8. [Crossref]
• 6. Pinsky MR. The right ventricle: Interaction with the pulmonary circulation. Crit Care 2016;20(1):266. [Crossref]
• 7. Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R. Anatomy, function, and dysfunction of the right ventricle: JACC state-of-the-art review. J Am Coll Cardiol 2019;73(12):1463-82. [Crossref]
• 8. Pavasini R, Fiorencis A, Tonet E, Gaudenzi E, Balla C, Maietti E, et al. Right ventricle function in patients with acute coronary syndrome and concomitant undiagnosed chronic obstructive pulmonary disease. COPD. 2019;16(3-4):284-91. [Crossref]
• 9. Cassady SJ, Ramani GV. Right heart failure in pulmonary hypertension. Cardiol Clin 2020;38(2):243-55. [Crossref]
• 10. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23(7):685-713. [Crossref]
• 11. Sciatti E, Vizzardi E, Bonadei I, Curnis A, D’Aloia A, Metra M. Prognostic value of RV isovolumic acceleration and tissue strain in moderate HfrEF. Eur J Clin Invest 2015;45(10):1052-9. [Crossref]
• 12. Peyrou J, Parsaï C, Chauvel C, Simon M, Dehant P, Abergel E. Echocardiographic assessment of right ventricular systolic function in a population of unselected patients before cardiac surgery: A multiparametric approach is necessary. Arch Cardiovasc Dis 2014;107(10):529-39. [Crossref]
• 13. Baysal SS, Has M. Evaluation of pulmonary artery stiffness in newly diagnosed adult patients with asthma. Echocardiography 2019;36(5):870-6. [Crossref]
• 14. Baysal SS, Has M. Assessment of biventricular function with speckle tracking echocardiography in newly-diagnosed adult-onset asthma. J Asthma 2020:1- 9. [Crossref]
• 15. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. an official american thoracic society and european respiratory society technical statement. Am J Respir Crit Care Med 2019;200(8):e70-e88. [Crossref]
• 16. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: Recommendations from the american society of echocardiography. J Am Soc Echocardiogr 2019;32(1):1-64. [Crossref]
• 17. Mims JW. Asthma: Definitions and pathophysiology. Int Forum Allergy Rhinol 2015;5 Suppl 1:S2-6. [Crossref]
• 18. Schanen J, Iribarren C, Shahar E, Punjabi NM, Rich S, Sorlie P, et al. Asthma and incident cardiovascular disease: The Atherosclerosis Risk in Communities Study. Thorax 2005;60(8):633-8. [Crossref]
• 19. Onufrak SJ, Abramson JL, Austin HD, Holguin F, McClellan WM, Vaccarino LV. Relation of adult-onset asthma to coronary heart disease and stroke. Am J Cardiol 2008;101(9):1247-52. [Crossref]
• 20. Tattersall MC, Dasiewicz AS, McClelland RL, Gepner AD, Kalscheur MM, Field ME, et al. Persistent asthma is associated with increased risk for ıncident atrial fibrillation in the MESA. Circ Arrhythm Electrophysiol 2020;13(2):e007685 [Crossref]
• 21. Calverley P, Gatterall J, Shapiro C, Douglas N. Cor pulmonale in asthma. Br J Dis Chest 1983;77:303-7. [Crossref]
• 22. Kubba S, Davila CD, Forfia PR. Methods for evaluating right ventricular function and ventricular-arterial coupling. Prog Cardiovasc Dis 2016 Jul- Aug;59(1):42-51. [Crossref]
• 23. Vogel M, Cheung MM, Li J, Kristiansen SB, Schmidt MR, White PA, et al. Noninvasive assessment of left ventricular force-frequency relationships using tissue Doppler-derived isovolumic acceleration: Validation in an animal model. Circulation 2003;107(12):1647-52. [Crossref]
• 24. Kjaergaard J, Snyder EM, Hassager C, Oh JK, Johnson BD. Impact of preload and afterload on global and regional right ventricular function and pressure: A quantitative echocardiography study. J Am Soc Echocardiogr 2006;19(5):515-21. [Crossref]
• 25. Tayyareci Y, Tayyareci G, Tastan CP, Bayazit P, Nisanci Y. Early diagnosis of right ventricular systolic dysfunction by tissue Doppler-derived isovolumic myocardial acceleration in patients with chronic obstructive pulmonary disease. Echocardiography 2009;26(9):1026-35. [Crossref]
• 26. Schattke S, Knebel F, Grohmann A, Dreger H, Kmezik F, Riemekasten G, et al. Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: A Doppler tissue and speckle tracking echocardiography study. Cardiovasc Ultrasound 2010;8:3. [Crossref]
• 27. Shahlaee S, Alimi H, Poorzand H, Morovatdar N, Vakilian F, Shahlaee Shirin. Relationship between isovolumic acceleration (IVA) and TEI index with Pro-BNP in heart failure. Clin Res Cardiol 2020;11:57-63. [Crossref]
• 28. Tugcu A, Yildirimtürk O, Tayyareci Y, Demiroglu C, Aytekin S. Evaluation of subclinical right ventricular dysfunction in obstructive sleep apnea patients using velocity vector imaging. Circ J 2010;74(2):312-9. [Crossref]
• 29. Yang T, Liang Y, Zhang Y, Gu Q, Chen G, Ni XH, et al. Echocardiographic parameters in patients with pulmonary arterial hypertension: correlations with right ventricular ejection fraction derived from cardiac magnetic resonance and hemodynamics. PLoS One 2013;8(8):e71276. [Crossref]
• 30. Ono A, Hayabuchi Y, Tanaka M, Kagami S. Assessment of right ventricular function by isovolumic acceleration of pulmonary and tricuspid annulus in surgically repaired tetralogy of Fallot. J Med Invest 2020;67(1.2):145-50. [Crossref]
• 31. Ertürk M, Öner E, Kalkan AK, Püşüroğlu H, Özyılmaz S, Akgül Ö, et al. The role of isovolumic acceleration in predicting subclinical right and left ventricular systolic dysfunction in patient with metabolic syndrome. Anatol J Cardiol 2015;15(1):42-9. [Crossref]
• 32. Tosu AR, Gürsu O, Aşker M, Etli M, Işcan S, Eker E, et al. Isovolumic contraction acceleration before and after percutaneous closure of atrial septal defects. Postepy Kardiol Interwencyjnej 2014;10(1):7-11. [Crossref]
• 33. Van Orman JR, Connelly K, Albinmousa Z, Tousignant C. Early recovery of tricuspid annular isovolumic acceleration after mitral valve surgery - an observational study. Can J Anaesth 2016;63(8):920-7. [Crossref]
• 34. Tigen K, Karaahmet T, Zencirkiran H, Cevik C, Gurel E, Fotbolcu H, et al. Usefulness of isovolumic acceleration and tissue Doppler echocardiographic parameters for predicting postoperative functional recovery after heart valve surgery. Rev Esp Cardiol 2010;63(4):430-8. [Crossref]