Echocardiographic assessment of right ventricle diastolic function in patients with multivessel coronary artery disease

Abstract

Aim. The study was aimed at assessing the right ventricle diastolic function in patients with multivessel coronary artery disease.Methods. 62 patients (32 males (51.6 %)) with multivessel coronary artery disease (SYNTAX Score 33.04±4.1) were examined over a period from 2014 to 2016. The mean age was 58.5±8.3 years). To examine the diastolic function of the left and right ventricles (LV, RV), conventional echocardiographic (EchoCG) parameters, as well as a longitudinal diastolic strain rate at the level of RV free wall segments were analyzed by using tissue Doppler imaging in 2D strain imaging mode.Results. The systolic function of both ventricles was moderately decreased (LV EF 43.2 ± 5.5%, RV EF 42±6 %). 41 patients (66.1 %) demonstrated LV diastolic dysfunction (DD, impaired relaxation) of grade I and 46 patients (74.2 %) – RV DD of grade I. Pseudonormal LV DD grade II was revealed in 18 patients (29 %) and RV DD of grade II – in 15 patients (24.2 %). 3 patients (4.8 %) had LV DD (restrictive) of grade III and only 1 patient (1.6 %) showed a restrictive type of RV filling. The early diastolic strain rate (ESR) was 0.86±0.18 s–1 in patients with DD of grade I, the late diastolic strain rate was 0.88±0.27 s–1 (ASR), with their ratio ESR / ASR running to 0.99±0.16. For patients with DD of grade II, ESR was 0.62±0.04 s–1, ASR – 0.41±0.04 s–1 and the ratio of ESR / ASR – 1.5±0.19. For patients with DD of grade III (n = 1), ESR was 0.41 s–1, ASR – 0.2 s–1 and the ratio ESR / ASR – 2.05. A significant inverse correlation between the coronary artery disease complexity (SYNTAX Score) and the strain rate in the early diastolic phase of RV filling ESR (RS = –0.73, p = 0.001) was identified.Conclusion. Longitudinal systolic strain and diastolic strain rate decrease in parallel, thus reflecting a close relation of systolic and diastolic mechanics of the right ventricle. The intensity of right ventricle diastolic dysfunction is associated with the coronary artery disease complexity.Received 18 October 2016. Accepted 6 February 2017.Financing: The study required no additional funding and sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsConception and study design: E.N. Orekhova, O.A. Osetrova.Data collection and analysis: O.A. Osetrova, O.A. Balyshova.Drafting the article: E.N. Orekhova, O.A. Osetrova.Critical revision of the article: Yu.S. Sinelnikov, E.N. Orekhova.Final approval of the version to be published: Yu.S. Sinelnikov, E.N. Orekhova, O.A. Osetrova, O.A. Balyshova.