DYNAMICS OF SYSTOLIC AND DIASTOLIC RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH MULTIPLE CORONARY ARTERY DAMAGES AFTER SURGICAL MYOCARDIAL REVASCULARIZATION

Abstract

Aim. To assess the dynamics of systolic and diastolic function of the right ventricle in patients with multiple damage of coronary artery after surgical myocardial revascularization. Materials and methods. Fifty two patients with multivascular damage of coronary arteries (Syntax Score 32,2 ± 4,3 scores) were examined. Initially and 14 ± 3,3 months after the coronary artery bypass grafting (CABG), echocardiography by means of 2D-Speckle Tracking Imaging, magnetic resonance imaging (MRI) with contrast gadolinium intensification was performed. Results. According to MRI results, systolic function of the right ventricle (RV) raised (EF from 45 ± 11 % to 58 ± 11 %; р = 0,02). Longitudinal deformation of RV improved (from -16,4 ± 4,6 % to -18,4 ± 5,6 %, р = 0,0000). When estimating segmental function of RV, the correspondence of the zones of contrast accumulation by MRI data to the segments with significantly reduced longitudinal deformation both before CABG and after it was revealed. Longitudinal deformation correlates with both RV EF (before surgery RS = -0,78, р = 0,0001, after surgery RS = -0,73, р = 0,001) and gadolinium accumulation levels and segments. Conclusions. 1. Surgical myocardial revascularization is associated with decrease in volumes and rise in ejection fraction (EF) of the right ventricle by MRI data. 2. Contrast accumulation zones in RV correspond to the segments of reduced RV longitudinal deformation at the level of a free wall both before the surgery and after CABG. 3. After CABG, deformation parameters at the level of RV free wall are improved, but not normalized. The quantity of gadolinium accumulation zones in the right ventricle does not fall. 4. Diastolic function of the right ventricle both before CABG and after it depends on the diastolic function of the left ventricle.

Keywords

Surgical revascularization / right ventricle / echocardiography / longitudinal systolic deformation / magnetic resonance imaging

References

[1] Bleeker G.B., Steendijk P., Holman E.R. Assessing right ventricular function: the role of echocardiography and complementary technologies. Heart 2006; 92 (1): i19-i26.

[2] Denault A.Y., Couture P., Buithieu J. Left and right ventricular diastolic dysfunction as predictors of difficult separation from cardiopulmonary bypass. Can J Anaesth 2006; 53: 1020-1029.

[3] D’hooge J., Heimdal A., Jamal F. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 2000; 1: 154-170.

[4] Ersboll M., Andersen M.J., Valeur N. Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: a two-dimensional speckle-tracking study. Eur Heart J 2014; 35: 648-656.

[5] Fihn S.D., Blankenship J.C., Alexander K.P. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. JACC 2014. DOI: 10.1016/j.jacc.2014.07.017

[6] Jamal F., Bergerot C. Argaut L. Longitudinal strain quantitates regional right ventricular contractile function. Am J Physiol Heart Circ Physiol 2003; 285: H2842-H2847.

[7] Kowalski M., Kukulski T., Jamal F. Can natural strain and strain rate quantify regional myocardial deformation? A study in healthy subjects. Ultrasound Med Biol 2001; 27: 1087-1097.

[8] Lang R.M., Badano L.P., Mor-Avi V. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1-39.

[9] Rudski L.G., Lai W.W., Afilalo J. 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: 685-713.

[10] Sianos G., Morel M.-A., Kappetein A.P. The SYNTAX Score: an angiographic tool gra-ding the complexity of coronary artery disease. EuroInterv 2005; 1: 219-227.

RIGHTS & PERMISSIONS

Sinelnikov Y.S., Orekhova E.N., Osetrova O.S.