Right ventricular dysfunction in patients with non-severe idiopathic pulmonary fibrosis: a cross-sectional prospective single-center study

ABSTRACT

Background

Little is known about right ventricular dysfunction in non-advanced idiopathic pulmonary fibrosis (IPF) patients without hypoxemia at rest. We evaluated it at rest and during exercise.

Research design and methods

123 IPF patients were evaluated, and 27 met all the following criteria: Gender-Age-Physiology Index score ≤5, modified Medical Research Council dyspnea score ≤3, peripheral oxygen saturation ≥92% at rest, and no history of oxygen therapy. They were submitted to two-dimensional speckle-tracking echocardiography at rest and during cardiopulmonary exercise to analyze right ventricular global longitudinal strain.

Results

Abnormal speckle-tracking echocardiography findings were identified in 10/27 patients (37%), indicating right ventricular (RV) dysfunction. No patients had abnormalities observed in conventional echocardiographic parameters. Significant differences in mPAP were observed between patients with RV dysfunction and those without dysfunction (at rest: 26.0 ± 4.8 vs. 19.1 ± 4.2 mmHg, p = 0.001; during exercise: 51.3 ± 6.4 vs. 36.9 ± 14.7 mmHg, p = 0.002).

Conclusions

RV dysfunction was detected in 37% of non-advanced IPF patients and early recognition was only possible using speckle-tracking echocardiography. Special attention should be given to these patients as RV dysfunction is suggestive of worse prognosis. These patients could benefit from new specific drugs or even oxygen therapy for transitory hypoxia.

KEYWORDS:

• Echocardiography
• idiopathic pulmonary fibrosis
• pulmonary hypertension
• right ventricle
• speckle-tracking strain

Article highlights

• IPF patients at early stages of disease did not have abnormalities in RV function by conventional echocardiography parameters

• Speckle tracking echocardiography detected early RV dysfunction in 37% of those patients

• RV dysfunction is associated to pulmonary hypertension in the early stages of IPF

• Mean pulmonary pressure during exercise becomes even higher in patients with RV dysfunction compared to those without RV dysfunction

• Special attention should be given to patients with RV dysfunction, as they may have worse prognosis.

Acknowledgments

The authors specially thank Lauro Casqueiro Vianna, PhD, from NeuroVASQ-Integrative Physiology Laboratory (University of Brasília), for helping in data execution. We would like to thank Editage for English language editing.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability

The data that support the findings of this study are available on request from the corresponding author, SBC. The data are not publicly available due to their containing information that could compromise the privacy of participants.

Author contributions

SBC analyzed and interpreted patient data and was a major contributor in writing the manuscript. MPR reviewed all data and made substantial contributions to the conception and design of the work. FXM acquired and analyzed data from CPT. Both NMCF and VVPS selected all patients. VMA reviewed the work. CAMS acquired and analyzed the data and revised the work. All authors read and approved the final manuscript.

Ethics statement

The study was approved by the Ethics Committee of the University of Brasília (approval number-CAAE: 71,022,817.2.0000.5558)

Additional information

Funding

This paper was not funded.