Echocardiographic predictors of subclinical systemic right ventricular dysfunction

Abstract

Introduction: Transposition of the great arteries with physiological surgical correction predisposes to dysfunction of systemic right ventricle. It is believed that asymptomatic patients have a subclinical dysfunction of this ventricle. Transthoracic echocardiography is sensitive to assess right ventricular function. To date, medical treatment is started when the patient begins with symptoms suggestive of ventricular dysfunction.

Objective: To estimate echocardiographic predictors of subclinical dysfunction of systemic right ventricle.

Method: Observational prospective study from May 2011 to December 2012. The sample (n = 65) was divided into two groups: asymptomatic (n = 33) and symptomatic (n = 32), according to the absence or presence of clinical symptoms suggestive of right ventricular dysfunction..

Results: The two groups were homogeneous in terms of age and surgical time. In both hypertrophy of the right ventricle anterior wall was showed, although lower in the asymptomatic group (p < 0.001). Subclinical systolic dysfunction in the asymptomatic group was evident. There were no differences in diastolic function between the two groups. There were correlations between the tricuspid annular plane systolic excursion and the right ventricular ejection fraction, both in the asymptomatic (r = 0.68, CI 95 % 0.44 to 0.83, p < 0.0001) and symptomatic groups (r = 0.77, CI 95 % 0.59 to 0.88, p < 0.0001). Echocardiographic predictors of subclinical systemic right ventricular dysfunction were identified.

Conclusions: Age, right ventricle anterior wall thickness, surgical time, and diastolic and systolic diameters of the right ventricle are echocardiographic predictors of subclinical systemic right ventricular dysfunction, useful for the timely initiation of medical treatment.