Focus on echocardiographic right ventricular strain analysis in cystic fibrosis adults without cardiovascular risk factors: a case–control study
Strain echocardiography is able to detect subclinical ventricular systolic and diastolic dysfunction. Prolonged survival to cystic fibrosis favors heart and vessel involvement. The purpose of the present study was to compare clinically stable adult patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate right ventricular (RV) systolic and diastolic function by means of strain and tissue Doppler imaging (TDI), respectively. 22 adults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors or overt pulmonary hypertension. All people underwent blood pressure measurement and transthoracic echocardiography. Cystic fibrosis patients showed higher sPAP [median 25 (IQR 21–30) vs 22 (22–22) mmHg; p = 0.02] and more frequent RV diastolic dysfunction (p < 0.001). Among cases, some RV systolic parameters were significantly altered than controls, such as TAPSE [20 (18–24) vs. 23 (21–28) mm; p = 0.001], FAC [34 (26–44) vs. 49 (48–50)%; p < 0.001], midwall tissue strain [− 25.0 (− 31.3 to − 22.8) vs. − 30.5 (− 31.8 to − 29.3)%; p = 0.03], apical tissue strain [− 22 (− 29.3 to − 19.0) vs. − 30.5 (− 32.8 to − 28.3)%; p = 0.001] and 2D strain [− 22.0 (− 25.1 to − 19.0) vs. − 29.5 (− 31.8 to − 27.3)%; p < 0.001]. Finally, 2D strain correlated with spirometric FEV1 (ρ = − 0.463, p = 0.03) and nearly with FEF25–75% (ρ = − 0.393, p = 0.07). Our study confirmed a RV subclinical systo-diastolic dysfunction in clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension nor cardiovascular risk factors. This may be due to systemic inflammation and temporary recurrent pulmonary hypertension. We retain that RV 2D strain and TDI echocardiography could become an important tool in the follow-up of these patients.