{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:16:45Z","timestamp":1783574205466,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":83,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Right ventricular (RV) mechanical dyssynchrony represents a maladaptive response to increased afterload in pulmonary hypertension (PH). However, its hemodynamic and biochemical determinants remain unclear. This study aimed to identify the clinical, hemodynamic, and biochemical correlates of RV dyssynchrony in patients with pre\u2010capillary PH. Thirty patients with pre\u2010capillary PH (83% female; age 56\u2009\u00b1\u200919 years), all without intraventricular conduction delay (QRS\u2009&lt;\u2009120\u2009ms), underwent right heart catheterization, cardiac magnetic resonance imaging, and two\u2010dimensional speckle\u2010tracking echocardiography. RV dyssynchrony was quantified using the coefficient of variation of time\u2010to\u2010peak systolic strain in four mid\u2010basal RV segments (RV\u2010CV4) adjusted for heart rate. Mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and RV\u2010CV4 averaged 34.1\u2009\u00b1\u200911.2\u2009mmHg, 522.3 (interquartile range, 289.4\u2013692.6) dyn\u00b7s\u00b7cm\n                    <jats:sup>\u22125<\/jats:sup>\n                    , and 0.134\u2009\u00b1\u20090.083, respectively, in a cohort with predominantly mild\u2010to\u2010moderate RV systolic dysfunction. RV dyssynchrony correlated significantly with mPAP (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.509) PVR (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.507), and RV\u2010pulmonary artery coupling (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u2009\u22120.406) (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). In multivariate analysis, mPAP remained the sole independent predictor of RV dyssynchrony (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u20090.509, 95% CI 0.001\u20130.006,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004), accounting for 26% of its variance. Neither RV end\u2010diastolic volume nor RV ejection fraction were independently associated with dyssynchrony. RV mechanical dyssynchrony reflects hemodynamic afterload, particularly elevated mPAP, rather than structural remodeling. Notably, dyssynchrony was evident even in mild\u2010to\u2010moderate RV dysfunction, indicating an early manifestation of pressure\u2010induced impairment. RV\u2010CV4 may serve as a noninvasive marker of pulmonary vascular load and highlight the importance of afterload reduction in optimizing RV mechanical coordination. Accordingly, RV dyssynchrony assessment may provide a practical echocardiographic surrogate for invasive hemodynamic evaluation in clinical practice.\n                  <\/jats:p>","DOI":"10.1002\/pul2.70343","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T10:23:50Z","timestamp":1782210230000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Right Ventricular Mechanical Dyssynchrony Reflects Hemodynamic Load in Pre\u2010Capillary Pulmonary Hypertension"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-583X","authenticated-orcid":false,"given":"Sachiyo","family":"Igata","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"},{"name":"Division of Cardiology University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Tahara","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuko","family":"Tahara","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Honda","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadahiro","family":"Kugai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiko","family":"Eto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoko","family":"Maeda\u2010Ogata","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Fukumoto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiovascular Medicine Kurume University School of Medicine Kurume Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.847707"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.027"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2015.01.023"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2012.10.009"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2010.09.013"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2013.11.004"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2015.01.008"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euje.2006.02.005"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.05.005"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.111.971465"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2011.06.005"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.02.010"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.02.001"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.02.009"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.06.010"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045894020925759"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.11.244"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045894019883609"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045894019883609"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.102.8.865"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000560"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.2.9812078"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi879"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.01.853"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.029024"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2025.07.007"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2015.02.009"}],"container-title":["Pulmonary 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