Deformation pattern and predictive value of right ventricular longitudinal strain in children with pulmonary arterial hypertension

Abstract

BackgroundRight ventricular function has been identified as an important prognostic factor in children with pulmonary arterial hypertension. The aim of the study was to assess the deformation pattern and prognostic value of right ventricular longitudinal strain in children with pulmonary arterial hypertension.MethodsWe prospectively evaluated 46 children (25 with pulmonary arterial hyperetension and 21 age and sex matched controls) using conventional and speckle-tracking echocardiography, brain natriuretic peptide levels and clinical status expressed by WHO functional class and 6-min walking test. According to the clinical status after 12 months of follow-up, the pulmonary arterial hypertension patients were divided in two groups: non-worsening (13) and worsening (12).ResultsRight ventricular free wall longitudinal strain and strain rate were significantly lower in children with PAH compared with controls (−24.72 ± 3.48 vs −15.60 ± 3.40, p = 0.0001 and −1.44 ± 0.09 vs −1.09 ± 0.15, p = 0.0001, respectively). There was a more expressed decrease of basal than apical region of right ventricular free wall longitudinal strain/strain rate in pulmonary arterial hypertension patients compared with controls (strain: p = 0.0001 vs p = 0.07 and strain rate: p = 0.0001 vs p = 0.002). Comparing worsening and non-worsening pulmonary arterial hypertension patients there was a significant difference in Mid right ventricular free wall longitudinal strain (−14.00 ± 3.13 vs. −20.76 ± 4.62, p = 0.0001). In multivariable logistic regression analysis Mid right ventricular free wall longitudinal strain was an independent predictor of worsening in pulmonary arterial hypertension children (OR 0.45; 95 % CI: 0.21–0.96, p = 0.041). In ROC curve analysis a cut-off value of Mid right ventricular free wall longitudinal strain of −18.50 % predicted clinical worsening in pulmonary arterial hypertension children, with a sensitivity and specificity of 91.7 and 30.8 %, respectively (area under curve = 0.88 ± 0.06, 95 % CI: 0.75–1.00, p = 0.001).ConclusionsTwo-dimensional speckle-tracking echocardiography is a complementary non-invasive tool for assessment of right ventricular function in children with severe pulmonary arterial hypertension, allowing also clinical prediction and segmental analysis of right ventricular myocardial performance in these patients.

Prognostic biomarkers in pediatric pulmonary arterial hypertension

“…More advanced echocardiographic techniques have also been suggested to be valuable in the assessment of children with PAH. Right ventricular free wall longitudinal strain assessed by speckle tracking echocardiography has been shown to be decreased in children with PAH, and to be associated with clinical outcomes (91)(92)(93)(94). This assessment is suggested to be better reproducible with lower inter-/intraobserver variability compared to other echocardiographic variables and better suited for serial follow-up (92,95,96).…”

Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients

“…Despite of current advances in clinical management and therapies, PAH patients remain suffering from debilitating symptoms with high mortality. 1 It is widely accepted that right ventricle (RV) performances determine the clinical outcomes of PAH; [2][3][4][5][6][7] however, the indicators of RV dysfunction and their relationship with the disease severity of PAH remain to be defined.…”

Regional right ventricular longitudinal systolic strain for detection of severely impaired right ventricular performance in pulmonary hypertension

“…In addition, strain rate representing the rate of systolic shortening of the myocardium has been found to be a strong index of left ventricular contractility 25 . Strain rate is relatively less influenced by loading conditions and may better reflect the change in myocardial contractility compared with strain 26,27 …”