Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance

Abstract

Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r = 0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤-14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25-17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable non-geometric 2DE surrogate of CMR-RVEF in PAH patients, constituting a powerful independent predictor of long-term outcome in this cohort with relatively preserved functional capacity.

Echocardiographic right ventricular strain from multiple apical views is superior for assessment of right ventricular systolic function

“…Da Costa et al . (da Costa Junior et al ., ) demonstrated similar results as our study. However, other studies report both strong (Focardi et al ., ) and weak correlations (Li et al ., ; Addetia et al ., ) to RVEF CMR .…”

“…The strongest correlation with RVEF CMR was seen with multiplane RVGLS which also showed the lowest interobserver variability. The results are compatible with previous studies showing that strain (derived from a 4‐chamber view) had a strong correlation compared to RVEF CMR (Leong et al ., ; Focardi et al ., ; Vizzardi et al ., ; da Costa Junior et al ., ).…”

“…In our study, TAPSE had a modest correlation ( r = 0·592) with RVEF CMR . Previous studies have shown similar correlation (Focardi et al ., ; Li et al ., ; Vizzardi et al ., ; da Costa Junior et al ., ). Mean TAPSE was within normal values according to ASE guidelines (Lang et al ., ) although RVEF CMR was reduced.…”

“…RIMP (or Tei‐index) showed only a modest correlation with RVEF CMR in our study ( r = −0·521) which is in concordance with a study performed in patients with PH (da Costa Junior et al ., ). However, other studies have only demonstrated weak correlation to RVEF CMR (Leong et al ., ; Li et al ., ; Lu et al ., ).…”

Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se

“…Peak global longitudinal strain (GLS) by echocardiography has been shown to have prognostic value in SSc and PAH from various aetiologies (Goda et al ., ; Cusmà Piccione et al ., ; da Costa Junior et al ., ; Henein et al ., 2015). High negative GLS is a marker for good clinical outcome, while low negative GLS implies poor outcome (Goda et al ., ; Cusmà Piccione et al ., ; da Costa Junior et al ., ; Henein et al ., 2015).…”