Right ventricular regional and global systolic function is diminished in patients with pulmonary arterial hypertension: a 2-dimensional ultrasound speckle tracking echocardiography study

Abstract

The purpose of the study is to evaluate right ventricular (RV) regional and global systolic function in patients with pulmonary arterial hypertension (PAH) by 2-dimensional ultrasound speckle tracking echocardiography (STE) and explore the impact of pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) on RV systolic function. 42 patients with PAH and 31 healthy controls were included in this study. RV longitudinal peak systolic strain (LS) and strain rate (LSRs) were measured at the basal, mid and apical segments of the RV free wall and septum by STE. RV global longitudinal peak systolic strain (GLS) and strain rate (GLSRs) were also measured by STE. RV ejection fraction (EF) was determinated by cardiac magnetic resonance (CMR) imaging. LS and LSRs of RV 6 segments were significantly reduced in patients with PAH compared with controls. RV GLS and GLSRs were lower in patients with varying degrees of PAH than controls. Furthermore, RV GLS were most altered in patients with severe PAH compared with mild PAH. PVR was correlated with RV GLS and GLSRs (r₁ = -0.549; r₂ = -0.466, respectively, P < 0.05). Similarly, there was correlation between PASP and RV GLS and GLSRs (r₁ = -0.551; r₂ = -0.425, respectively, P < 0.05). GLS and GLSRs were correlated with CMR-derived RVEF. (r₁ = 0.693; r₂ = 0.560, respectively, P < 0.05). STE can identify impaired RV regional and global systolic function in patients with PAH. STE-derived strain and strain rate can be used as novel indices for RV function assessment from 2-dimensional echocardiographic images.

Evaluation of Right Ventricle by Speckle Tracking and Conventional Echocardiography in Rats With Right Ventricular Heart Failure

“…Based on these reports, in clinical RV evaluation, measurement of LS has been widely used and LS is currently recognized as the most useful strain variable in RV evaluation. 14,17,19) However, in terms of RV evaluation in the rat model, our results showed that only CS, but not LS, has significant differences although the reproducibility of LS and CS was similar. This result goes against our expectation.…”

“…Pirat, et al 16) used STE to evaluate RV function in 48 patients with PH and 19 age-matched controls and reported that STE can provide angle independent quantitation of RV function. Li, et al 17) evaluated 42 patients with PH and 31 healthy controls using STE and concluded that STE can identify impaired RV function. Hardegree, et al 18) assessed 50 patients with PH before and after the initiation of therapy.…”

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

“…60 While RV strain reflects myocardial performance, it is influenced by increased afterload and will decrease with increasing RV afterload. 61 RV global longitudinal peak systolic strain and strain rate were significantly impaired in adults with PH, compared to controls, 62 with RV systolic strain most altered in patients with severe PH, when compared with patients with mild PH. 62 Significant correlations between RV strain and strain rate and mPAP were found in adult PAH patients.…”

“…61 RV global longitudinal peak systolic strain and strain rate were significantly impaired in adults with PH, compared to controls, 62 with RV systolic strain most altered in patients with severe PH, when compared with patients with mild PH. 62 Significant correlations between RV strain and strain rate and mPAP were found in adult PAH patients. 63 The important value of serial measurement of RV systolic strain in the prediction of long-term prognosis was also shown in patients with PH.…”

Right Ventricle in Pulmonary Hypertension

“…Indeed, although standard 2D transthoracic echocardiography has provided merely 3 potential treatment goals-preserved tricuspid annulus systolic excursion, normal right atrial area, and the absence of pericardial effusion-modern right heart echocardiography has potentially more to offer. [10][11][12][13][14][15][16][17][18][19][20] Of note, in their study, Ryo et al did not follow this direction but limited the assessment to rather rudimental estimation of RV volumes, simply expecting better precision of the measurements assisted by 3D wall motion tracking when compared with traditional 2D echocardiography. Similar to CMR, this still required manual tracing of endocardial and epicardial borders.…”