Usefulness of Right Ventricular Basal Free Wall Strain by Two-Dimensional Speckle Tracking Echocardiography in Patients With Chronic Thromboembolic Pulmonary Hypertension

Abstract

SummaryRecently two-dimensional (2D) speckle tracking echocardiography (STE) derived from right ventricular (RV) free wall has been shown to be a very useful tool for the estimation of RV performance. The purpose of this study was to examine whether RV basal free wall strain can detect increased mean pulmonary arterial pressure (mPAP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We investigated a total of 126 patients with CTEPH (mean age, 56 ± 12 years). They underwent echocardiography and right heart catheter examination. 2D STE-derived longitudinal strain was measured by placing 2 regions of interests (ROIs) on the RV basal free wall in RV-focused apical 4-chamber view. Peak strain (RV-PS) was acquired between the 2 ROIs. Conventional echocardiographic RV parameters (RV fractional area change, RV myocardial performance index, tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, and tricuspid regurgitant pressure gradient) were evaluated as well. Right heart catheterization was performed on the day following of echocardiographic evaluation. Among RV echo parameters, RV-PS showed the best correlation with mPAP (r = 0.75, P < 0.0001). Receiver operating characteristic analysis revealed that a cut-off value of RV-PS -20.8% could detect mPAP ≧ 25 mmHg (sensitivity 78%, specificity 93%, area under the curve 0.90, P < 0.001). RV basal free wall strain was a useful tool for the non-invasive detection of increased mPAP in patients with CTEPH. (Int Heart J 2015; 56: 100-104) Key words: Peak longitudinal strain, Right ventricular function, Mean pulmonary arterial pressure C hronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition characterized by pulmonary thromboemboli that obstruct or obliterate the pulmonary vascular bed, followed by increased pulmonary vascular resistance (PVR) and progressive pulmonary hypertension (PH).Most standard techniques for assessing pulmonary hemodynamics, such as mean pulmonary arterial pressure (mPAP) or PVR, are invasive and impractical for serial assessment. Therefore, a non-invasive method to measure pulmonary hemodynamics accurately is clearly more useful. Echocardiography is a key tool for estimating pulmonary artery pressure in patients with PH. It is valuable in diagnosing, assessing a prognosis, and monitoring the efficacy of treatment.1) However, conventional echocardiographic methods are often challenging to assess right-sided hemodynamics or right ventricular (RV) function because of the complexity of RV anatomy. The recently developed technique, two-dimensional (2D) RV speckle tracking echocardiography (STE), has been introduced for the evaluation of RV function.2,3) The purpose of this study was to examine the utility of 2D RV basal strain in comparison with other RV echocardiographic parameters as well as invasive estimation of pulmonary hemodynamics in patients with CTEPH.

Pulmonary Artery Diameter Predicts Lung Injury After Balloon Pulmonary Angioplasty in Patients With Chronic Thromboembolic Pulmonary Hypertension

“…An elevated mean pulmonary arterial pressure (mPAP) (> 30 mmHg) is reported to have a poor prognosis. 1,2) Recently, the CHEST-1 study demonstrated the improvement of exercise tolerance by administration of riociguat, a soluble guanylate cyclase stimulator, 3) but there was insufficient reduction of mPAP. Although pulmonary endoaterectomy (PEA) is a first choice for treatment of CTEPH, 4) not all patients are suitable candidates due to distal localization of the lesions or to the high risk associated with surgery.…”

Ultrasound Accelerated Thrombolysis May Be an Effective and Safe Treatment Modality for Intermediate Risk/Submassive Pulmonary Embolism

“…The median RV end diastolic diameter was reduced from 41 (36-52) mm to 34 (29-41) mm (P = 0.005). The Qanadli score was significantly reduced from 19 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27) to 11 (3-15) (P = 0.005).…”

“…All patients had a symptom duration of less than 14 days and were at intermediate risk (normotensive, RV dysfunction or dilatation). On CT, PE with a median Qanadli score of 19 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27) USAT IN SUBMASSIVE PULMONARY EMBOLISM was 34 (22-50) mmHg during catheterization. USAT were performed successfully in all patients.…”

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension

“…Polanowski, et al 28) showed that dynamic coupling between the RV and pulmonary arteries is more disturbed in CTEPH than in PAH, despite similar levels of PAP. This may cause RV strain, 29) resulting in T wave inversion in the precordial leads. However, the reason is uncertain.…”