Utility of Right Ventricular Free Wall Speckle-Tracking Strain for Evaluation of Right Ventricular Performance in Patients with Pulmonary Hypertension

Fukuda, Yuko; Tanaka, Hidekazu; Sugiyama, Daisuke; Ryo, Keiko; Onishi, Tetsuari; Fukuya, Hiroyuki; Nogami, Munenobu; Ohno, Yoshiharu; Emoto, Noriaki; Kawai, Hiroya; Hirata, Ken Ichi

doi:10.1016/j.echo.2011.06.005

Cited by 172 publications

(134 citation statements)

References 27 publications

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“…(Fukuda, Tanaka, 2011, Yang et al , 2013 The difference might be attributed to differences in patients' backgrounds, but the exact reason is unknown. Both TAPSE and RV FAC provide information on global RV function, but do not include potentially important regional variations in contractility and do not assess contraction synchronicity.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed the usefulness of RV free wall longitudinal strain for the assessment of RV performance compared with RV septal wall longitudinal strain. (Fukuda, Tanaka, 2011, Huez, Vachiery, 2007, Lopez-Candales, Dohi, 2005, Utsunomiya et al , 2011 In the clinical setting, we often find that a fine image of the RV apex cannot be obtained in the 4-chamber view. Pirat et al showed that magnitude of PSS at apex of RV free wall were similar with that at mid portion in normal subjects.…”

Section: Study Limitationsmentioning

confidence: 99%

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Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

et al. 2014

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Aims: Echocardiography is widely used for screening of pulmonary hypertension (PH). More recently developed two-dimensional speckle-tracking echocardiography (2D-STE) can assess regional deformation of the myocardium and is useful for detecting left ventricular dysfunction. However, its usefulness to assess right ventricular (RV) dysfunction is not clear. Therefore, the aim of this study was to investigate the ability of peak systolic strain (PSS) and post-systolic strain index (PSI) at the RV free wall determined by 2D-STE to detect PH.Main methods: Thirty-six images (27 images from PH patients, nine from patients with connective tissue disease without PH) obtained by 2D-STE were analysed. We investigated the relationship between RV hemodynamics measured by right heart catheterization and PSS, PSI and other echocardiographic parameters reflecting RV overload including RV end-diastolic diameter (RVDd) and tricuspid valve regurgitant pressure gradient (TRPG).Key findings: PSS, PSI, RVDd and TRPG were all correlated with mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR). Furthermore, when PSS and MPAP were measured twice, the change in PSS was correlated with the change in MPAP (r=0.633, p=0.037). Multivariate logistic regression analysis identified PSS as the only independent factor associated with MPAP≥35 mmHg [odds ratio (OR), 1.616; 95% confidence interval (CI) 1.017-2.567; p=0.042] and PVR≥400 dyne·sec·cm -5 (OR, 1.804; 95% CI 1.131-2.877; p=0.013). Furthermore, the optimal PSS cut-off value to detect an elevated MPAP and PVR was -20.75%, based on receiver operating characteristic curve analysis.Significance: PSS of the RV free wall might serve as a useful non-invasive 2 indicator of PH.

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Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

et al. 2014

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“…6 Of the conventional techniques, TAPSE is well known as a highly reproducible and robust non-invasive measure of RV function and is predictive of outcome for patients with PH. 7, 8 The present objective was to test the hypothesis that RV-free can predict long-term outcome after the addition of PH-specific drugs for the treatment of PH.…”

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confidence: 99%

Efficacy of Right Ventricular Free-Wall Longitudinal Speckle-Tracking Strain for Predicting Long-Term Outcome in Patients With Pulmonary Hypertension

Motoji

Tanaka

Fukuda

et al. 2013

Circ J

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103

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We previously published a comparative study of 2-D speckle tracking longitudinal strain from RV free wall (RV-free) as an independent echocardiographic predictor of hemodynamic RV performance including mPAP and PVR, and current conventional echocardiographic techniques including tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), RV index of myocardial performance (RIMP), and tissue Doppler-derived tricuspid lateral annular systolic velocity (S'). 6 Of the conventional techniques, TAPSE is well known as a highly reproducible and robust non-invasive measure of RV function and is predictive of outcome for patients with PH. 7, 8 The present objective was to test the hypothesis that RV-free can predict long-term outcome after the addition of PH-specific drugs for the treatment of PH. We also tested the hypothesis that the addition of an RV-free-based assessment to that based on TAPSE using conventional echocardiographic parameters can enhance the capability of the ulmonary hypertension (PH) is a clinical syndrome characterized by progressive increases in pulmonary vascular load, leading to marked increases in pulmonary artery pressure and exercise intolerance, and is usually associated with a poor outcome. 1-5 The natural history of patients with PH is heterogeneous, with more rapid clinical deterioration seen in patients with the highest degree of right ventricular (RV) dysfunction. Recently, several investigators reported that PH-specific drugs reduced the mortality and morbidity for patients with PH. 3 Consequently, interest is high in the assessment of RV performance for predicting long-term outcome after treatment with PH-specific drugs. While the assessment of RV function has thus become increasingly important in the management of patients with PH, most standard techniques for assessing RV hemodynamics, such as mean pulmonary artery pressure (mPAP) or pulmonary vascular resistance (PVR) are invasive and time-consuming. Background: The development of right ventricular (RV) dysfunction in pulmonary hypertension (PH) patients is associated with adverse outcome, so that the assessment of RV function has become increasingly important in the management of such patients. The present objective was to test the hypothesis that RV free-wall longitudinal speckle-tracking strain (RV-free), an independent echocardiographic predictor of hemodynamic RV performance, can predict long-term outcome.

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“…Right ventricular free wall STE-derived longitudinal strain and strain rate were recently demonstrated to correlate well with CMR-derived RV EF, mean pulmonary artery pressure, and pulmonary vascular resistance in people affected with pulmonary hypertension. 37 The current study was designed to determine if 5 echocardiographic indices of RV systolic function could detect anticipated changes in systolic function induced by pimobendan and atenolol in healthy dogs. It was not necessarily designed to compare the 5 RV systolic function indices to each other, as none are a recognized gold standard.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic assessment of right ventricular systolic function in conscious healthy dogs following a single dose of pimobendan versus atenolol

Visser

Scansen

Brown

et al. 2015

Journal of Veterinary Cardiology

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Objective: To quantify drug-induced changes in right ventricular (RV) systolic function after administration of pimobendan and atenolol. Animals: 80 healthy privately-owned dogs. Methods: Using a prospective, blinded, fully-crossed study design with randomized drug administration, RV systolic function was determined twice at two time periods; before and 3 h after administration of pimobendan (0.25 mg/kg PO) or atenolol (1 mg/kg PO). Indices of RV systolic function included tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulsed-wave tissue Dopplerderived systolic myocardial velocity of the lateral tricuspid annulus (S 0 ), and speckle-tracking-derived global longitudinal RV free wall strain and strain rate. The effect of treatment on percent change from baseline RV function was analyzed with a linear mixed model including the covariates heart rate, body weight, age, gender, drug sequence, and time period. Results: All indices showed a significant (p < 0.0001) increase and decrease from baseline following pimobendan and atenolol, respectively. Significant differences from baseline were attributed to drug treatment (p < 0.0001); whereas, effects of other covariates were not significant. The greatest percent changes, but also highest variability, were observed for S 0 and strain rate (p < 0.0001). Postatenolol, a significantly greater proportion of dogs exceeded the repeatability coefficient of variation for FAC and S 0 compared to TAPSE (p 0.007). Conclusions: Echocardiographic indices in healthy dogs tracked expected changes in RV systolic function following pimobendan and atenolol and warrant study in dogs with cardiovascular disease. ª

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Utility of Right Ventricular Free Wall Speckle-Tracking Strain for Evaluation of Right Ventricular Performance in Patients with Pulmonary Hypertension

Cited by 172 publications

References 27 publications

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

Efficacy of Right Ventricular Free-Wall Longitudinal Speckle-Tracking Strain for Predicting Long-Term Outcome in Patients With Pulmonary Hypertension

Echocardiographic assessment of right ventricular systolic function in conscious healthy dogs following a single dose of pimobendan versus atenolol

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