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

• Published in: International Journal of Cardiovascular Imaging 2017, Vol.33 (1), p.39-46
• Main Authors: da Costa Junior, Augusto Alberto, Ota-Arakaki, Jaquelina Sonoe, Ramos, Roberta Pulcheri, Uellendahl, Marly, Mancuso, Frederico José Neves, Gil, Manuel Adan, Fischer, Cláudio Henrique, Moises, Valdir Ambrosio, de Camargo Carvalho, Antonio Carlos, Campos, Orlando
• Format: Article
• Language: English
• Subjects: Adult; Cardiac Imaging; Cardiology; Case-Control Studies; Disease Progression; Echocardiography, Doppler; Female; Hospitalization; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - physiopathology; Imaging; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Myocardial Contraction; Original Paper; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Radiology; Risk Factors; Stress, Mechanical; Stroke Volume; Time Factors; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - mortality; Ventricular Dysfunction, Right - physiopathology; Ventricular Function, Right
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-016-0966-1

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