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.
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The study was approved by the ethical review board of our institution, Escola Paulista de Medicina, Federal University of São Paulo—UNIFESP.
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Augusto Alberto da Costa Junior, Jaquelina Sonoe Ota-Arakaki, Roberta Pulcheri Ramos, Marly Uellendahl, Frederico José Neves Mancuso, Manuel Adan Gil, Cláudio Henrique Fischer, Valdir Ambrosio Moises, Antonio Carlos de Camargo Carvalho, Orlando Campos takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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None of the Authors has received research grants from any companies and all them declare that there were no conflicts of interests
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There were no animals involved in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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da Costa Junior, A.A., Ota-Arakaki, J.S., Ramos, R.P. et al. 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. Int J Cardiovasc Imaging 33, 39–46 (2017). https://doi.org/10.1007/s10554-016-0966-1
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DOI: https://doi.org/10.1007/s10554-016-0966-1