Skip to main content

Advertisement

Log in

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

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. D’Alonzo GE, Barst RJ, Ayres SM et al (1991) Survival in patients with primary pulmonary hypertension. Results from a National Prospective Registry. Ann Intern Med 115:343–349

    Article  PubMed  Google Scholar 

  2. Rich S, Dantzker DR, Ayres SM et al (1987) Primary pulmonary hypertension. A national prospective study. Ann Intern Med 107:216–223

    Article  CAS  PubMed  Google Scholar 

  3. Cacciapuoti F (2009) Echocardiographic evaluation of right heart function and pulmonary vascular bed. Int J Cardiovasc Imaging 25:689–697

    Article  PubMed  Google Scholar 

  4. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  5. Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  PubMed  Google Scholar 

  6. Puwanant S, Park M, Popovi´c ZB et al (2010) Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 121:259–266

    Article  PubMed  PubMed Central  Google Scholar 

  7. Meris A, Faletra F, Conca C et al (2010) Timing and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr 23(8):823–831

    Article  PubMed  Google Scholar 

  8. Fukuda Y, Tanaka H, Sugiyama D et al (2011) Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 24:1101–1108

    Article  PubMed  Google Scholar 

  9. Li Y, Xie M, Wang X, Lu Q, Fu M (2013) Right ventricular regional and global systolic function is diminished in patients with pulmonary arterial hypertension: a 2-dimensional ultrasound speckle tracking echocardiography study. Int J Cardiovasc Imaging 29:545–551

    Article  PubMed  Google Scholar 

  10. Freed BH, Tsang W, Bhave NM et al (2015) Right ventricular strain in pulmonary arterial hypertension: a 2D echocardiography and cardiac magnetic resonance study. Echocardiography 32:257–263

    Article  PubMed  Google Scholar 

  11. Sachdev A, Villarraga HR, Frantz RP et al (2011) Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension. Chest 139(6):1299–1309

    Article  PubMed  Google Scholar 

  12. Park JH, Kusunose K, Kwon DH et al (2015) Relationship between right ventricular longitudinal strain, invasive hemodynamics, and functional assessment in pulmonary arterial hypertension. Korean Circ J 45(5):398–407

    Article  PubMed  PubMed Central  Google Scholar 

  13. Motoji Y, Tanaka H, Fukuda Y, Ryo K, Kawai H, Hirata K (2013) Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 77:756–763

    Article  PubMed  Google Scholar 

  14. Haeck MLA, Scherptong RWC, Marsan NA et al (2012) Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging 5:628–636

    Article  PubMed  Google Scholar 

  15. Fine NlM, Chen L, Bastiansen PM et al (2013) Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging 6:711–721

    Article  PubMed  Google Scholar 

  16. Giusca S, Dambrauskaite V, Scheurwegs C et al (2010) Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring. Heart 96:281–288

    Article  CAS  PubMed  Google Scholar 

  17. Galie N, Humbert M, Vachiery J et al Guidelines for the diagnosis and treatment of pulmonary hypertension the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) 2015, endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. doi:10.1093/eurheartj/ehv317

  18. Yock PG, Popp RL (1984) Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 70(4), 657–662

    Article  Google Scholar 

  19. Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ (2003) A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol 41:1021–1027

    Article  PubMed  Google Scholar 

  20. Sade LE, Gulmez O, Eroglu S, Sezgin A, Muderrisoglu H (2007) Noninvasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery. J Am Soc Echocardiogr 20(8):982–988

    Article  PubMed  Google Scholar 

  21. Crapo RO, Casaburi R, Coates AL et al (2002) American thoracic society ATS statement: guidelines for the 6-min walk test this official statement of the American Thoracic Society was approved by the ATS board of directors March 2002. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  22. McLaughlin VV, Presberg KW, Doyle RL et al (2004)Prognosis of pulmonary arterial hypertension accp evidence-based clinical practice guidelines. Chest 126:78S–92S

    Article  PubMed  Google Scholar 

  23. Badano LP, Ginghina C, Easaw J et al (2010) Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr 11:27–37

    Article  PubMed  Google Scholar 

  24. Lindqvist P; Calcutteea A, Henein M (2008) Echocardiography in the assessment of right heart function Eur J Echocardiogr 9:225–234

    PubMed  Google Scholar 

  25. Moaref A, Abtahi F, Aghasadeghi K, Shekarforoush S (2014) Right ventricular strain and strain rate in patients with systemic sclerosis without pulmonary hypertension. Arch Cardiovasc Imaging 2(3):e20735

    Article  Google Scholar 

  26. Leather HA, Ama’ R, Missant C, Rex S, Rademakers FE, Wouters PF (2006) Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with open pericardium. Am J Physiol Heart Circ Physiol 290:H2369–H2375

    Article  CAS  PubMed  Google Scholar 

  27. Ozawa K, Funabashi N, Tanabe N et al (2014) Two-dimensional global longitudinal strain of right ventricle using transthoracic echocardiography can detect right ventricular fibrosis confirmed by 320 CT in pulmonary hypertension. Int J Cardiol 172:e320–e323

    Google Scholar 

  28. Hardegree EL, Sachdev A, Villarraga HR et al (2013) Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol 111:143–148

    Article  PubMed  Google Scholar 

  29. Miyamoto S, Nagaya N, Satoh T et al (2000) Clinical correlates and prognostic significance of 6-min walk test in patients with primary pulmonary hypertension comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487–492

    Article  CAS  PubMed  Google Scholar 

  30. Farber HW, Miller DP, McGoon MD et al (2015) Predicting outcomes in pulmonary arterial hypertension based on the 6-min walk distance. J Heart Lung Transplant 34:362–368

    Article  PubMed  Google Scholar 

  31. Castel AL, Szymanski C, Delelis F et al (2014) Prospective comparison of speckle tracking longitudinal bidimensional strain between two vendors. Arch Cardiovasc Dis 107:96–104

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study was approved by the ethical review board of our institution, Escola Paulista de Medicina, Federal University of São Paulo—UNIFESP.

Author contributions

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Augusto Alberto da Costa Junior.

Ethics declarations

Conflict of interest

None of the Authors has received research grants from any companies and all them declare that there were no conflicts of interests

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-016-0966-1

Keywords

Navigation