title: Abnormal right ventricular myocardial strain generation in mild pulmonary hypertension.
abstract: BACKGROUND
  Although right ventricular (RV) dyssynchrony has been identified in patients with severe pulmonary hypertension due to significant RV enlargement and compromise in systolic function, a more clinically relevant question pertains to RV mechanical properties in patients with mild elevation in pulmonary artery systolic pressures (PASP).
  
  
  METHODS
  Several echocardiographic parameters and peak longitudinal strain were measured in 40 patients and divided into two groups of 20 patients based on their PASP.
  
  
  RESULTS
  Group I included 20 individuals (mean age 48 +/- 16 years with a mean PASP of 27 +/- 5 mmHg) and Group II included 20 patients (mean age 63 +/- 14 years with a mean PASP of 49 +/- 7 mmHg.) All time intervals were adjusted for heart rate. RV fractional area change and tricuspid annular plane systolic excursion for Group I (62 +/- 12% and 2.74 +/- 0.56 cm) and Group II (49 +/- 14%; P < 0.02 and 2.09 +/- 0.40; P < 0.002) were both normal. However, Group II had lower peak longitudinal RV free wall (RVF) strain (-27.3 +/- 7.1 % vs. -31.9 +/- 8.7%, P < 0.04), longer time to peak RVF strain (448 +/- 57 ms vs. 411 +/- 43 ms; P < 0.03) and evidence of significant RV dyssynchrony (-83 +/- 55 ms vs. 1 +/- 17 ms, P < 0.00001) in contrast to Group I.
  
  
  CONCLUSIONS
  In conclusion, mild elevations in PASP affect the mechanical properties of the RV and result in RV dyssynchrony despite absence of gross abnormalities in RV size or function.
authors.affiliation: Cardiovascular Institute at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA. lopezcandalesa@upenn.edu
authors.forename: Angel
authors.initials: A
authors.lastname: López-Candales
authors.forename: Navin
authors.initials: N
authors.lastname: Rajagopalan
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.forename: Beth
authors.initials: B
authors.lastname: Gulyasy
authors.forename: Kathy
authors.initials: K
authors.lastname: Edelman
authors.forename: Raveen
authors.initials: R
authors.lastname: Bazaz
mesh_terms: D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology*