title: Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a devastating illness of pulmonary vascular remodeling, right-sided heart failure, and limited survival. Whether strain-based measures of right ventricular (RV) systolic function predict future right-sided heart failure and/or death is untested.
  
  
  METHODS
  RV longitudinal systolic strain and strain rate were evaluated by echocardiography in 80 patients with World Health Organization group 1 pulmonary hypertension (PH) (72% were functional class [FC] III or IV). Survival status was assessed over 4 years.
  
  
  RESULTS
  All patients had a depressed RV systolic strain (-15% ± 5%) and strain rate (-0.80 ± 0.29 s(-1)). Of the parameters assessed, average RV free wall systolic strain worse than -12.5% identified a cohort with greater severity of disease (82% were FC III/IV), greater RV systolic dysfunction (RV stroke volume index 26 ± 9 mL/m(2)), and higher right atrial pressure (12 ± 5 mm Hg). Patients with an RV free wall strain worse than -12.5% were associated with a greater degree of disease progression within 6 months, a greater requirement for loop diuretics, and/or a greater degree of lower extremity edema, and it also predicted 1-, 2-, 3-, and 4-year mortality (unadjusted 1-year hazard ratio, 6.2; 2.1-22.3). After adjusting for age, sex, PH cause, and FC, patients had a 2.9-fold higher rate of death per 5% absolute decline in RV free wall strain at 1 year.
  
  
  CONCLUSIONS
  Noninvasive assessment of RV longitudinal systolic strain and strain rate independently predicts future right-sided heart failure, clinical deterioration, and mortality in patients with PAH.
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Arun
authors.initials: A
authors.lastname: Sachdev
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Villarraga
authors.affiliation: Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.affiliation: Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Michael D
authors.initials: MD
authors.lastname: McGoon
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Ju-Feng
authors.initials: JF
authors.lastname: Hsiao
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Maalouf
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Naser M
authors.initials: NM
authors.lastname: Ammash
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN; Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Robert B
authors.initials: RB
authors.lastname: McCully
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Fletcher A
authors.initials: FA
authors.lastname: Miller
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN; Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN. Electronic address: kane.garvan@mayo.edu.
authors.forename: Garvan C
authors.initials: GC
authors.lastname: Kane
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013318:Stroke Volume; D015996:Survival Rate; D014463:Ultrasonography; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D017725:Ventricular Pressure / Q000502:physiology*