title: Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension.
abstract: The aim of this study was to assess whether serial quantitative assessment of right ventricular (RV) function by speckle-based strain imaging is affected by pulmonary hypertension-specific therapies and whether there is a correlation between serial changes in RV strain and clinical status. RV longitudinal systolic function was assessed using speckle-tracking echocardiography in 50 patients with pulmonary arterial hypertension (PAH) before and after the initiation of therapy. The mean interval to follow-up was 6 ± 2 months. Subsequent survival was assessed over 4 years. Patients demonstrated a mean increase in RV systolic strain from -15 ± 5 before to -20 ± 7% (p = 0.0001) after PAH treatment. Persistence of or progression to a severe reduction in free wall systolic strain (<-12.5%) at 6 months was associated with greater disease severity (100% were in functional class III or IV vs 42%, p = 0.005), greater diuretic use (86% vs 40%, p = 0.02), higher mean pulmonary artery pressure (67 ± 20 vs 46 ± 17 mm Hg, p = 0.006), and poorer survival (4-year mortality 43% vs 23%, p = 0.002). After adjusting for age, functional class, and RV strain at baseline, patients with ≥ 5% improvement in RV free wall systolic strain had a greater than sevenfold lower mortality risk at 4 years (hazard ratio 0.13, 95% confidence interval 0.03 to 0.50, p = 0.003). In conclusion, serial echocardiographic assessment of RV longitudinal systolic function by quantitative strain imaging independently predicts clinical deterioration and mortality in patients with PAH after the institution of medical therapy.
authors.affiliation: Mayo School of Graduate Medical Education, Rochester, MN, USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Hardegree
authors.forename: Arun
authors.initials: A
authors.lastname: Sachdev
authors.forename: Hector R
authors.initials: HR
authors.lastname: Villarraga
authors.forename: Robert P
authors.initials: RP
authors.lastname: Frantz
authors.forename: Michael D
authors.initials: MD
authors.lastname: McGoon
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: Ju-Feng
authors.initials: JF
authors.lastname: Hsiao
authors.forename: Robert B
authors.initials: RB
authors.lastname: McCully
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Garvan C
authors.initials: GC
authors.lastname: Kane
mesh_terms: D016001:Confidence Intervals; D004452:Echocardiography / Q000379:methods*; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013599:Systole; D016278:Ventricular Function, Right / Q000502:physiology*