title: Comprehensive assessment of right ventricular function in patients with pulmonary hypertension with global longitudinal peak systolic strain derived from multiple right ventricular views.
abstract: BACKGROUND
  Right ventricular (RV) function is a strong predictor of mortality in pulmonary hypertension (PH), but two-dimensional (2D) echocardiography-derived assessments of RV function that could aid in risk assessment and management of patients with PH are of limited utility. RV longitudinal peak systolic strain (RVLS) derived from 2D speckle-tracking echocardiography is a relatively novel method for quantifying RV function but typically is derived from a single apical four-chamber view of the right ventricle and may have inherent limitations. The objective of this study was to determine the utility of regional and global RVLS calculated from multiple views of the right ventricle to comprehensively assess RV function in a cohort of patients with PH.
  
  
  METHODS
  Regional and global RVLS were obtained from multiple views of the right ventricle (centered on the right ventricle-focused apical position) in 40 patients with PH, defined as a mean pulmonary artery pressure ≥ 25 mm Hg, most of whom also had pulmonary capillary wedge pressures ≤ 15 mm Hg and were thus defined as having pulmonary arterial hypertension. This was compared with other 2D echocardiography-derived parameters of RV function and functional parameters.
  
  
  RESULTS
  Global RVLS calculated from multiple views had a superior correlation with 6-min walk distance compared with other parameters of RV function, including tricuspid annular plane systolic excursion, RV myocardial performance index, and fractional area change. Although global RVLS calculated from multiple views displayed a similar correlation with 6-min walk distance as global RVLS calculated from a single four-chamber view, analysis of regional strains provided by multiple views identified distinct patterns of RV dysfunction, consisting of global, free wall, or septal dysfunction, that were associated with specific clinical characteristics.
  
  
  CONCLUSIONS
  Global RVLS derived from multiple right ventricle-focused views yields a comprehensive quantitative assessment of regional and global RV function that correlates moderately with functional parameters and may be useful in the assessment of PH. Distinct patterns of regional RV dysfunction are associated with different clinical characteristics.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina. Electronic address: sudarshan.rajagopal@dm.duke.edu.
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Rajagopal
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forsha
authors.affiliation: Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark; Beverly Hills, California.
authors.forename: Niels
authors.initials: N
authors.lastname: Risum
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Abby D
authors.initials: AD
authors.lastname: Poms
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Fortin
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Beverly Hills, California (V.F.T.).
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kisslo
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000379:methods; D054459:Elasticity Imaging Techniques; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*; D016278:Ventricular Function, Right
keywords: 6-minute walk distance; Pulmonary hypertension; Right ventricular function; Speckle-tracking echocardiography; Strain