title: Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension.
abstract: BACKGROUND
  New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics by assessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, the prognostic significance of impaired GLSRV is unclear in these patients.
  
  
  METHODS
  Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40 females, 48 ± 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI, Siemens Medical System, Mountain View, CA, USA).
  
  
  RESULTS
  GLSRV showed significant correlation with RV fractional area change (r = -0.606, p < 0.001), tricuspid annular plane systolic excursion (r = -0.579, p < 0.001), and RV Tei index (r = 0.590, p < 0.001). It showed significant correlations with pulmonary vascular resistance (r = 0.469, p = 0.001) and B-natriuretic peptide concentration (r = 0.351, p = 0.012). During a clinical followup time (45 ± 15 months), 20 patients experienced one or more adverse events (12 death, 2 lung transplantation, and 15 heart failure hospitalization). After multivariate analysis, age [hazard ratio (HR) = 2.343, p = 0.040] and GLSRV (HR = 2.122, p = 0.040) were associated with adverse clinical events. Age (HR = 3.200, p = 0.016) and GLSRV (HR = 2.090, p = 0.042) were also significant predictors of death. Impaired GLSRV (≥ -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001) and increased mortality (HR = 8.842, p = 0.005).
  
  
  CONCLUSIONS
  GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RV systolic function. Lower GLSRV (≥ -15.5%) was significantly associated with presence of adverse clinical events and deaths in PAH patients.
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA. ; Cardiology Division of Internal Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Jae-Hyeong
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Park
authors.affiliation: Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Samar
authors.initials: S
authors.lastname: Farha
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Sharp
authors.affiliation: Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Lundgrin
authors.affiliation: Pulmonary and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Suzy
authors.initials: S
authors.lastname: Comhair
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Wai Hong
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Cardiology Division of Internal Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea.
authors.forename: Serpil C
authors.initials: SC
authors.lastname: Erzurum
authors.affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA. ; Center for Heart Valve Disease, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
keywords: Pulmonary arterial hypertension; Right ventricle; Strain echocardiography