title: Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values.
abstract: Pulmonary hypertension (PH) is a progressively fatal disease having a significant impact on right ventricular (RV) function, a major determinant of long-term outcome in PH patients. In our clinic we frequently noticed the combination of PH and reduced RV function, but with discordant Tricuspid Annular Plane Systolic Excursion (TAPSE) values. The present study focuses on whether RV free wall strain measured using 2-dimensional speckle-tracking echocardiography is able to predict mortality in this subgroup of PH patients. 57 patients with PH and RV dysfunction (visual echocardiographic assessment of ≥2) and pseudo-normalized TAPSE values (defined as ≥16 mm) were retrospectively evaluated. Patients were divided by RV free -20 % as cut-off value. Follow-up data on all-cause mortality were registered after a median follow-up time of 27.9 ± 1.7 months. RV free of ≥-20 % was predictive of all-cause mortality after a median follow-up time of 27.9 ± 1.7 months (HR 3.76, 95 % CI 1.02-13.92, p = 0.05). RV free ≥-20 % remained a significant predictor of all-cause mortality (HR 4.30, 95 % CI 1.11-16.61, p = 0.04) after adjusting for PH-specific treatment. On the contrary, TAPSE was not a significant predictor of all-cause mortality. RV free wall strain provides prognostic information in patients with PH and RV dysfunction, but with normal TAPSE values. Future studies with larger cohorts, longer follow-up periods and inclusion of more echocardiographic parameters measuring LV and RV function could confirm the strength of RV free ≥-20 % as a predictor of mortality for this subgroup of patients with PH.
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. marco.kessel@student.ru.nl.|School of Allied Health Sciences, Heart Foundation Research Centre and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. marco.kessel@student.ru.nl.
authors.forename: Marco
authors.identifier: 0000-0003-2168-6155
authors.initials: M
authors.lastname: van Kessel
authors.affiliation: Queensland Nuclear Imaging, The Prince Charles Campus, Brisbane, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Seaton
authors.affiliation: School of Allied Health Sciences, Heart Foundation Research Centre and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.|Cardiology Department, The Prince Charles Hospital, Brisbane, Australia.|School of Medicine, Griffith University, Gold Coast, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chan
authors.affiliation: School of Allied Health Sciences, Heart Foundation Research Centre and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.|Cardiology Department, The Prince Charles Hospital, Brisbane, Australia.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Kermeen
authors.forename: Christian
authors.initials: C
authors.lastname: Hamilton-Craig
authors.affiliation: Cardiology Department, The Prince Charles Hospital, Brisbane, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Butler
authors.affiliation: School of Allied Health Sciences, Heart Foundation Research Centre and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
authors.forename: Surendran
authors.initials: S
authors.lastname: Sabapathy
authors.affiliation: School of Allied Health Sciences, Heart Foundation Research Centre and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.|Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia.
authors.forename: Norman
authors.initials: N
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016278:Ventricular Function, Right
keywords: Echocardiography; Mortality; Pulmonary hypertension; Right ventricular function