title: Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two-dimensional (2D) speckle tracking strain.
  
  
  METHODS
  The study enrolled 37 group 1 PAH patients and 38 age- and gender-matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six-minute walk test (6MWT) and brain natriuretic peptide (BNP) levels were also obtained in patients with PAH.
  
  
  RESULTS
  The mean age of patients was 46.4 ± 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH. The overall 6MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (-17.9 ± 2.8 vs. -20.5 ± 1.9; P < 0.001 and 30.8 ± 10.5 vs. 49.8 ± 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion.
  
  
  CONCLUSIONS
  This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction.
authors.affiliation: Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. racorrea9@gmail.com.
authors.forename: Ricardo
authors.initials: R
authors.lastname: de Amorim Corrêa
authors.affiliation: Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.|Ecocenter, Hospital Socor, Belo Horizonte, Brazil.
authors.forename: Fernanda Brito
authors.initials: FB
authors.lastname: de Oliveira
authors.affiliation: Ecocenter, Hospital Socor, Belo Horizonte, Brazil.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Barbosa
authors.affiliation: Ecocenter, Hospital Socor, Belo Horizonte, Brazil.
authors.forename: Jose Augusto A
authors.initials: JA
authors.lastname: Barbosa
authors.affiliation: School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Taís Soares
authors.initials: TS
authors.lastname: Carvalho
authors.affiliation: School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Michele Campos
authors.initials: MC
authors.lastname: Barreto
authors.affiliation: Hospital Júlia Kubistchek, Belo Horizonte, Brazil.
authors.forename: Frederico Thadeu A F
authors.initials: FT
authors.lastname: Campos
authors.affiliation: Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Maria Carmo Pereira
authors.initials: MC
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D000328:Adult; D015150:Echocardiography, Doppler / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*; D055815:Young Adult
keywords: left ventricular function; pulmonary arterial hypertension; right ventricle; speckle tracking strain