title: Deformation pattern and predictive value of right ventricular longitudinal strain in children with pulmonary arterial hypertension.
abstract: BACKGROUND
  Right ventricular function has been identified as an important prognostic factor in children with pulmonary arterial hypertension. The aim of the study was to assess the deformation pattern and prognostic value of right ventricular longitudinal strain in children with pulmonary arterial hypertension.
  
  
  METHODS
  We prospectively evaluated 46 children (25 with pulmonary arterial hyperetension and 21 age and sex matched controls) using conventional and speckle-tracking echocardiography, brain natriuretic peptide levels and clinical status expressed by WHO functional class and 6-min walking test. According to the clinical status after 12 months of follow-up, the pulmonary arterial hypertension patients were divided in two groups: non-worsening (13) and worsening (12).
  
  
  RESULTS
  Right ventricular free wall longitudinal strain and strain rate were significantly lower in children with PAH compared with controls (-24.72 ± 3.48 vs -15.60 ± 3.40, p = 0.0001 and -1.44 ± 0.09 vs -1.09 ± 0.15, p = 0.0001, respectively). There was a more expressed decrease of basal than apical region of right ventricular free wall longitudinal strain/strain rate in pulmonary arterial hypertension patients compared with controls (strain: p = 0.0001 vs p = 0.07 and strain rate: p = 0.0001 vs p = 0.002). Comparing worsening and non-worsening pulmonary arterial hypertension patients there was a significant difference in Mid right ventricular free wall longitudinal strain (-14.00 ± 3.13 vs. -20.76 ± 4.62, p = 0.0001). In multivariable logistic regression analysis Mid right ventricular free wall longitudinal strain was an independent predictor of worsening in pulmonary arterial hypertension children (OR 0.45; 95 % CI: 0.21-0.96, p = 0.041). In ROC curve analysis a cut-off value of Mid right ventricular free wall longitudinal strain of -18.50 % predicted clinical worsening in pulmonary arterial hypertension children, with a sensitivity and specificity of 91.7 and 30.8 %, respectively (area under curve = 0.88 ± 0.06, 95 % CI: 0.75-1.00, p = 0.001).
  
  
  CONCLUSIONS
  Two-dimensional speckle-tracking echocardiography is a complementary non-invasive tool for assessment of right ventricular function in children with severe pulmonary arterial hypertension, allowing also clinical prediction and segmental analysis of right ventricular myocardial performance in these patients.
authors.affiliation: Clinic of Paediatric Cardiology, Institute of Cardiovascular Diseases and Transplantation, University of Medicine and Pharmacy, Tîrgu-Mures, Romania.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Muntean
authors.affiliation: Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu-Mures, Romania.
authors.forename: Theodora
authors.initials: T
authors.lastname: Benedek
authors.affiliation: Laboratory Department, Institute of Cardiovascular Diseases and Transplantation, Tîrgu-Mures, Romania.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Melinte
authors.affiliation: Clinic of Paediatric Cardiology, Institute of Cardiovascular Diseases and Transplantation, University of Medicine and Pharmacy, Tîrgu-Mures, Romania. suteucarmen@yahoo.com.|Clinic of Paediatric Cardiology, Institute of Cardiovascular Diseases and Transplantation, University of Medicine and Pharmacy Tîrgu-Mures, 50 Gh Marinescu St, Tîrgu-Mures, 540136, Romania. suteucarmen@yahoo.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Suteu
authors.affiliation: Clinic of Paediatric Cardiology, Institute of Cardiovascular Diseases and Transplantation, University of Medicine and Pharmacy, Tîrgu-Mures, Romania.
authors.forename: Rodica
authors.initials: R
authors.lastname: Togãnel
mesh_terms: D006328:Cardiac Catheterization; D002648:Child; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012372:ROC Curve; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Children; Deformation pattern; Pulmonary arterial hypertension; Right ventricle; Strain