title: Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance.
abstract: Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r = 0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤-14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25-17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable non-geometric 2DE surrogate of CMR-RVEF in PAH patients, constituting a powerful independent predictor of long-term outcome in this cohort with relatively preserved functional capacity.
authors: Echocardiography Laboratory, Cardiology Division, Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Alameda Lorena 1246 apto 1301, São Paulo, 01424-001, Brazil. augustoacostajrtrab@globo.com.
authors: Augusto Alberto
authors: AA
authors: da Costa Junior
authors: Pulmonary Circulation Group, Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 3° andar, São Paulo, CEP 04024-002, Brazil.
authors: Jaquelina Sonoe
authors: JS
authors: Ota-Arakaki
authors: Pulmonary Circulation Group and Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Department of Medicine, Universidade Federal de São Paulo - UNIFESP, Rua Napoleão de Barros 771 3° andar, São Paulo, CEP 04024-002, Brazil.
authors: Roberta Pulcheri
authors: RP
authors: Ramos
authors: Echocardiography Laboratory and Imaging Department, Cardiology Division, Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Marly
authors: M
authors: Uellendahl
authors: Echocardiography Laboratory, Cardiology Division - Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Frederico José Neves
authors: FJ
authors: Mancuso
authors: Echocardiography Laboratory, Cardiology Division - Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Manuel Adan
authors: MA
authors: Gil
authors: Echocardiography Laboratory, Cardiology Division - Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Cláudio Henrique
authors: CH
authors: Fischer
authors: Echocardiography Laboratory, Cardiology Division - Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Valdir Ambrosio
authors: VA
authors: Moises
authors: Echocardiography Laboratory, Cardiology Division - Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Antonio Carlos
authors: AC
authors: de Camargo Carvalho
authors: Echocardiography Laboratory, Cardiology Division - Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Rua Napoleão de Barros 771 2° andar, São Paulo, CEP 04024-002, Brazil.
authors: Orlando
authors: O
authors: Campos
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016278:Ventricular Function, Right
keywords: Pulmonary arterial hypertension; Right ventricular dysfunction; Right ventricular longitudinal strain; Speckle-tracking echocardiography