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http://dx.doi.org/10.4070/kcj.2015.45.5.398

Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension  

Park, Jae-Hyeong (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Kusunose, Kenya (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Kwon, Deborah H. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Park, Margaret M. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Erzurum, Serpil C. (Department of Pathobiology, Lerner Research Institute, Cleveland Clinic)
Thomas, James D. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Grimm, Richard A. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Griffin, Brian P. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Marwick, Thomas H. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Popovic, Zoran B. (Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic)
Publication Information
Korean Circulation Journal / v.45, no.5, 2015 , pp. 398-407 More about this Journal
Abstract
Background and Objectives: Right ventricular longitudinal strain (RVLS) is a new parameter of RV function. We evaluated the relationship of RVLS by speckle-tracking echocardiography with functional and invasive parameters in pulmonary arterial hypertension (PAH) patients. Subjects and Methods: Thirty four patients with World Health Organization group 1 PAH (29 females, mean age $45{\pm}13$ years old). RVLS were analyzed with velocity vector imaging. Results: Patients with advanced symptoms {New York Heart Association (NYHA) functional class III/IV} had impaired RVLS in global RV (RVLSglobal, $-17{\pm}5$ vs.$ -12{\pm}3%$, p<0.01) and RV free wall (RVLSFW, $-19{\pm}5$ vs. -$14{\pm}4%$, p<0.01 to NYHA class I/II). Baseline RVLSglobal and RVLSFW showed significant correlation with 6-minute walking distance (r=-0.54 and r=-0.57, p<0.01 respectively) and logarithmic transformation of brain natriuretic peptide concentration (r=0.65 and r=0.65, p<0.01, respectively). These revealed significant correlations with cardiac index (r=-0.50 and r=-0.47, p<0.01, respectively) and pulmonary vascular resistance (PVR, r=0.45 and r=0.45, p=0.01, respectively). During a median follow-up of 33 months, 25 patients (74%) had follow-up examinations. Mean pulmonary arterial pressure (mPAP,$ 54{\pm}13$ to $46{\pm}16mmHg$, p=0.03) and PVR ($11{\pm}5$ to $6{\pm}2$ wood units, p<0.01) were significantly decreased with pulmonary vasodilator treatment. RVLSglobal ($-12{\pm}5$ to $-16{\pm}5%$, p<0.01) and RVLSFW ($-14{\pm}5$ to $-18{\pm}5%$, p<0.01) were significantly improved. The decrease of mPAP was significantly correlated with improvement of RVLSglobal (r=0.45, p<0.01) and RVLSFW (r=0.43, p<0.01). The PVR change demonstrated significant correlation with improvement of RVLSglobal (r=0.40, p<0.01). Conclusion: RVLS correlates with functional and invasive hemodynamic parameters in PAH patients. Decrease of mPAP and PVR as a result of treatment was associated with improvement of RVLS.
Keywords
Familial primary pulmonary hypertension; Heart ventricles; Ventricular function, right;
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