Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension
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Background: New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics byassessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, theprognostic significance of impaired GLSRV is unclear in these patients. Methods: Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40females, 48 ± 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI,Siemens Medical System, Mountain View, CA, USA). Results: GLSRV showed significant correlation with RV fractional area change (r = -0.606, p < 0.001), tricuspid annular planesystolic excursion (r = -0.579, p < 0.001), and RV Tei index (r = 0.590, p < 0.001). It showed significant correlations with pulmonaryvascular resistance (r = 0.469, p = 0.001) and B-natriuretic peptide concentration (r = 0.351, p = 0.012). During a clinical followuptime (45 ± 15 months), 20 patients experienced one or more adverse events (12 death, 2 lung transplantation, and 15 heartfailure hospitalization). After multivariate analysis, age [hazard ratio (HR) = 2.343, p = 0.040] and GLSRV (HR = 2.122, p =0.040) were associated with adverse clinical events. Age (HR = 3.200, p = 0.016) and GLSRV (HR = 2.090, p = 0.042) were alsosignificant predictors of death. Impaired GLSRV (≥ -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001)and increased mortality (HR = 8.842, p = 0.005). Conclusion: GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RVsystolic function. Lower GLSRV (≥ -15.5%) was significantly associated with presence of adverse clinical events and deaths inPAH patients.
Abstract
Background: New 2-dimensional strain echocardiography enables quantification of right ventricular (RV) mechanics byassessing global longitudinal strain of RV (GLSRV) in patients with pulmonary arterial hypertension (PAH). However, theprognostic significance of impaired GLSRV is unclear in these patients. Methods: Comprehensive echocardiography was performed in 51 consecutive PAH patients without atrial fibrillation (40females, 48 ± 14 years old) with long-term follow-up. GLSRV was measured with off-line with velocity vector imaging (VVI,Siemens Medical System, Mountain View, CA, USA). Results: GLSRV showed significant correlation with RV fractional area change (r = -0.606, p < 0.001), tricuspid annular planesystolic excursion (r = -0.579, p < 0.001), and RV Tei index (r = 0.590, p < 0.001). It showed significant correlations with pulmonaryvascular resistance (r = 0.469, p = 0.001) and B-natriuretic peptide concentration (r = 0.351, p = 0.012). During a clinical followuptime (45 ± 15 months), 20 patients experienced one or more adverse events (12 death, 2 lung transplantation, and 15 heartfailure hospitalization). After multivariate analysis, age [hazard ratio (HR) = 2.343, p = 0.040] and GLSRV (HR = 2.122, p =0.040) were associated with adverse clinical events. Age (HR = 3.200, p = 0.016) and GLSRV (HR = 2.090, p = 0.042) were alsosignificant predictors of death. Impaired GLSRV (≥ -15.5%) was associated with lower event-free survival (HR = 4.906, p = 0.001)and increased mortality (HR = 8.842, p = 0.005). Conclusion: GLSRV by VVI showed significant correlations with conventional echocardiographic parameters indicating RVsystolic function. Lower GLSRV (≥ -15.5%) was significantly associated with presence of adverse clinical events and deaths inPAH patients.
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