Korean Circ J.  2015 Sep;45(5):398-407. 10.4070/kcj.2015.45.5.398.

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

• Park JH
• Kusunose K
• Kwon DH
• Park MM
• Erzurum SC
• Thomas JD
• Grimm RA
• Griffin BP
• Marwick TH
• Popovic ZB

• KMID: 2223804
• DOI: http://doi.org/10.4070/kcj.2015.45.5.398

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+/-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 (RVLS(global), -17+/-5 vs. -12+/-3%, p<0.01) and RV free wall (RVLS(FW), -19+/-5 vs. -14+/-4%, p<0.01 to NYHA class I/II). Baseline RVLS(global) and RVLS(FW) 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+/-13 to 46+/-16 mmHg, p=0.03) and PVR (11+/-5 to 6+/-2 wood units, p<0.01) were significantly decreased with pulmonary vasodilator treatment. RVLS(global) (-12+/-5 to -16+/-5%, p<0.01) and RVLS(FW) (-14+/-5 to -18+/-5%, p<0.01) were significantly improved. The decrease of mPAP was significantly correlated with improvement of RVLS(global) (r=0.45, p<0.01) and RVLS(FW) (r=0.43, p<0.01). The PVR change demonstrated significant correlation with improvement of RVLS(global) (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.

Keyword

Familial primary pulmonary hypertension; Heart ventricles; Ventricular function, right

MeSH Terms

Arterial Pressure
Echocardiography
Female
Follow-Up Studies
Heart
Heart Ventricles
Hemodynamics*
Humans
Hypertension*
Natriuretic Peptide, Brain
Vascular Resistance
Ventricular Function, Right
Walking
Wood
World Health Organization
Natriuretic Peptide, Brain

Figure

• 

  Fig. 1 Association of right ventricular longitudinal strain (RVLS) with clinical symptoms. Patients with advanced symptoms (NYHA Fc III/IV) have significantly impaired global right ventricular longitudinal strain (RVLSglobal) value. Error bar equals 1SD. RV: right ventricle, NYHA Fc: New York Heart Association functional class.

• 

  Fig. 2 Correlations between A) right ventricular global longitudinal strain of right ventricle and 6-minute walking distance; B) right ventricular global longitudinal strain of right ventricle and logarithmic transformation of B-type natriuretic peptide. C) global longitudinal strain of right ventricular free wall and 6-minute walking distance; D) global longitudinal strain of right ventricular free wall and logarithmic transformation of B-type natriuretic peptide. RVLSglobal: Right ventricular global longitudinal strain of right ventricle, RVLSFW: global longitudinal strain of right ventricular free wall, LogBNP: B-type natriuretic polypeptide concentration expressed as a logarithm of its value, RV: right ventricle.

• 

  Fig. 3 Correlations between A) right ventricular global longitudinal strain and mean pulmonary arterial pressure; B) global longitudinal strain of right ventricular free wall and mean pulmonary arterial pressure; C) right ventricular global longitudinal strain and cardiac index; D) global longitudinal strain of right ventricular free wall and cardiac index; E) right ventricular global longitudinal strain and pulmonary vascular resistance; F) global longitudinal strain of right ventricular free wall and pulmonary vascular resistance. mPAP: mean pulmonary arterial pressure, RVLSglobal: right ventricular global longitudinal strain of right ventricle, RVLSFW: global longitudinal strain of right ventricular free wall, PVR: pulmonary vascular resistance.

• 

  Fig. 4 Correlations between the changes of hemodynamic parameters and right ventricular global longitudinal strain with specific pulmonary vasodilator therapy. Change of variables was derived by subtraction of follow-up value from baseline value, and positive values indicate better response. A) change in right ventricular global longitudinal strain of right ventricle versus change in mean pulmonary arterial pressure; B) change in global longitudinal strain of right ventricular free wall versus change in mean pulmonary arterial pressure; C) change in right ventricular global longitudinal strain of right ventricle versus change in pulmonary vascular resistance; D) change in global longitudinal strain of right ventricular free wall versus change in pulmonary vascular resistance. mPAP: mean pulmonary arterial pressure, RVLSglobal: right ventricular global longitudinal strain of right ventricle, PVR: pulmonary vascular resistance, WU: wood units, RVLSFW: global longitudinal strain of right ventricular free wall.

• 

  Fig. 5 RVLSglobal during follow up. Data are presented at baseline, within the first 6 months, and after more than a year after initial echocardiogram. Patients were separated into the group already on treatment for pulmonary hypertension (n=6), and a group of in whom treatment was initiated or in intensified (n=28) after the baseline echocardiogram. Patients who were already on treatment had better RVLSglobal (p=0.04) during the study period. However, patients in whom treatment was initiated or intensified showed significant improvement in RVLSglobal during follow up (p=0.03). Error bars show 1 standard deviation. RVLSglobal: right ventricular global longitudinal strain of right ventricle.

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