Prognostic Value of Right Ventricular Longitudinal Peak Systolic Strain in Patients with Pulmonary Hypertension

OBJECTIVES: Right ventricular (RV) function is an important prognostic marker in patients with pulmonary hypertension. The present evaluation assessed the prognostic value of RV longitudinal peak systolic strain (LPSS) in patients with pulmonary hypertension.

METHODS: A total of 150 patients with pulmonary hypertension of different etiologies (mean age 59±15 years, 37.3% male) were evaluated. RV fractional area change and tricuspid annular plane systolic excursion (TAPSE) index were evaluated with 2-dimensional echocardiography. RV LPSS was assessed with speckle tracking echocardiography. The patient population was categorized according to a RV LPSS value of -19%. Among several clinical and echocardiographic parameters, the significant determinants of all-cause mortality were evaluated.

RESULTS: There were no significant differences in age, sex, pulmonary hypertension etiology and left ventricular ejection fraction between patients with RV LPSS <-19% and patients with RV LPSS ≥-19%. However, patients with RV LPSS ≥-19% had significantly worse NYHA functional class (2.7±0.6 vs. 2.3±0.8, p=0.003) and lower TAPSE (16±4 mm vs. 18±3 mm, p<0.001) than their counterparts. During a median follow-up of 2.6 years, 37 patients died. RV LPSS was a significant determinant of all-cause mortality (HR 3.40, 95% CI 1.19-9.72, p=0.02).

CONCLUSIONS: In patients with pulmonary hypertension, RV LPSS is significantly associated with all-cause mortality. RV LPSS may be a valuable parameter for risk stratification of these patients. Future studies are needed to confirm these results in the pulmonary hypertension subgroups. 

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One Comment

  1. See also:

    A simple method to predict impaired right ventricular performance and disease severity in chronic pulmonary hypertension using strain rate imaging.
    Utsunomiya H, Nakatani S, Okada T, Kanzaki H, Kyotani S, Nakanishi N, Kihara Y, Kitakaze M.
    Int J Cardiol. 2011 Feb 17;147(1):88-94.
    http://www.ncbi.nlm.nih.gov/pubmed/19747741

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