Abstract 13642: Right Ventricular Strain in Pulmonary Arterial Hypertension: Comparison Between 2D Echocardiography and Cardiovascular Magnetic Resonance

Abstract

Background: Right ventricular (RV) strain is a potentially useful prognostic marker in patients with pulmonary arterial hypertension (PAH). Two-dimensional (2D) speckle-tracking echocardiography (STE) derived RV strain is feasible and reproducible in patients with RV dysfunction. However, published reports regarding the accuracy of 2D-STE derived RV strain against an independent reference in this patient population is limited.

Objectives: Our aims were: (1) to compare global 2D-STE RV longitudinal strain to cardiovascular magnetic resonance (CMR)-derived RV ejection fraction (RVEF) and strain encoding (SENC) based RV strain; and (2) to determine the inter-observer variability of both 2D-STE and CMR-SENC global RV longitudinal strain in patients with PAH.

Methods: 25 patients with PAH underwent 2DE (Philips iE33) and CMR study (Philips 1.5T) within one hour. 2D-STE RV longitudinal strain was measured from a modified 4-chamber view using customized ST software (Epsilon). Short-axis SSFP cines were used to calculate RVEF by method of disks. Peak CMR global RV longitudinal strain was defined as the average of five pre-determined regions on a mid-ventricular short-axis slice using SENC software (Diagnosoft).

Results: 2D-STE analysis was possible in 21/25 patients (84%). RV global longitudinal strain using 2D-STE software correlated strongly with both CMR-derived RVEF and CMR-SENC peak strain (Figure). Inter-observer variability of global longitudinal strain measurements was low for both 2D-STE (95% limits of agreement (LOA) ± 6.1) and CMR-SENC (95% LOA ± 4.4).

Conclusions: This study demonstrates using CMR reference that RV longitudinal strain obtained by 2D-STE provides accurate and reproducible assessment of RV systolic function in patients with PAH. Moreover, these measurements compared well with CMR derived strain values, suggesting that 2D-STE RV strain is a reasonable and practical option for examining RV myocardial deformation.