Abstract 14407: Three Dimensional Speckle Tracking Strain Evaluation of Right Heart Function and Hemodynamics in Patients with Pulmonary Hypertension

Abstract

Background: Assessment of right ventricular (RV) function in pulmonary hypertension (PH) patients is difficult but clinically important.

Objective: To compare novel 3-dimensional (3D) speckle tracking strain echocardiography to 2-dimensional (2D) echo and RV hemodynamic measures in patients with chronic PH.

Methods: 32 chronic PH patients, aged 61±14 years were prospectively studied by both 2D and 3D echo. Routine 2D and Doppler measures were RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), peak tricuspid regurgitation jet velocity (V_TR), and time velocity integral at RV outlet (TVI_RVOT). 3D speckle tracking echo assessed global area tracking strain in RV wall (Aplio Artida, Toshiba Corp). Of these, 23 patients also underwent right heart catheter evaluation and mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were estimated in all using Doppler methods. 2D and 3D echo were performed in 18 normal controls.

Results: As expected when compared with normal controls, chronic PH patients had statistically different RVFAC (29±10 vs. 44±7cm², p<0.0001), TAPSE (16±3 vs. 26±3mm, p<0.0001), V_TR (3.7±0.6 vs. 1.7±0.3mmHg, p<0.0001), TVI_RVOT (16±3 vs. 20±2cm, p<0.0001), and 3D global area tracking strain (19± 6 vs. 31±4%, p<0.0001). 3D global area tracking strain correlated well with PVR and mPAP (r=0.80, p<0.001; and r=0.78, p<0.001, respectively) in both PH patients and normal controls. Furthermore, global area tracking strain demonstrated good sensitivity and specificity of 92% and 86%, respectively, to predict PVR ≥5Wood units using a cutoff value of ≤ 20% (area under the receiver operating characteristic curve 0.95).

Conclusion: 3D speckle tracking strain echocardiography is a novel technique to assess RV function and estimate RV hemodynamic measures in patients with chronic PH and has potential for clinical applications.