Abstract 17138: Usefulness of Right Ventricular 2D-Strain For Prediction of Mortality and Clinical Deterioration in Pulmonary Hypertension
INTRODUCTION: Right ventricular (RV) function is the main determinant of prognosis in pulmonary hypertension (PH), but its estimation with conventional echocardiography lacks accuracy. Speckle-tracking derived strain (S) has successfully been applied to RV function assessment in PH. Whether this parameter has a prognostic role in the setting of the disease is still unclear.
METHODS: We prospectively studied 46 consecutive patients with PH (groups I, III and IV of the Dana Point classification) and 22 controls. Patients with PH secondary to left heart disease were excluded from the analysis. We measured maximum longitudinal systolic S with speckle tracking for 6 RV segments (3 septal and 3 lateral) from the 4 chamber view. Our endpoint was the combination of death, transplantation, hospitalization due to heart failure or advanced functional class (NYHA III or IV).
RESULTS: RV S was significantly depressed in PH patients when compared to controls: Global S -15.1±5.6 vs -25.9±3.9 (p < 0.005). During a mean follow-up of 15.1±9.6 months, 20 cardiovascular (CV) events occurred. We identified five variables significantly associated with CV events at follow-up: Fractional area change (26.2±12.4 vs 36,9±11,7, P=0.004), right atrial volume (105.9±50.8 vs 72.9±30.0, P=0.04), TAPSE (15.4±3.9 vs 17.8±4.2, P=0.05), NT-proBNP (6704.1±7395.4 vs 1218.6±1773.6, P=0.005) and Global S (-11.2±3.2 vs -18.1±5.3, P<0.005). A RV S worse than -13% in patients with PH identified a cohort of patients with a high risk of death or clinical deterioration. Global S was the only independent predictor for CV events in multivariate analysis (RR 1.69, CI 1.06-2.68, P=0.027).
CONCLUSION: RV longitudinal S emerges as a new prognostic parameter in PH, where S values lower than -13% are associated with a higher risk of clinical deterioration and mortality. We suggest routine measurement of RV deformation parameters in PH patients in order to improve the follow up of the disease progression.
- © 2012 by American Heart Association, Inc.