Abstract 9974: A Novel Comprehensive RV Strain Analysis: Echocardiographic Approach to Define a Normal Adult Population

Abstract

Introduction: This study was performed to test the feasibility of and to establish normal ranges of a novel 3 view RV strain analysis. Such an approach is a necessary precursor for more detailed studies of RV regional dysfunction since RV failure is the primary problem in many congenital heart disorders. To date, 2D speckle-tracking strain experience with the RV is limited.

Hypothesis: This novel methodology is feasible and will allow significantly improved RV data to be produced via strain analysis.

Methods: Twenty-five healthy subjects were prospectively studied from the apical position using a 3 view RV approach with views equivalent to a LV 60º rotational model (Figure). Subjects received a complete echo optimized for 18 segment (SEG) RV strain analysis using a GE Vivid e9 with off-line 2D speckle-tracking analysis performed using EchoPAC BT11 software.

Results: Mean age was 30 years (range 20-52, 36% male). All had a normal QRS duration, TAPSE, and LVEF. Adequate tracking was obtained in 457/468 of all segments (98%). Using global functional RV analysis, the global peak longitudinal systolic strain (PLSS) mean was -23.5% (range -18.1% to -27.3%). Regional PLSS was greatest in the free-wall > apical > septal segments (p<0.001). The standard deviation of time to peak intervals (SDTTP) in the 18-SEG model was 26.7±8.2 ms (range 14.9 - 41.9ms) versus 22.5±9.2 ms in the traditional apical 4 chamber single view (p=0.004). No dyssynchronous patterns were observed. Coefficients of variation for independent intra/inter-observer measures were 6% and 9% for global PLSS and 12% and 11% for SDTTP.

Conclusions: The 18-SEG regional RV strain analysis is feasible, and normal ranges follow a consistent synchronous pattern. This novel comprehensive methodology adds information to the traditional model and provides a baseline for further study of regional RV strain in patients with suspected RV dysfunction and/or abnormal contraction patterns.