Abstract 12618: The Relation of Right Ventricular Mechanical Delay by Three-Dimentional Echocardiographic Strain to Right Heart Hemodynamics in Patients With Pulmonary Hypertension
Background: The relationship of 3-dimensional (3D) right ventricular (RV) regional mechanics to hemodynamics in chronic pulmonary hypertension (PAH) is unclear.
Methods: We studied 31 chronic PAH patients using novel 3D speckle area tracking strain (Toshiba Corp.) to analyze LV and RV area tracking strain in the septal and free wall segments. Timing of 3D area tracking strain (T) was assessed from the onset of QRS to peak strain in left ventricle (LV) and RV free wall and septal surfaces; and normalized to the RR interval (TCRV free, TCRV septum, TCLV free, TCLV septum). Data were compared with right heart catheter assessment of systolic and mean pulmonary artery pressures (sPAP, mPAP), pulmonary vascular resistance (PVR), pulmonary wedge pressure (PCWP) and stroke volume index (SVI).
Results: The time to peak of RV free wall strain (TCRV free) was significantly prolonged in PAH patients for both TCRV septum and TCLV free regions: 0.53 vs. 0.47 for TCRV septum (p≤0.01); 0.53 vs. 0.44 for TCLV free (p≤0.01). RV free wall and septum peak strain differences ([[Unable to Display Character: ▵]] TCRV free - TCRV septum) were significantly correlated with sPAP (r=0.33, p≤0.05), mPAP (r=0.45, p≤0.01) and PVR (r=0.41, p≤0.05), and SVI (r=-0.53, p≤0.01). RV and LV free wall peak strain ([[Unable to Display Character: ▵]] TRV free - TLV free), was significant correlated with mPAP (r=0.40, p≤0.05), PVR (r=0.40, p≤0.05) and SVI (r=-0.61, p≤0.01). [[Unable to Display Character: ▵]] TCRV free - TCRV septum was associated with SVI ≤30 ml/m2 *(Cutoff of > 0.067) with sensitivity of 88% and specificity of 85%, (area under the receiver operating characteristic curve 0.85). [[Unable to Display Character: ▵]] TCRV free - TCLV free with cutoff of > 0.11 had sensitivity of 89% and specificity of 73% (area under curve 0.87).
Conclusions: 3D speckle tracking strain imaging in PAH patients revealed that RV free wall delay was related to invasive hemodynamics measurements. RV free wall delay has promise to quantify cardiac performance in PAH patients.
- © 2013 by American Heart Association, Inc.