Abstract 16727: Advanced Echocardiographic Comparison of Pulmonary Arterial Hypertension And Pulmonary Hypertension Secondary to Left Heart Disease: 3-Dimensional Speckle Tracking and 3D Tricuspid Reconstruction
Purpose: The aim of this study was to compare right ventricular remodeling (RV) in pulmonary arterial hypertensive patients (PAH) and patients with pulmonary hypertension due to left heart disease (PH-HF) with 3-dimensional speckle tracking and 3D-tricuspid assessment.
Methods: Twenty-eight PH-HF patients were compared to 29 PAH patients. All patients underwent 2D, 3D and 3D-speckle tracking echocardiographic examination. Tomtec software adapted for the right ventricular assessment (modification of frame rate and depth) was employed for the analysis of 3D-speckle tracking and the assessment of 3D-TR PISA. The results were indexed to the RV end-diastolic volume (according to Frank-Starling principle) and indexed for body surface area (BSA).
Results: PH-HF patients had greater BSA when compared to PAH (1.9 ± 0.22 vs. 1.68 ± 0.13, p=0.0002) as well as greater left atrial diameter (51.2 ± 4.7 vs. 37 ± 3.2, p<0.001). Right ventricular (RV) end-diastolic volume was greater in PAH patients (PAH: 203.8 ± 66.8 mls vs. PH-HF: 122 ± 33 mls, p<0.001) and PAH patients had more impaired RV function (RVEF: PAH: 28 ± 20% vs. PH-HF: 50 ± 11%, p<0.001).
With regards to 3D speckle tracking, global RV strain indexed to RV-end diastolic volume was lower in PAH patients (PAH: -0.04 ± 0.01 vs. PH-HF: -0.07 ± 0.02, p=0.0054) however RV-free wall strain was similar for both populations: (PAH: -0.16 ± 0.03 vs. PH-LV: -0.21 ± 0.07, p=0.14).
2-dimensional PISA was greater in PH-LV patients (PH-HF: 0.77 ± 0.36 cm vs. PAH: 0.5 ± 0.22 cm, p=0.0035). 3-dimensional tricuspid vena contracta was similar in both groups (PH-HF: 0.76 ± 0.34 vs. PAH: 0.82 ± 0.4, p=0.06). When Bland-Altman was performed for 2D and 3D assessment, vena contracta was underestimated with 2-dimensional echocardiography (mean bias: -0.098, SD of bias: 0.08).
Conclusion: Right ventricular remodeling is different in PAH when compared to PH-LV patients. RV free wall strain may be more significant when compared to global strain for the assessment of RV function, due to the interventicular dependence. Finally, 3D-tricuspid vena contracta may be more important in the assessment of tricuspid regurgitation because it may help identifying the eccentric tricuspid jets, when compared to 2D-echocardiography.
- © 2013 by American Heart Association, Inc.