Abstract 16080: Right Ventricular Free Wall Strain Differentiates Acute Pulmonary Afterload Increases From Chronic Pulmonary Hypertension
Introduction: Distinction between an acute (pulmonary embolism (PE)) or chronic afterload etiology (pulmonary vascular disease (PHT)) of the right ventricle (RV) has important therapeutic implications. RV free wall strain (RVGS) may help to quantify this distinction.
Hypothesis: RVGS can differentiate chronic from acute RV ventricular afterload.
Methods: Study groups ; PE pts (n=45) with echo performed 48 h of CT pulmonary angiogram were compared with 1)PHT pts 1;1 matched for age, gender and pulmonary artery systolic pressure (PASP) (n=45), and 2) un-matched PHT control group (n=116). RVGS was assessed by speckle tracking. Diagnostic ability of RV measurements was assessed using receivers operating characteristic (ROC) curves in the matched pts, then incremental ability of RVGS was examined in un-matched pts. Multivariate logistic regression models were adjusted for age, sex, gender and PASP.
Results: RVEDA, FAC, and RVGS were significantly impaired in PE pts (p<.05) with no significant differences in other clinical variables. ROC curve analysis revealed RVGS had a significantly better discriminative power than RVEDA (p<.001) (figure) (Cut-off of -17.4% ; sensitivity of 76%, specificity of 87%, AUC .82) in matched pts. In multivariate logistic regression analysis, RVGS was associated with the etiology of PH, independent of PASP, PVR and RVEDA (p<.001). Sequential logistic regression analyses demonstrated an incremental and independent benefit of using RVGS to predict acuity of afterload (Table)(p=.033). Concordance was superior in RVGS compared to FAC(ICC .851 versus .65, p<.01).
Conclusions: In a matched group RVGS is superior to RVEDA in determining chronic from acute pressure overload. There is less variability between readers for RV free wall strain compared to FAC. RVGS adds incremental and independently to the assessment RV afterload acuity during clinical practice.
Author Disclosures: L. Wright: None. K. Negishi: None. N. Dwyer: None. T. Marwick: None.
- © 2014 by American Heart Association, Inc.