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Chest. 2011 Jun;139(6):1299-1309. doi: 10.1378/chest.10-2015. Epub 2010 Dec 9.

Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension.

Author information

1
Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN.
2
Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN.
3
Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN; Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN.
4
Echocardiography Laboratory, Department of Medicine, Mayo Clinic, Rochester, MN; Pulmonary Hypertension Clinic, Department of Medicine, Mayo Clinic, Rochester, MN. Electronic address: kane.garvan@mayo.edu.

Abstract

BACKGROUND:

Pulmonary arterial hypertension (PAH) is a devastating illness of pulmonary vascular remodeling, right-sided heart failure, and limited survival. Whether strain-based measures of right ventricular (RV) systolic function predict future right-sided heart failure and/or death is untested.

METHODS:

RV longitudinal systolic strain and strain rate were evaluated by echocardiography in 80 patients with World Health Organization group 1 pulmonary hypertension (PH) (72% were functional class [FC] III or IV). Survival status was assessed over 4 years.

RESULTS:

All patients had a depressed RV systolic strain (-15% ± 5%) and strain rate (-0.80 ± 0.29 s(-1)). Of the parameters assessed, average RV free wall systolic strain worse than -12.5% identified a cohort with greater severity of disease (82% were FC III/IV), greater RV systolic dysfunction (RV stroke volume index 26 ± 9 mL/m(2)), and higher right atrial pressure (12 ± 5 mm Hg). Patients with an RV free wall strain worse than -12.5% were associated with a greater degree of disease progression within 6 months, a greater requirement for loop diuretics, and/or a greater degree of lower extremity edema, and it also predicted 1-, 2-, 3-, and 4-year mortality (unadjusted 1-year hazard ratio, 6.2; 2.1-22.3). After adjusting for age, sex, PH cause, and FC, patients had a 2.9-fold higher rate of death per 5% absolute decline in RV free wall strain at 1 year.

CONCLUSIONS:

Noninvasive assessment of RV longitudinal systolic strain and strain rate independently predicts future right-sided heart failure, clinical deterioration, and mortality in patients with PAH.

PMID:
21148241
DOI:
10.1378/chest.10-2015
[Indexed for MEDLINE]

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