• DOI:10.1378/chest.10-2015
• Corpus ID: 18930436

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

@article{Sachdev2011RightVS,
  title={Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension.},
  author={Arun Sachdev and Hector R. Villarraga and Robert P. Frantz and Michael Mcgoon and Ju-feng Hsiao and Joseph Maalouf and Naser M. Ammash and Robert B McCully and Fletcher A. Jr. Miller and Patricia A. Pellikka and Jae Keun Oh and Garvan C. Kane},
  journal={Chest},
  year={2011},
  volume={139 6},
  pages={
          1299-1309
        }
}

• A. Sachdev, H. Villarraga, +9 authors G. Kane
• Published 1 June 2011
• Medicine
• Chest

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.