TY - JOUR
T1 - Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension
AU - Sachdev, Arun
AU - Villarraga, Hector R.
AU - Frantz, Robert P.
AU - McGoon, Michael D.
AU - Hsiao, Ju Feng
AU - Maalouf, Joseph F.
AU - Ammash, Naser M.
AU - McCully, Robert B.
AU - Miller, Fletcher A.
AU - Pellikka, Patricia A.
AU - Oh, Jae K.
AU - Kane, Garvan C.
N1 - Funding Information:
Funding/Support: This work was supported by the Mayo Clinic CR20 program.
PY - 2011/6/1
Y1 - 2011/6/1
N2 - 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/m2), 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.
AB - 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/m2), 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.
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U2 - 10.1378/chest.10-2015
DO - 10.1378/chest.10-2015
M3 - Article
C2 - 21148241
AN - SCOPUS:79958731745
SN - 0012-3692
VL - 139
SP - 1299
EP - 1309
JO - Chest
JF - Chest
IS - 6
ER -