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

Arun Sachdev, Hector R. Villarraga, Robert P. Frantz, Michael D. McGoon, Ju Feng Hsiao, Joseph F. Maalouf, Naser M. Ammash, Robert B. McCully, Fletcher A. Miller, Patricia A. Pellikka, Jae K. Oh, Garvan C. Kane

Research output: Contribution to journalArticle

204 Scopus citations

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/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.

Original languageEnglish (US)
Pages (from-to)1299-1309
Number of pages11
JournalChest
Volume139
Issue number6
DOIs
StatePublished - Jun 1 2011

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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