Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two-Dimensional Speckle Tracking Strain

Background Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function i...

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Published in:	Echocardiography (Mount Kisco, N.Y.) Vol. 33; no. 9; pp. 1326 - 1334
Main Authors:	de Amorim Corrêa, Ricardo, de Oliveira, Fernanda Brito, Barbosa, Marcia M., Barbosa, Jose Augusto A., Carvalho, Taís Soares, Barreto, Michele Campos, Campos, Frederico Thadeu A. F., Nunes, Maria Carmo Pereira
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01-09-2016
Subjects:	Adolescent Adult Echocardiography, Doppler - methods Elasticity Imaging Techniques - methods Female Humans Hypertension, Pulmonary - complications Hypertension, Pulmonary - diagnostic imaging Image Interpretation, Computer-Assisted - methods left ventricular function Male Middle Aged pulmonary arterial hypertension Reproducibility of Results right ventricle Schistosoma Sensitivity and Specificity speckle tracking strain Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - etiology Young Adult speckle tracking strain left ventricular function right ventricle pulmonary arterial hypertension
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Summary:	Background Pulmonary arterial hypertension (PAH) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular (RV) pressure overload that may alter left ventricular (LV) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two‐dimensional (2D) speckle tracking strain. Methods The study enrolled 37 group 1 PAH patients and 38 age‐ and gender‐matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six‐minute walk test (6MWT) and brain natriuretic peptide (BNP) levels were also obtained in patients with PAH. Results The mean age of patients was 46.4 ± 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH. The overall 6MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (−17.9 ± 2.8 vs. −20.5 ± 1.9; P < 0.001 and 30.8 ± 10.5 vs. 49.8 ± 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion. Conclusions This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction.
Bibliography:	ArticleID:ECHO13267 istex:0678E8236F932BF9EA790EC707EC5DE8C523D860 ark:/67375/WNG-8CSR1GFQ-S Conselho Nacional do Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0742-2822 1540-8175
DOI:	10.1111/echo.13267