Right heart chambers longitudinal strain provides enhanced diagnosis and
categorization in patients living with pulmonary hypertension
Abstract
BACKGROUND: Increased systolic pulmonary artery pressure (sPAP) could
lead to mechanical dysfunction and myocardial fibrosis of right heart
chambers. Echocardiographic strain analysis has not been adequately
studied in patients living with pulmonary hypertension (PH). METHODS AND
RESULTS: A cross-sectional cohort of patients with suspected PH and
echocardiographic strain evaluation was recruited. Cut-off values of
peak tricuspid regurgitation velocity with low probability of PH (≤ 2.8
m/s), intermediate probability (2.9-3.4 m/s, without other echo PH
signs) and high probability of PH (2.9-3.4 m/s with other echo PH signs
and >3.4 m/s) categories were studied by right ventricular
and right atrial strain analysis in a sample of 236 patients, 58
(56.9%) had low, 15 (14.7%) intermediate, and 29 (28.4%) high
probability of PH. We observed a negative association between right
ventricular free wall strain and atrial global strain with sPAP. As PH
severity increased, right atrial reservoir, conduit, and contraction
(booster) strain values decreased. Identified cut-off values of strain
parameters had an adequate ability to detect PH severity categories In
addition, post-mortem biopsies of right heart chambers from subjects
with known severe pulmonary hypertension were analyzed to quantify
myocardial fibrosis. Our sample of right heart biopsies (n=12)
demonstrated an association between increased sPAP before death and
right ventricular and right atrial fibrosis. CONCLUSIONS: Mechanical
dysfunction and fibrosis in right chambers is associated with increased
sPAP. Right ventricular and atrial strain could provide enhancement in
the diagnosis and categorization of subjects with suspected PH.