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Right heart chambers longitudinal strain provides enhanced diagnosis and categorization in patients living with pulmonary hypertension
  • +11
  • Nilda Espinola-Zavaleta,
  • Neftali Antonio-Villa,
  • Enrique Guerra,
  • Navin C. Nanda,
  • Lawrence Rudski,
  • Ricardo Alvarez-Santana,
  • Gyselle Camacho-Camacho,
  • Alberto Aranda-Fraustro,
  • Jorge Cossio-Aranda,
  • Karina Zamora,
  • Diego Oregel-Camacho,
  • Javier Armenta-Moreno,
  • Joaquin Berarducci,
  • Erick Alexanderson-Rosas
Nilda Espinola-Zavaleta
Instituto Nacional de Cardiología

Corresponding Author:[email protected]

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Neftali Antonio-Villa
UNAM Facultad de Medicina
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Enrique Guerra
Universidad Nacional Autonoma de Mexico
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Navin C. Nanda
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Lawrence Rudski
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Ricardo Alvarez-Santana
Autonomous University of Ciudad Juarez
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Gyselle Camacho-Camacho
National Institute of Cardiology Ignacio Chavez
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Alberto Aranda-Fraustro
National Institute of Cardiology Ignacio Chavez
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Jorge Cossio-Aranda
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Karina Zamora
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Diego Oregel-Camacho
National Institute of Cardiology Ignacio Chavez
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Javier Armenta-Moreno
Instituto Nacional de Cardiologia Ignacio Chavez
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Joaquin Berarducci
Instituto Nacional de Cardiologia Ignacio Chavez
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Erick Alexanderson-Rosas
National Institute of Cardiology Ignacio Chavez
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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.