Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging.

Published on May 1, 2019in Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques1.393
· DOI :10.1111/ECHO.14328
Hong Meng2
Estimated H-index: 2
,
Krishnaswamy Chandrasekaran35
Estimated H-index: 35
(Mayo Clinic)
+ 5 AuthorsJames B. Seward137
Estimated H-index: 137
(Mayo Clinic)
Source
Abstract
OBJECTIVE: To evaluate whether global peak systolic strain (PSS) and peak systolic strain rate (PSSR) derived from velocity vector imaging (VVI) allow early recognition of regional and global right ventricular (RV) dysfunction and the impact of this on left ventricular (LV) function in patients with pulmonary hypertension (PHT). BACKGROUND: RV function is an important determinant of prognosis in patients with heart failure, pulmonary hypertension, heart transplant, and congenital heart diseases. However, evaluation of the right ventricle is often limited by its complex geometry and inadequate visualization of RV free wall. Furthermore, the impact of RV dysfunction on the LV function is not well elucidated. METHODS: Ninety-nine participants, 35 control patients with normal RV systolic pressure (RVSP) (  0.60; P < 0.001) was noted between RVSP and systolic and diastolic strain and strain rate at basal segment in IVS and global RV function. Peak early diastolic strain rate at all segments was also decreased in PHT patients compared with control patients (P < 0.01). Furthermore, RV systolic and diastolic strain and strain rate were lower in group 2 with mild-to-moderate hypertension while the conventional echo parameters were normal. Except for IVS segments, other LV segments had no statistical differences in systolic and diastolic velocity, strain, and strain rate compared to controls. However, they were lower than the published normal range. CONCLUSIONS: Strain and strain rate derived from VVI demonstrates early recognition of systolic and diastolic RV dysfunction in patients with PHT compared to controls. PHT is associated with global and regional RV systolic and diastolic dysfunction. Systolic and diastolic strain and strain rate from LV was lower compared to controls but were not statistically significant. This may indicate subclinical LV dysfunction in these patients, suggesting that conventional LV function parameters may not be sensitive to recognize subclinical LV dysfunction.
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Right heart size and function at baseline and follow-up are important predictors of outcome in pulmonary arterial hypertension (PAH). The traditional imaging indicators of right heart health include metrics of right ventricular (RV) systolic function under resting conditions. Transthoracic echocardiography is commonly used; RV size and function are often qualitatively described and may be quantifiable as well. Cardiac MRI is the "standard of reference" for RV morphology, whereas nuclear imaging ...
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