Right ventricular systolic function in patients with pulmonary hypertension

Background. The quantification of right ventricular (RV) systolic function by conventional echocardiography has serious limitations. In recent years novel echocardiographic techniques such as strain and strain rate allows us to evaluate the function of the various cardiac chambers.
Objective. Compare RV systolic function in patients with pulmonary hypertension (PH) and in healthy subjects, with the use of myocardial deformation analysis.
Methods and material. We included patients with PH. The variables analyzed were: RV diastolic diameter, systolic pulmonary artery pressure, RV ejection fraction (Simpson), tricuspid annular plane systolic excursion (TAPSE), velocity time integral of RV outflow tract, among others. Were analyzed 6 segments of RV, free wall 3 and interventricular septum 3 with velocity vector imaging. Were investigated peak systolic velocity, peak systolic strain, strain rate and systolic RV global strain. The statistic used was the Student t test for grouped data or linear correlation (statistical significance p<0.05).
Results. We included 42 patients, 21 (50%) diagnosed with PH (Group A) and 21 healthy subjects (Group B). Average age of group A 68, group B 58 years. Seventeen patients in group A were women (81%). The size of RV for patients in group A was significantly higher (3.9 cm vs 3.08 cm). RV ejection fraction in group A was significantly lower compared to healthy subjects (45% vs 57%, respectively). The TAPSE was significantly lower in patients with PH compared to healthy subjects (17.28 mm vs 20.84 mm; p<0.05). The average speed of the segments of RV patients in group A was significantly lower (2.37 cm/s vs 3.39 cm/s; p<0.001). The same was observed in the global strain (-8.71% vs -15.61%; p<0.001).
Conclusion. RV systolic function in patients with PH was significantly decreased compared with the control group. The measurement of regional and global systolic function of the RV, through the longitudinal strain and strain rate, was feasible and correlated well with other parameters of RV systolic function.

Keywords: Pulmonary hypertension; Strain; Strain rate; Right ventricular; Echocardiography