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Original Research: PULMONARY VASCULAR DISEASE |

Right Ventricular Strain for Prediction of Survival in Patients With Pulmonary Arterial Hypertension

Arun Sachdev, MD; Hector R. Villarraga, MD; Robert P. Frantz, MD; Michael D. McGoon, MD, FCCP; Ju-Feng Hsiao, MD; Joseph F. Maalouf, MD; Naser M. Ammash, MD; Robert B. McCully, MD; Fletcher A. Miller, MD; Patricia A. Pellikka, MD; Jae K. Oh, MD; Garvan C. Kane, MD, PhD, FCCP
Author and Funding Information

From the Echocardiography Laboratory (Drs Sachdev, Villarraga, Hsiao, Maalouf, Ammash, McCully, Miller, Pellikka, Oh, and Kane); the Pulmonary Hypertension Clinic (Drs Frantz, McGoon, McCully, and Kane), Department of Medicine, Mayo Clinic, Rochester, MN.

Correspondence to: Garvan C. Kane, MD, PhD, FCCP, Pulmonary Hypertension Clinic, Division of Cardiovascular Diseases, Department of Medicine, Gonda 5, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: kane.garvan@mayo.edu


Funding/Support: This work was supported by the Mayo Clinic CR20 program.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1299-1309. doi:10.1378/chest.10-2015
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Background:  Pulmonary arterial hypertension (PAH) is a devastating illness of pulmonary vascular remodeling, right-sided heart failure, and limited survival. Whether strain-based measures of right ventricular (RV) systolic function predict future right-sided heart failure and/or death is untested.

Methods:  RV longitudinal systolic strain and strain rate were evaluated by echocardiography in 80 patients with World Health Organization group 1 pulmonary hypertension (PH) (72% were functional class [FC] III or IV). Survival status was assessed over 4 years.

Results:  All patients had a depressed RV systolic strain (−15% ± 5%) and strain rate (−0.80 ± 0.29 s−1). Of the parameters assessed, average RV free wall systolic strain worse than −12.5% identified a cohort with greater severity of disease (82% were FC III/IV), greater RV systolic dysfunction (RV stroke volume index 26 ± 9 mL/m2), and higher right atrial pressure (12 ± 5 mm Hg). Patients with an RV free wall strain worse than −12.5% were associated with a greater degree of disease progression within 6 months, a greater requirement for loop diuretics, and/or a greater degree of lower extremity edema, and it also predicted 1-, 2-, 3-, and 4-year mortality (unadjusted 1-year hazard ratio, 6.2; 2.1–22.3). After adjusting for age, sex, PH cause, and FC, patients had a 2.9-fold higher rate of death per 5% absolute decline in RV free wall strain at 1 year.

Conclusions:  Noninvasive assessment of RV longitudinal systolic strain and strain rate independently predicts future right-sided heart failure, clinical deterioration, and mortality in patients with PAH.

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