Abstract 14015: Right Ventricular Remodeling is Additive to Global Longitudinal Strain in Predicting Long Term Survival in Patients with Pulmonary Hypertension

Abstract

Introduction: Right ventricular (RV) global longitudinal strain has been recently shown to be a marker of prognosis in patients with pulmonary hypertension (PH) but the additive role of RV remodeling on long term outcome is unclear. Hypothesis: Our aim was to test the hypothesis that RV remodeling measured by the RV area to left ventricular (LV) area ratio is additive to RV longitudinal strain in predicting prognosis in PH. Methods: We studied 120 PH patients, excluding patients with LVEF<50%, congenital heart disease, or coronary disease and 15 normal subjects. We measured the RV to LV area ratio in the 4 chamber view at end-diastole as an RV remodeling index and calculated the peak RV global longitudinal strain using 2D speckle tracking. Outcome events were predefined as death or lung transplantation over 8 years. Results: The RV-LV area ratio was larger in PH patients than in normal control subjects as expected (0.64±0.09 vs. 1.18±0.59, p<0.001). Using the RV global longitudinal strain cut off of -15% previously reported, it was significantly associated with death or lung transplant (AUC 0.629, p=0.0138). When the RV remodeling index RV-LV area ratio > 0.73 was combined with RV global longitudinal strain > -15%, patients had a significantly worse prognosis compared to RV strain value or RV remodeling index alone (p=0.0017; Hazard Ratio 2.29, 95% confidence interval of 1.34 to 3.9). Conclusion: RV remodeling by the echocardiographic RV-LV area ratio was additive to RV global longitudinal strain at predicting long term outcomes in PH patients and has promise for clinical applications.