Left ventricular strain and strain rate by 2D speckle tracking in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.

Nicholas Olson,Daniel G Blanchard,Michael M Madani,Jason P Brown,Andrew M Kahn,Thomas J Waltman,William R Auger

doi:10.1186/1476-7120-8-43

Nicholas Olson, Daniel G Blanchard + Show 5 more

Open Access

https://doi.org/10.1186/1476-7120-8-43

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Abstract

BackgroundEchocardiographic evaluation of left ventricular (LV) strain and strain rate (SR) by 2D speckle tracking may be useful tools to assess chronic thromboembolic pulmonary hypertension (CTEPH) severity as well as response to successful pulmonary thromboendarterectomy (PTE).MethodsWe evaluated 30 patients with CTEPH before and after PTE using 2D speckle tracking measurements of LV radial and circumferential strain and SR in the short axis, and correlated the data with right heart catheterization (RHC).ResultsPTE resulted in a decrease in mean PA pressure (44 ± 15 to 29 ± 9 mmHg), decrease in PVR (950 ± 550 to 31 ± 160 [dyne-sec]/cm5), and an increase in cardiac output (3.9 ± 1.0 to 5.0 ± 1.0 L/min, p < 0.001 for all). Circumferential and posterior wall radial strain changed by -11% and +15% respectively (p < 0.001 for both). Circumferential SR and posterior wall radial SR changed by -7% and 6% after PTE. While the increase in posterior wall SR with PTE reached statistical significance (p = 0.04) circumferential SR did not (p = 0.07). In addition, septal radial strain and SR did not change significantly after PTE (p = 0.1 and 0.8 respectively). Linear regression analyses of circumferential and posterior wall radial strain and SR revealed little correlation between strain/SR measurements and PVR, mean PA pressure, or cardiac output. However, change in circumferential strain and change in posterior wall radial strain correlated moderately well with changes in PVR, mean PA pressure and cardiac output (r = 0.69, 0.76, and 0.51 for circumferential strain [p < 0.001 for all] and r = 0.7, 0.7, 0.45 for posterior wall radial strain [p = 0.001, 0.001, and 0.02, respectively]).ConclusionsLV circumferential and posterior wall radial strain change after relief of pulmonary arterial obstruction in patients with CTEPH, and these improvements occur rapidly. These changes in LV strain may reflect effects from improved LV diastolic filling, and may be useful non-invasive markers of successful PTE.

Highlights

Once thought of as a rare complication, chronic thromboembolic pulmonary hypertension (CTEPH) has recently been demonstrated to be relatively common in the post-pulmonary embolism patient
We evaluated 2D speckle tracking measurements of radial and circumferential strain and strain rate (SR) in the left ventricular (LV) short axis, and correlated the data with right heart catheterization results to assess whether strain and SR are useful parameters of LV function in CTEPH before and after pulmonary thromboendarterectomy (PTE)
Circumferential strain decreased by 11% after PTE from -21 ± 3% to -23 ± 4% (p = 0.0002)

Summary

Introduction

Once thought of as a rare complication, chronic thromboembolic pulmonary hypertension (CTEPH) has recently been demonstrated to be relatively common in the post-pulmonary embolism patient. Echocardiographic evaluation of the left ventricle may be a useful tool to assess CTEPH severity and response to PTE. We evaluated 2D speckle tracking measurements of radial and circumferential strain and SR in the LV short axis, and correlated the data with right heart catheterization results to assess whether strain and SR are useful parameters of LV function in CTEPH before and after PTE. Echocardiographic evaluation of left ventricular (LV) strain and strain rate (SR) by 2D speckle tracking may be useful tools to assess chronic thromboembolic pulmonary hypertension (CTEPH) severity as well as response to successful pulmonary thromboendarterectomy (PTE)

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