Preload Dependency of 2D Right Ventricle Speckle Tracking Echocardiography Parameters in Healthy Volunteers: A Prospective Pilot Study.

Hervé Dupont,Abou-Arab Osama,Christophe Beyls,Guillaume Haye,Matthieu Caboche,Yohann Bohbot,Pierre Huette,Yazine Mahjoub

doi:10.3390/jcm11010019

Abstract

(1) Background: Right ventricular (RV) strain parameters derived from the analysis of the tricuspid annular displacement (TAD) are emergent two-dimensional speckle tracking echocardiography (2D-STE) parameter used for the quantitative assessment of RV systolic function. Few data are available regarding 2D-STE parameters and their dependency on RV preload. Our aim was to evaluate the effect of an acute change in RV preload on 2D-STE parameters in healthy volunteers. (2) Methods: Acute modification of RV preload was performed by a fluid challenge (FC): an infusion of 500 mL of 0.9% sodium chloride was given over 5 min in supine position. Preload dependency (responder group) was confirmed by a stroke volume increase of at least 10% measured by echocardiography. (3) Results: Among 32 healthy volunteers, 19 (59%) subjects were classified as non-responders and 13 (41%) as responders. In the responder group, the tricuspid annular plane systolic excursion (TAPSE) significantly increased (20 (20–23.5) mm to 24 (20.5–26.5) mm; p = 0.018), while RV strain parameters significantly decreased after FC: −23.5 ((−22.3)–(−27.3))% to −25 ((−24)–(29.6))%; p = 0.03) for RV free wall longitudinal strain and −22.8 ((−20.4)–(−30.7))% to −23.7 ((−21.2)–(−27))%; p = 0.02) for RV four-chamber longitudinal strain. 2D-STE parameters derived from the TAD analysis were not influenced by the FC (all p > 0.05). (4) Conclusions: In young, healthy volunteers, RV strain parameters and TAPSE are preload dependent, while TAD parameters were not. The loading conditions must be accounted for when evaluating RV systolic function by 2D-STE parameters.

Highlights

Two-dimensional (2D) transthoracic echocardiographic (TTE) assessment of the right ventricular (RV) systolic function is challenging, requiring a multi-parametric approach due to the complex geometry of the RV and its retrosternal location and to the loading dependency of most echocardiographic parameters [1,2]
The tricuspid annular plane systolic excursion (TAPSE) significantly increased (20 (20–23.5) mm to 24 (20.5–26.5) mm; p = 0.018), while RV strain parameters significantly decreased after fluid challenge (FC): −23.5 ((−22.3)–(−27.3))% to −25 ((−24)–(29.6))%; p = 0.03) for RV free wall longitudinal strain and −22.8 ((−20.4)–(−30.7))% to −23.7 ((−21.2)–(−27))%; p = 0.02) for RV four-chamber longitudinal strain. 2D-STE parameters derived from the tricuspid annular displacement (TAD) analysis were not influenced by the FC
There was no significant difference after FC in terms of Left ventricular (LV) systolic or diastolic parameters, TAPSE, RV-S’, fractional area change (FAC), and RVFWSL

Summary

Introduction

Two-dimensional (2D) transthoracic echocardiographic (TTE) assessment of the right ventricular (RV) systolic function is challenging, requiring a multi-parametric approach due to the complex geometry of the RV and its retrosternal location and to the loading dependency of most echocardiographic parameters [1,2]. Conventional 2D echocardiographic assessment of the RV systolic function includes parameters evaluating only the longitudinal contraction of the RV lateral free wall, measured at the level of the tricuspid annulus, such as the tricuspid annular plane systolic excursion (TAPSE) and the systolic tricuspid annular velocity (RV-S’) [1], and RV global systolic function parameters, such as the RV fractional area change (FAC). TAPSE and RV-S’ are easy to perform and reproducible, but their major limitation is their angle dependency [1]. Two-dimensional speckle-tracking echocardiography (2D-STE) is a relatively new, noninvasive echocardiography technique that allows an objective and quantitative assessment of RV systolic function [2] using simple parameters, such as RV longitudinal strain [3] and tricuspid annular displacement (TAD) [4]. TAD is an emerging 2D-STE parameter-tracking annular tissue toward the RV apex to assess the RV systolic function [8] by using three parameters, generated by a dedicated software

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