Right ventricular function in pulmonary hypertension due to left heart disease by two-dimensional speckle tracking and real time three-dimensional echocardiography

Abstract

Objective The aim of this study was to assess right ventricular (RV) function in pulmonary hypertension due to left heart disease (LHD-PH) by two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE) and to compare them with conventional echocardiography in identifying reactive PH.Subjects and methods The study consisted of 40 controls and 65 patients with LHD-PH. According to pulmonary vascular resistance, patients were divided into a passive PH and a reactive PH group. RV fractional area change (FAC), myocardial performance index (MPI) and systolic velocity (S’) were acquired by conventional echocardiography. Longitudinal peak systolic strain (LS) was measured at the basal (LSbas), middle (LSmid) and apical (LSapi) segments of RV free wall by 2D-STE, and global free wall LS (LSfw) was calculated. RV end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) and stroke volume (SV) were acquired using RT-3DE.Results Compared with the passive PH group, LSbas, LSfw, EF, FAC and S’ decreased in reactive PH group (all P < 0.05). However, they showed no significant differences between controls and the passive PH group (all P> 0.05). EDV, ESV and MPI increased gradually as the disease progressed (all P < 0.05). By logistic regression analysis, only LSbas and EF were independently associated with reactive PH. By ROC analysis, they were indicative of reactive PH with sensitivity of 83% and 86%, and specificity of 89% and 81%.Conclusions RV presented gradual dilatation with deteriorated systolic function that occurred late. 2D strain and3D volumetric assessments were able to identity reactive PH better than conventional echocardiography.