Right Ventricular Longitudinal Peak Systolic Strain Measurements from the Subcostal View in Patients with Suspected Pulmonary Hypertension: A Feasibility Study

Abstract

The assessment of right ventricular (RV) function with two-dimensional echocardiography can be challenging in patients with pulmonary hypertension, especially in those with chronic pulmonary disease. The aim of the present study was to evaluate the feasibility of measuring RV longitudinal peak systolic strain (LPSS) in the echocardiographic subcostal view in patients with suspected pulmonary hypertension. A total of 179 patients evaluated for pulmonary hypertension were included (85 with systemic disorder, 64 with pulmonary disease, and 30 with RV dilatation and dysfunction). Additionally, 30 normal controls were evaluated. The feasibility of RV LPSS speckle-tracking measurements in the apical four-chamber view and in the subcostal view was evaluated. Furthermore, the RV LPSS speckle-tracking measurements performed in these two echocardiographic views were compared. The feasibility of RV LPSS in the subcostal view was 95.3%, 92.2%, 93.3%, and 93.3% in patients with systemic disorder, with pulmonary disease, with RV dilatation and dysfunction, and controls, respectively. In comparison, the feasibility of RV LPSS in the apical four-chamber view was 92.9%, 82.8%, 90%, and 93.3% in each group, respectively. Bland-Altman analysis showed good agreement between measurements in both echocardiographic views (systemic disorder: mean bias, -0.14; pulmonary disease: mean bias, 0.28; RV dilatation and dysfunction: mean bias, 0.3; and normal controls: mean bias, -0.14). The subcostal view provides a good alternative for RV strain assessment in patients who are evaluated for pulmonary hypertension. This measurement may be a valuable surrogate of RV function in patients with challenging apical windows.