The relationship between RV strain and haemodynamic parameters in patients with pulmonary arterial hypertension

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) failure and death. Risk stratification is crucial for patient management. Guideline recommends several imaging parameters for screening and risk stratification. Right ventricular 2-dimensional speckle tracking strain (RVS) is a promising parameter, as it is angle-independent, less load-dependent, and highly reproducible. We aimed to determine the relationship between invasive haemodynamic parameters and simultaneously measured RV global (RVGLS) and RV free wall strain (RVFWS). Methods A single-centre prospective cohort of 17 patients with idiopathic and systemic sclerosis-related PAH (54±15 years, 89% female) were consecutively enrolled. Right heart catheterisation was performed in all patients according to the recommendation of the recent guideline. The patients underwent simultaneous transthoracic echocardiography, complying with the rules of asepsis, and also, particular attention was paid to the standard zero reference level during the recordings. Results The RVGLS showed a strong correlation with systolic and mean pressure measured invasively in the RV (p<0.005, r−0.8 and p<0.05, r−0.73). Also observed was a strong correlation between RVGLS and mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) (p<0.005, r−0.749, and p<0.005, r−0.005- Figure 1.). RVGLS correlated with NT-proBNP level (p<0.05, r−0.58), but, we did not find a relationship between RVFWS and invasively measured parameters. Conclusion In our cohort of patients with PAH, RVGLS correlated well with simultaneously measured haemodynamic parameters. RVFWS was not shown to have a relationship with RHC parameters. The observation highlights the importance of global RV dysfunction caused by elevated PVR and mPAP.