Department of Cardiology, Near East University Hospital; Nicosia-Cyprus.
Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey.
Anatol J Cardiol. 2020 Apr;23(5):277-287. doi: 10.14744/AnatolJCardiol.2020.01379.
The purpose of this study is to compare the analysis of right ventricular (RV) free wall strain via 2D speckle tracking echocardiography with conventional echocardiography and clinical parameters in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) receiving specific treatment. This study also aims to describe the differences between patients with repaired and unrepaired defects.
This prospective study included 44 adult patients with PAH-CHD who were receiving PAH-specific treatment in a single center. This study excluded patients with complex congenital heart disease. The authors studied the conventional echocardiographic parameters, such as RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), right atrial (RA) area, Tricuspid S', and hemodynamic parameters, such as functional class, 6-minute walking distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.
The mean age of participants was 33.8±11.6 years, and 65.9% of participants were female. The mean RV free wall strain was -14.8±4.7%. Majority of the patients belonged to WHO functional class 2 (61.4%) with a mean NT-proBNP level of 619.2±778.4 and mean 6MWD of 400.2±86.9 meters. During the follow-up of 30.8±9.0 months, 6 patients (13.6%) developed clinical right heart failure, whereas 9 (20.5%) of them died. There was a positive and significant correlation between RV free wall strain and WHO functional class (r=0.320, p=0.03), whereas there was a negative correlation between RV free wall strain and FAC (r=-0.392, p=0.01), TAPSE (r=-0.577, p=0.0001), and Tricuspid S' (r=-0.489, p=0.001). There was no significant correlation of RV free wall strain with either RA area or 6MWD. Patients with repaired congenital heart defects had worse RV functional parameters and RV free wall strain than patients with unrepaired defects.
The assessment of RV free wall strain via 2D speckle tracking echocardiography is a feasible method and correlates well with conventional echocardiography and clinical parameters in patients with PAH-CHD receiving specific treatment. (Anatol J Cardiol 2020; 23: 277-87).
本研究旨在比较二维斑点追踪超声心动图分析肺动脉高压合并先天性心脏病（PAH-CHD）患者右心室（RV）游离壁应变与常规超声心动图和临床参数的相关性，这些患者接受了特定的治疗。本研究还旨在描述修补和未修补缺陷患者之间的差异。
这是一项前瞻性研究，纳入了 44 名在单中心接受肺动脉高压特异性治疗的成年 PAH-CHD 患者。本研究排除了患有复杂先天性心脏病的患者。作者研究了常规超声心动图参数，如 RV 局部射血分数（FAC）、三尖瓣环平面收缩期位移（TAPSE）、右心房（RA）面积、三尖瓣瓣环收缩期运动速度（Tricuspid S'）和血流动力学参数，如心功能分级、6 分钟步行距离（6MWD）和 N 末端脑钠肽前体（NT-proBNP）水平。
参与者的平均年龄为 33.8±11.6 岁，65.9%的参与者为女性。RV 游离壁应变的平均值为-14.8±4.7%。大多数患者属于世界卫生组织（WHO）心功能分级 2 级（61.4%），平均 NT-proBNP 水平为 619.2±778.4pg/ml，平均 6MWD 为 400.2±86.9 米。在 30.8±9.0 个月的随访期间，6 名患者（13.6%）出现临床右心衰竭，9 名患者（20.5%）死亡。RV 游离壁应变与 WHO 心功能分级呈正相关（r=0.320，p=0.03），而与 FAC（r=-0.392，p=0.01）、TAPSE（r=-0.577，p=0.0001）和三尖瓣瓣环收缩期运动速度（r=-0.489，p=0.001）呈负相关。RV 游离壁应变与 RA 面积或 6MWD 均无显著相关性。与未修补的先天性心脏病患者相比，修补的先天性心脏病患者的 RV 功能参数和 RV 游离壁应变更差。
二维斑点追踪超声心动图评估 RV 游离壁应变是一种可行的方法，与接受特定治疗的 PAH-CHD 患者的常规超声心动图和临床参数相关性良好。（安纳托利亚心脏病学杂志 2020；23：277-87）
