Medizinische Klinik m.S. Kardiologie und Angiologie, Charité-Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
DZHK (German Center for Cardiovascular Research), partner site, Berlin, Germany.
Cardiovasc Ultrasound. 2020 May 14;18(1):13. doi: 10.1186/s12947-020-00197-z.
We aimed to evaluate associations of right atrial (RA) and right ventricular (RV) strain parameters assessed by 2D speckle tracking echocardiography (2D STE) with invasively measured hemodynamic parameters in patients with and without pulmonary hypertension (PH).
In this study, we analyzed 78 all-comer patients undergoing invasive hemodynamic assessment by left and right heart catheterization. Standard transthoracic echocardiographic assessment was performed under the same hemodynamic conditions. RA and RV longitudinal strain parameters were analyzed using 2D STE. PH was defined as invasively obtained mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest and was further divided into pre-capillary PH (pulmonary capillary wedge pressure [PCWP] ≤ 15 mmHg), post-capillary PH (PCWP > 15 mmHg) and combined PH (PCWP > 15 mmHg and difference between diastolic PAP and PCWP of ≥7 mmHg). Correlation analyses between variables were calculated with Pearson's or Spearman's correlation coefficient as applicable.
Out of 78 patients, 45 presented with PH. Within the PH group, 39 had post-capillary, five had combined pre- and post-capillary PH, and one had pre-capillary PH. Patients with PH had a significantly increased RA area (PH 22.0 ± 9.2 cm, non-PH 17.3 ± 10.7 cm; p = 0.003) and end-systolic RV area (PH 14.7 ± 6.1, non-PH 11.9 ± 4.8 cm; p = 0.022). RV mid strain was significantly reduced in PH (PH -17.4 ± 7.8, non-PH: - 21.6 ± 5.5; p = 0.019). Average peak systolic RA strain (RAS) and average peak systolic RV strain (RVS) showed a significant association with mPAP (r = - 0.470, p = 0.001 and r = 0.490, p = 0.001, respectively) and with PCWP (r = - 0.296, p = 0.048 and r = 0.365, p = 0.015, respectively) in patients with PH. Furthermore, RV apical, mid and basal strain as well as RV free wall strain showed moderate associations with mPAP. In patients without PH, there were no associations detectable between RA or RV strain parameters and mPAP and PCWP.
In an all-comer cohort, RA and RV strain parameters showed significant associations with invasively assessed mPAP and PCWP in patients with predominantly post-capillary PH. These associations may be useful in clinical practice to assess the impact of post-capillary PH on myocardial right heart function.
我们旨在评估二维斑点追踪超声心动图（2D STE）评估的右心房（RA）和右心室（RV）应变参数与合并和不合并肺动脉高压（PH）患者的有创血流动力学参数之间的相关性。
本研究纳入 78 例接受左、右心导管有创血流动力学评估的所有患者。在相同的血流动力学条件下进行标准经胸超声心动图评估。使用 2D STE 分析 RA 和 RV 纵向应变参数。PH 定义为有创测量得到的平均肺动脉压（mPAP）在休息时≥25mmHg，并进一步分为毛细血管前 PH（肺毛细血管楔压 [PCWP]≤15mmHg）、毛细血管后 PH（PCWP>15mmHg）和混合 PH（PCWP>15mmHg 且舒张 PAP 和 PCWP 之间的差值≥7mmHg）。根据适用情况，使用 Pearson 或 Spearman 相关系数计算变量之间的相关性。
78 例患者中 45 例存在 PH。在 PH 组中，39 例为毛细血管后 PH，5 例为混合前、后毛细血管 PH，1 例为毛细血管前 PH。PH 患者的 RA 面积（PH 22.0±9.2cm，非 PH 17.3±10.7cm；p=0.003）和收缩末期 RV 面积（PH 14.7±6.1cm，非 PH 11.9±4.8cm；p=0.022）明显增加。PH 患者的 RV 中部应变明显降低（PH -17.4±7.8，非 PH：-21.6±5.5；p=0.019）。平均收缩期 RA 应变（RAS）和平均收缩期 RV 应变（RVS）与 mPAP 呈显著相关性（r=-0.470，p=0.001 和 r=-0.490，p=0.001），与 PCWP 呈显著相关性（r=-0.296，p=0.048 和 r=-0.365，p=0.015）。此外，RV 心尖、中部和基底应变以及 RV 游离壁应变与 mPAP 呈中度相关。在非 PH 患者中，RA 或 RV 应变参数与 mPAP 和 PCWP 之间没有可检测到的相关性。
在所有患者队列中，RA 和 RV 应变参数与主要为毛细血管后 PH 患者的有创评估 mPAP 和 PCWP 呈显著相关性。这些相关性可能有助于临床实践中评估毛细血管后 PH 对右心心肌功能的影响。
