Prieto Omar, Cianciulli Tomás Francisco, Stewart-Harris Alejandro, Rodriguez Andrea, Saccheri María Cristina, Lax Jorge Alberto, Kazelián Lucia Raquel, Argento Laura Vanina, Marambio Gerardo Manuel, Gagliardi Juan Alberto
Division of Cardiology, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina.
Pulmonary Hypertension Reference Center, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina.
J Cardiovasc Imaging. 2021 Jul;29(3):236-251. doi: 10.4250/jcvi.2020.0192. Epub 2021 Mar 18.
Right ventricular (RV) systolic dysfunction is a strong predictor of mortality in pulmonary hypertension (PH). The goal of this study was to investigate whether right atrium (RA) and RV myocardial strain related to PH using speckle tracking echocardiography provide a superior estimation of RV systolic function than 2-dimensional (2D)-echo.
This cross-sectional study analyzed 22 patients with a diagnosis of PH stratified by right heart catheterization, and they were compared to a control group of 22 age- and sex-matched healthy subjects.
Global longitudinal peak systolic strain measured in the RV free wall from the apical 4 chamber view was -15% vs. -14.5% when measured from the subcostal view (p = 0.99). Mean longitudinal strain during reservoir phase, and longitudinal strain rate during atrial reservoir and passive conduit function was significantly impaired measured in the right atrial free wall in patients with PH.
This study showed impaired LV contractility in patients with PH assessed by speckle tracking strain. RV free wall longitudinal strain does not correlate with any of the measurements of RV systolic function obtained by 2D echocardiography. A major strength of RV longitudinal strain is its ability to assess the RV function without the limitations of 2D parameters. The subcostal RV strain is a feasible and accurate alternative to conventional RV strain from the apical view in patients with poor acoustic apical 4-chamber windows. The RA strain and strain rates values may be a valuable additive to assess right-sided heart function.
右心室（RV）收缩功能障碍是肺动脉高压（PH）患者死亡率的有力预测指标。本研究的目的是调查使用斑点追踪超声心动图测量的右心房（RA）和RV心肌应变与PH的关系，是否比二维（2D）超声心动图能更好地评估RV收缩功能。
这项横断面研究分析了22例经右心导管检查诊断为PH的患者，并与22名年龄和性别匹配的健康受试者组成的对照组进行比较。
从心尖四腔心切面测量的RV游离壁整体纵向收缩期峰值应变与从肋下切面测量的值分别为-15%和-14.5%（p = 0.99）。PH患者右心房游离壁在心房储存期的平均纵向应变以及心房储存期和被动管道功能期的纵向应变率均显著受损。
本研究表明，通过斑点追踪应变评估，PH患者存在左心室收缩功能受损。RV游离壁纵向应变与通过2D超声心动图获得的任何RV收缩功能测量值均无相关性。RV纵向应变的一个主要优势在于其能够在不受2D参数限制的情况下评估RV功能。对于心尖四腔心切面声学条件较差的患者，肋下RV应变是一种可行且准确的替代方法，可替代传统的心尖切面RV应变。RA应变和应变率值可能是评估右心功能的有价值的补充指标。
