Right Heart Strain Parameters May Be Associated With mPAP and PCWP in PH

Significant associations were detected between right heart strain parameters assessed by 2D speckle tracking echocardiography (2D STE) and mean pulmonary arterial pressure (mPAP) and pulmonary capillary wedge pressure (PCWP) in patients with pulmonary hypertension (PH), according to study results published in Cardiovascular Ultrasound.

Although transthoracic echocardiography (TTE) is routinely used to screen for and monitor PH, there is little evidence on the relationship between right atrial (RA) and right ventricular (RV) functionality and invasive hemodynamics in individuals with PH. In addition, little guidance regarding the assessment of RA and RV dysfunction secondary to PH using 2D STE, is available.

In this retrospective analysis, the data of 78 all-comer patients (mean age, 72.6±12.8 years; 78.0% men) who underwent hemodynamic monitoring via left and right heart catheterization were examined. Participants were enrolled between 2013 and 2015. In this cohort, 45 patients had PH (mean age, 75.1±11.5 years; 64.4% men), and 33 did not (mean age, 69.3±13.9 years; 3.0% men). Standard TTE was performed on all patients, with RA and RV longitudinal strain parameters evaluated by 2D STE. PH was defined as mPAP ≥25 mm Hg at rest. Participants were subdivided into those with pre-capillary PH (mPAP ≥25 mm Hg and PCWP ≤15 mm Hg; n=1), post-capillary PH (mPAP ≥25 mm Hg and PCWP >15 mm Hg; n=39), or combined PH (≥7 mm Hg difference between PCWP and diastolic PAP and PCWP >15 mm Hg; n=5).

Patients with vs without PH had greater RA area (22.0±9.2 cm² vs 17.3±10.7 cm², respectively; P =.003) and end-systolic RV area (14.7±6.1 cm² vs 11.9±4.8 cm², respectively; P =.022), and lower RV mid strain (-17.4±7.8 vs -21.6±5.5, respectively; P =.019).

Correlations were established in patients with PH between average peak systolic RA strain and mPAP (r = -0.470; P =.001), between average peak systolic RV strain and mPAP (r = 0.490; P =.001), and between average peak systolic RA / RV strain and PCWP (r = -0.296; P =.048 and r = 0.365; P =.015, respectively). Moderate correlations were detected between RV free wall strain and mPAP, as well as RV apical, mid and basal strain, and mPAP in patients with PH. No correlations were established in participants without PH between right heart strain parameters and mPAP or PCWP.

Study limitations include its single-center setup, small sample size, use of an all-comer cohort that comprised patients with multiple cardiovascular comorbidities, and lack of follow-up measurements.

“These associations may be useful in clinical practice to assess the impact of post-capillary PH on myocardial right heart function,” noted the authors.

Reference                                                                                                                            

Theres L, Hübscher A, Stangl K, et al. Associations of 2D speckle tracking echocardiography-based right heart deformation parameters and invasively assessed hemodynamic measurements in patients with pulmonary hypertension. Cardiovasc Ultrasound. 2020;18(1). doi:10.1186/s12947-020-00197-z