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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Right ventricular longitudinal strain in echocardiographic evaluation of patients with pulmonary hypertension
Session:
Posters 2 - Écran 3 - Imagiologia Cardiovascular
Speaker:
Marta Fontes Oliveira
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Marta Fontes Oliveira; Maria Trêpa; Raquel Baggen Santos; Ricardo Costa; Inês Silveira; Sofia Cabral; Abílio Reis; Mário Silva Santos; Severo Torres
Abstract
<p>Introduction: Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Recently, speckle-tracking echocardiography has emerged as a new tool in the RV assessment. In this study, we aimed to study the value of global longitudinal strain in the RV evaluation of these patients.</p> <p>Methods: We collected clinical, laboratory, echocardiographic and right heart catheterization (RHC) data from consecutive patients with PH followed in our department from 12/2016 to 11/2018. Global RV systolic peak longitudinal strain (RVS) and RV free wall peak longitudinal strain (RVFWS) (mean of the basal, mid- and apical-segments) were measured by speckle-tracking technique with Echo-Pac software from GE Healthcare®.</p> <p>Results: Of the 93 included patients, 68 (73%) were female. The mean age was 60 ± 16 years. Group 2 PH was the most frequent etiology of HP (28%), followed by group 1 (25%), group 4 (24%), group 5 (4%) and group 3 (2%). The echocardiographic evaluation of this population showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 17.2 ± 4.3 mm, fractional area change (FAC) 33 ± 11% and S’ tricuspid wave 9.9 ± 2.7 cm/seg). Mean RVS was -14.6 ± 4.9 and mean RVFRS was -15.8 ± 6.8. Both strain parameters significantly correlated with other echocardiographic parameters such as TAPSE, FAC, RV diameter, eccentricity index (EI), systolic pulmonary artery pressure (SPAP), pulmonary acceleration time, presence of pericardial effusion and RV outflow tract notching. Strain parameters were also associated with mean pulmonary artery pressure (MPAP) and SPAP measured by RHC. In multivariate analysis, RV global longitudinal strain predicted invasive MPAP better (β=1,18, p=0,004) than other traditional measures such as TAPSE (β=0,46, p=0,47), S’ tricuspid wave (β=0,76, p=0,37) and FAC (β=-0,33, p=0,10). RV global strain was significantly associated with pulmonary vascular resistance (PVR) in PH group 4 (r=0.52, p=0.039), but not in other groups.</p> <p>Conclusion: RV global and free wall longitudinal strain significantly correlate with other echocardiographic parameters of RV structure and function and with invasive pulmonary artery pressures. Larger studies are needed to better characterize its value on the RV assessment in each PH group.</p>
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