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Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values

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An Erratum to this article was published on 24 November 2016

Abstract

Pulmonary hypertension (PH) is a progressively fatal disease having a significant impact on right ventricular (RV) function, a major determinant of long-term outcome in PH patients. In our clinic we frequently noticed the combination of PH and reduced RV function, but with discordant Tricuspid Annular Plane Systolic Excursion (TAPSE) values. The present study focuses on whether RV free wall strain measured using 2-dimensional speckle-tracking echocardiography is able to predict mortality in this subgroup of PH patients. 57 patients with PH and RV dysfunction (visual echocardiographic assessment of ≥2) and pseudo-normalized TAPSE values (defined as ≥16 mm) were retrospectively evaluated. Patients were divided by RV free −20 % as cut-off value. Follow-up data on all-cause mortality were registered after a median follow-up time of 27.9 ± 1.7 months. RV free of ≥−20 % was predictive of all-cause mortality after a median follow-up time of 27.9 ± 1.7 months (HR 3.76, 95 % CI 1.02–13.92, p = 0.05). RV free ≥−20 % remained a significant predictor of all-cause mortality (HR 4.30, 95 % CI 1.11–16.61, p = 0.04) after adjusting for PH-specific treatment. On the contrary, TAPSE was not a significant predictor of all-cause mortality. RV free wall strain provides prognostic information in patients with PH and RV dysfunction, but with normal TAPSE values. Future studies with larger cohorts, longer follow-up periods and inclusion of more echocardiographic parameters measuring LV and RV function could confirm the strength of RV free ≥−20 % as a predictor of mortality for this subgroup of patients with PH.

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Abbreviations

PH:

Pulmonary hypertension

RV:

Right ventricular

TAPSE:

Tricuspid annular plane systolic excursion

HR:

Hazard ratio

PAH:

Pulmonary arterial hypertension

ESC:

European society of cardiology

6MWT:

Six minute walk test

RVSP:

Right ventricular systolic pressure

TR:

Tricuspid regurgitation

PASP:

Pulmonary artery systolic pressure

ASE:

American society of echocardiography

χ 2 :

Chi-squared

WHO:

World health organisation

BMI:

Body-mass index

6MWD:

Six minute walk distance

ROC:

Receiver operating characteristic

AUC:

Area under the curve

RV FAC:

Right ventricular fractional area change

LV:

Left ventricular

LVEDV:

Left ventricular end-diastolic volume

IPAH:

Idiopathic pulmonary arterial hypertension

References

  1. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Sanchez MAG, Kumar RK, Landzberg M, Machado RF, Olschewski H, Robbins IM, Souza R (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 25:D34–D41

    Article  Google Scholar 

  2. Dambrauskaite V, Delcroix M, Claus P, Herbots L, D’hooge J, Bijnens B, Rademakers F, Sutherland GR (2007) Regional right ventricular dysfunction in chronic pulmonary hypertension. J Am Soc Echocardiogr 10:1172–1180

    Article  Google Scholar 

  3. D’Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Kernis JT (1991) Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med 115:343–349

    Article  PubMed  Google Scholar 

  4. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ (2008) Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 11:1436–1448

    Article  Google Scholar 

  5. Petitjean C, Rougon N, Cluzel P (2005) Assessment of myocardial function: a review of quantification methods and results using tagged MRI. J Cardiovasc Magn Reson 2:501–516

    Article  Google Scholar 

  6. Dell’Italia LJ (1991) The right ventricle: anatomy, physiology, and clinical importance. Curr Prob Cardiol 10:653–720

    Google Scholar 

  7. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, Chamera E, Corretti MC, Champion HC, Abraham TP, Girgis RE, Hassoun PM (2006) Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 8:1034–1041

    Article  Google Scholar 

  8. Pettersen E, Helle-Valle T, Edvardsen T, Lindberg H, Smith HJ, Smevik B, Smiseth OA, Andersen K (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49:2450–2456

    Article  PubMed  Google Scholar 

  9. Giusca S, Dambrauskaite V, Scheurwegs C, Dhooge J, Claus P, Herbots L, Magro M, Rademakers F, Meyns B, Delcroix M, Voigt JU (2010) Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring. Heart 96:281–288

    Article  CAS  PubMed  Google Scholar 

  10. Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery J, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 30:2493–2537

    Article  PubMed  Google Scholar 

  11. Ghio S, Klersy C, Magrini G, D’Armini AM, Scelsi L, Raineri C, Pasotti M, Serio A, Campana C, Viganò M (2010) Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol 3:272–278

    Article  Google Scholar 

  12. Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ (2009) Global 2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol 54:618–624

    Article  PubMed  Google Scholar 

  13. Donal E, Tournoux F, Leclercq C, De Place C, Solnon A, Derumeaux G, Mabo P, Cohen-Solal A, Daubert JC (2009) Assessment of longitudinal and radial ventricular dyssynchrony in ischemic and nonischemic chronic systolic heart failure: a two-dimensional echocardiographic speckle-tracking strain study. J Am Soc Echocardiogr 21:58–65

    Article  Google Scholar 

  14. Reisner SA, Lysyansky P, Agmon Y, Mutlak D, Lessick J, Friedman Z (2004) Global longi- tudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr 17:630–633

    Article  PubMed  Google Scholar 

  15. Dandel M, Lehmkuhl HB, Hetzer R (2010) Tricuspid annulus systolic excursion for assessment of right ventricular function: limitations and sources of misinterpretation in patients with pulmonary hypertension. J Am Soc Echocardiogr 5:B9

    Google Scholar 

  16. Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, Kane GC (2013) Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging. 6:711–721

    Article  PubMed  Google Scholar 

  17. Haeck ML, Scherptong RW, Marsan NA, Holman ER, Schalij MJ, Bax JJ, Vliegen HW, Delgado V (2012) Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging 5:628–636

    Article  PubMed  Google Scholar 

  18. Sachdev A, Villarraga HR, Frantz RP, McGoon MD, Hsiao JF, Maalouf JF, Ammash NM, McCully RB, Miller FA, Pellikka PA, Oh JK, Kane GC (2011) Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension. Chest 6:1299–1309

    Article  Google Scholar 

  19. Hardegree EL, Sachdev A, Villarraga HR, Frantz RP, McGoon MD, Kushwaha SS, Hsiao JF, McCully RB, Oh JK, Pellikka PA, Kane GC (2013) Role of Serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol 111:143–148

    Article  PubMed  Google Scholar 

  20. Galiè N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, Olschewski H, Peacock A, Pietra G, Rubin LJ, Simonneau G (2004) Guidelines on diagnosis and treatment of pulmonary arterial hypertension: the task force on diagnosis and treatment of pulmonary arterial hypertension of the European Society of Cardiology. Eur Heart J 24:2243–2278

    Google Scholar 

  21. Statement ATS (2002) Guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117

    Article  Google Scholar 

  22. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 7:685–713

    Article  Google Scholar 

  23. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28:1–39

    Article  PubMed  Google Scholar 

  24. van de Veerdonk MC, Kind T, Marcus JT, Mauritz GJ, Heymans MW, Bogaard HJ, Boonstra A, Marques KM, Westerhof N, Vonk-Noordegraaf A (2011) Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol 24:2511–2519

    Article  Google Scholar 

  25. Brierre G, Blot-Souletie N, Degano B, Têtu L, Bongard V, Carrié D (2010) New echocardiographic prognostic factors for mortality in pulmonary arterial hypertension. Eur J Echocardiogr 6:516–522

    Article  Google Scholar 

  26. Raymond RJ, Hinderliter AL, Willis PW, Ralph D, Caldwell EJ, Williams W, Ettinger NA, Hill NS, Summer WR, de Boisblanc B, Schwartz T, Koch G, Clayton LM, Jöbsis MM, Crow JW, Long W (2002) Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 7:1214–1219

    Article  Google Scholar 

  27. van Wolferen SA, Marcus JT, Boonstra A, Marques KMJ, Bronzwaer JGF, Spreeuwenberg MD, Postmus PE, Vonk-Noordegraaf A (2007) Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J 28:1250–1257

    Article  PubMed  Google Scholar 

  28. Meris A, Faletra F, Conca C, Klersy C, Regoli F, Klimusina J, Penco M, Pasotti E, Pedrazzini GB, Moccetti T, Auricchio A (2010) Timing and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr 8:823–831

    Article  Google Scholar 

  29. Badano LP, Ginghina C, Easaw J, Muraru D, Grillo MT, Lancellotti P, Pinamonti B, Coghlan G, Marra MP, Popescu BA, De Vita S (2010) Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr 1:27–37

    Article  Google Scholar 

  30. Smith BC, Dobson G, Dawson D, Charalampopoulos A, Grapsa J, Nihoyannopoulos P (2014) Three-dimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 64:41–51

    Article  PubMed  Google Scholar 

  31. Atsumi A, Ishizu T, Kameda Y, Yamamoto M, Harimura Y, Machino-Ohtsuka T, Kawamura R, Enomoto M, Seo Y, Aonuma K (2013) Application of 3-dimensional speckle tracking imaging to the assessment of right ventricular regional deformation. Circul J 77:1760–1768

    Article  Google Scholar 

  32. Benza RL, Miller DP, Barst RJ, Badesch DB, Frost AE, McGoon MD (2012) An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry. Chest 142:448–456

    Article  PubMed  Google Scholar 

  33. Shapiro S, Traiger GL, Turner M, McGoon MD, Wason P, Barst RJ (2012) Sex differences in the diagnosis, treatment, and outcome of patients with pulmonary arterial hypertension enrolled in the registry to evaluate early and long-term pulmonary arterial hypertension disease management. Chest 141:363–373

    Article  PubMed  Google Scholar 

  34. Ventetuolo CE, Praestgaard A, Palevsky HI, Klinger JR, Halpern SD, Kawut SM (2014) Sex and haemodynamics in pulmonary arterial hypertension. Eur Respir J 43:523–530

    Article  PubMed  Google Scholar 

  35. Benza RL, Miller DP, Gomberg-Maitland M, Frantz RP, Foreman AJ, Coffey CS, Frost A, Barst RJ, Badesch DB, Elliott CG, Liou TG, McGoon MD (2010) Predicting survival in pulmonary arterial hypertension insights from the registry to evaluate early and long-term pulmonary arterial hypertension disease management (REVEAL). Circulation 122:164–172

    Article  PubMed  Google Scholar 

  36. Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K (2000) Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing. Am J Respir Crit Care Med 161:487–492

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Author M. van Kessel has received research Grants from Dutch heart association (Hartstichting www.hartstichting.nl).

Funding

This study was funded by Dutch heart association (Hartstichting www.hartstichting.nl).

Author information

Authors and Affiliations

  1. Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Marco van Kessel

  2. School of Allied Health Sciences, Heart Foundation Research Centre and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia

    Marco van Kessel, Jonathan Chan, Akira Yamada, Surendran Sabapathy & Norman Morris

  3. Queensland Nuclear Imaging, The Prince Charles Campus, Brisbane, Australia

    David Seaton

  4. Cardiology Department, The Prince Charles Hospital, Brisbane, Australia

    Jonathan Chan, Akira Yamada & Thomas Butler

  5. Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Australia

    Fiona Kermeen & Norman Morris

  6. School of Medicine, Griffith University, Gold Coast, Australia

    Jonathan Chan

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Correspondence to Marco van Kessel.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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An erratum to this article is available at http://dx.doi.org/10.1007/s10554-016-1025-7.

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van Kessel, M., Seaton, D., Chan, J. et al. Prognostic value of right ventricular free wall strain in pulmonary hypertension patients with pseudo-normalized tricuspid annular plane systolic excursion values. Int J Cardiovasc Imaging 32, 905–912 (2016). https://doi.org/10.1007/s10554-016-0862-8

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