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Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging.
Echocardiography. 2019 05; 36(5):877-887.E

Abstract

OBJECTIVE

To evaluate whether global peak systolic strain (PSS) and peak systolic strain rate (PSSR) derived from velocity vector imaging (VVI) allow early recognition of regional and global right ventricular (RV) dysfunction and the impact of this on left ventricular (LV) function in patients with pulmonary hypertension (PHT).

BACKGROUND

RV function is an important determinant of prognosis in patients with heart failure, pulmonary hypertension, heart transplant, and congenital heart diseases. However, evaluation of the right ventricle is often limited by its complex geometry and inadequate visualization of RV free wall. Furthermore, the impact of RV dysfunction on the LV function is not well elucidated.

METHODS

Ninety-nine participants, 35 control patients with normal RV systolic pressure (RVSP) (<30 mm Hg) and 64 patients with PHT (25 with mild-to-moderate increase in RVSP [≥36 and <60 mm Hg] and 39 with severe increase in RVSP [≥60 mm Hg]), underwent comprehensive echo-Doppler assessment and velocity vector imaging (VVI) for strain rate analysis. RV regional peak systolic and diastolic tangential velocity, strain, and strain rate were obtained from the basal, mid and apical segments of the RV free wall and interventricular septum (IVS) from apical 4-chamber view at end-expiration. Similar data were obtained from eighteen LV segments from apical 4-chamber, 2-chamber, and long-axis views.

RESULTS

Peak systolic strain, strain rate, and tangential velocity at all segments in the RV free wall and IVS were decreased compared to controls in patients with PHT (P < 0.001). Significant correlation (r > 0.60; P < 0.001) was noted between RVSP and systolic and diastolic strain and strain rate at basal segment in IVS and global RV function. Peak early diastolic strain rate at all segments was also decreased in PHT patients compared with control patients (P < 0.01). Furthermore, RV systolic and diastolic strain and strain rate were lower in group 2 with mild-to-moderate hypertension while the conventional echo parameters were normal. Except for IVS segments, other LV segments had no statistical differences in systolic and diastolic velocity, strain, and strain rate compared to controls. However, they were lower than the published normal range.

CONCLUSIONS

Strain and strain rate derived from VVI demonstrates early recognition of systolic and diastolic RV dysfunction in patients with PHT compared to controls. PHT is associated with global and regional RV systolic and diastolic dysfunction. Systolic and diastolic strain and strain rate from LV was lower compared to controls but were not statistically significant. This may indicate subclinical LV dysfunction in these patients, suggesting that conventional LV function parameters may not be sensitive to recognize subclinical LV dysfunction.

Authors+Show Affiliations

Fuwai Hospital, Beijing, China.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.Siriraj Hospital, Bangkok, Thailand.Division of Biostatistics, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30985965

Citation

Meng, Hong, et al. "Right and Left Ventricular Interaction in Pulmonary Hypertension: Insight From Velocity Vector Imaging." Echocardiography (Mount Kisco, N.Y.), vol. 36, no. 5, 2019, pp. 877-887.
Meng H, Chandrasekaran K, Villarraga HR, et al. Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging. Echocardiography. 2019;36(5):877-887.
Meng, H., Chandrasekaran, K., Villarraga, H. R., Shah, A. A., Kittipovanonth, M., Cha, S. S., Pellikka, P. A., & Seward, J. B. (2019). Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging. Echocardiography (Mount Kisco, N.Y.), 36(5), 877-887. https://doi.org/10.1111/echo.14328
Meng H, et al. Right and Left Ventricular Interaction in Pulmonary Hypertension: Insight From Velocity Vector Imaging. Echocardiography. 2019;36(5):877-887. PubMed PMID: 30985965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right and left ventricular interaction in pulmonary hypertension: Insight from velocity vector imaging. AU - Meng,Hong, AU - Chandrasekaran,Krishnaswamy, AU - Villarraga,Hector R, AU - Shah,Aijaz A, AU - Kittipovanonth,Maytinee, AU - Cha,Stephen S, AU - Pellikka,Patricia A, AU - Seward,James B, Y1 - 2019/04/15/ PY - 2019/01/07/received PY - 2019/02/12/accepted PY - 2019/4/16/pubmed PY - 2020/1/30/medline PY - 2019/4/16/entrez KW - pulmonary hypertension KW - right and left ventricular function SP - 877 EP - 887 JF - Echocardiography (Mount Kisco, N.Y.) JO - Echocardiography VL - 36 IS - 5 N2 - OBJECTIVE: To evaluate whether global peak systolic strain (PSS) and peak systolic strain rate (PSSR) derived from velocity vector imaging (VVI) allow early recognition of regional and global right ventricular (RV) dysfunction and the impact of this on left ventricular (LV) function in patients with pulmonary hypertension (PHT). BACKGROUND: RV function is an important determinant of prognosis in patients with heart failure, pulmonary hypertension, heart transplant, and congenital heart diseases. However, evaluation of the right ventricle is often limited by its complex geometry and inadequate visualization of RV free wall. Furthermore, the impact of RV dysfunction on the LV function is not well elucidated. METHODS: Ninety-nine participants, 35 control patients with normal RV systolic pressure (RVSP) (<30 mm Hg) and 64 patients with PHT (25 with mild-to-moderate increase in RVSP [≥36 and <60 mm Hg] and 39 with severe increase in RVSP [≥60 mm Hg]), underwent comprehensive echo-Doppler assessment and velocity vector imaging (VVI) for strain rate analysis. RV regional peak systolic and diastolic tangential velocity, strain, and strain rate were obtained from the basal, mid and apical segments of the RV free wall and interventricular septum (IVS) from apical 4-chamber view at end-expiration. Similar data were obtained from eighteen LV segments from apical 4-chamber, 2-chamber, and long-axis views. RESULTS: Peak systolic strain, strain rate, and tangential velocity at all segments in the RV free wall and IVS were decreased compared to controls in patients with PHT (P < 0.001). Significant correlation (r > 0.60; P < 0.001) was noted between RVSP and systolic and diastolic strain and strain rate at basal segment in IVS and global RV function. Peak early diastolic strain rate at all segments was also decreased in PHT patients compared with control patients (P < 0.01). Furthermore, RV systolic and diastolic strain and strain rate were lower in group 2 with mild-to-moderate hypertension while the conventional echo parameters were normal. Except for IVS segments, other LV segments had no statistical differences in systolic and diastolic velocity, strain, and strain rate compared to controls. However, they were lower than the published normal range. CONCLUSIONS: Strain and strain rate derived from VVI demonstrates early recognition of systolic and diastolic RV dysfunction in patients with PHT compared to controls. PHT is associated with global and regional RV systolic and diastolic dysfunction. Systolic and diastolic strain and strain rate from LV was lower compared to controls but were not statistically significant. This may indicate subclinical LV dysfunction in these patients, suggesting that conventional LV function parameters may not be sensitive to recognize subclinical LV dysfunction. SN - 1540-8175 UR - https://www.unboundmedicine.com/medline/citation/30985965/Right_and_left_ventricular_interaction_in_pulmonary_hypertension:_Insight_from_velocity_vector_imaging_ L2 - https://doi.org/10.1111/echo.14328 DB - PRIME DP - Unbound Medicine ER -