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Right ventricular speckle tracking assessment for differentiation of pressure‐ versus volume‐overloaded right ventricle
Author(s) -
Werther Evaldsson Anna,
Ingvarsson Annika,
Waktare Johan,
Smith Gustav J.,
Thilén Ulf,
Stagmo Martin,
Roijer Anders,
Rådegran Goran,
Meurling Carl
Publication year - 2018
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12477
Subject(s) - medicine , cardiology , ventricle , volume overload , pressure overload , speckle tracking echocardiography , pulmonary hypertension , muscle hypertrophy , cardiac hypertrophy , ejection fraction , heart failure
Summary Background Right ventricular ( RV ) dysfunction may be caused by either pressure or volume overload. RV function is conventionally assessed with echocardiography using tricuspid annular plane systolic excursion ( TAPSE ), RV fractional area change ( RVFAC ), tricuspid lateral annular systolic velocity (S′) and RV index of myocardial performance ( RIMP ). The purpose of this study was to evaluate whether RV global longitudinal strain ( RVGLS ) and RV ‐free wall strain ( RV ‐free) could add additional information to differentiate these two causes of RV overload. Methods and results The study enrolled 89 patients with an echocardiographic trans‐tricuspid gradient >30 mmHg. Forty‐five patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (pressure overload) were compared with 44 patients with an atrial septum defect (volume overload). RV size was larger in the volume group ( P <0·05). TAPSE and S′ were lower in the pressure group ( P <0·05, P <0·01). RVFAC was lower in the pressure group ( P <0·001) as well as RVGLS (−12·1 ± 3·3% versus −20·2 ± 3·4%, P <0·001) and RV ‐free (−12·9 ± 3·3% versus −19·4 ± 3·4%, P <0·001). Conclusion In this study, RVGLS and RV ‐free could more accurately discriminate RV pressure from volume overload than conventional measures. The reason could be that TAPSE and S′ are unable to differentiate active deformation from passive entrainment caused by the left ventricle. The pressure group had evidence of marked RV hypertrophy despite standard functional parameters ( TAPSE and S) within normal range. This would enhance the value of strain to more sensitively detect abnormal function. A cut‐off value of below −16% for RVGLS and RV ‐free predicts RV pressure overload with high accuracy.