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Left Ventricular Function in Patients with Pulmonary Arterial Hypertension: The Role of Two‐Dimensional Speckle Tracking Strain
Author(s) -
Amorim Corrêa Ricardo,
Oliveira Fernanda Brito,
Barbosa Marcia M.,
Barbosa Jose Augusto A.,
Carvalho Taís Soares,
Barreto Michele Campos,
Campos Frederico Thadeu A. F.,
Nunes Maria Carmo Pereira
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13267
Subject(s) - medicine , cardiology , ejection fraction , speckle tracking echocardiography , contractility , pressure overload , blood pressure , pulmonary hypertension , heart failure , cardiac hypertrophy
Background Pulmonary arterial hypertension ( PAH ) is characterized by elevated mean pulmonary arterial pressure with abnormal right ventricular ( RV ) pressure overload that may alter left ventricular ( LV ) function. The aim of this study was to assess the impact of RV pressure overload on LV function in PAH patients using two‐dimensional (2D) speckle tracking strain. Methods The study enrolled 37 group 1 PAH patients and 38 age‐ and gender‐matched healthy controls. LV longitudinal and radial 2D strains were measured with and without including the ventricular septum. Six‐minute walk test (6 MWT ) and brain natriuretic peptide ( BNP ) levels were also obtained in patients with PAH . Results The mean age of patients was 46.4 ± 14.8 years, 76% women, and 16 patients (43%) had schistosomiasis. Sixteen patients (43%) were in WHO class III or IV under specific treatment for PAH . The overall 6 MWT distance was 441 meters, and the BNP levels were 80 pg/mL. Patients with PAH more commonly presented with LV diastolic dysfunction and impairment of RV function when compared to controls. LV global longitudinal and radial strains were lower in patients than in controls (−17.9 ± 2.8 vs. −20.5 ± 1.9; P < 0.001 and 30.8 ± 10.5 vs. 49.8 ± 15.4; P < 0.001, respectively). After excluding septal values, LV longitudinal and radial strains remained lower in patients than in controls. The independent factors associated with global LV longitudinal strain were LV ejection fraction, RV fractional area change, and tricuspid annular systolic motion. Conclusions This study showed impaired LV contractility in patients with PAH assessed by speckle tracking strain, irrespective of ventricular septal involvement. Global LV longitudinal strain was associated independently with RV fractional area change and tricuspid annular systolic motion, after adjustment for LV ejection fraction.