Clinical study of right ventricular longitudinal strain for assessing right ventricular dysfunction and hemodynamics in pulmonary hypertension

This study aimed to appraise the application of right ventricular longitudinal strain for assessing right ventricular dysfunction and severe hemodynamic changes in pulmonary hypertension. The study included 53 patients clinically diagnosed with PH. Tissue Doppler- derived tricuspid lateral annular systolic velocity (s'), early diastolic peak velocity (e'), late diastolic peak velocity (a'), tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), and right ventricular fractional area change (FAC) were determined. The STI parameter was RV free wall longitudinal peak systolic strain (RV LPSS). The patients were assigned into two groups based on a RV LPSS value of -19%. RV LPSS, s', TAPSE, RIMP, FAC, a' and e'/a' showed significant differences. PH patients with an RV LPSS >=-19% exhibited a lower RV function (P<0.05). RV LPSS was negatively correlated with TAPSE (r=-0.326, P<0.05) and FAC (r=-0.495, P<0.001) and positively correlated with RIMP (r=0.508, P<0.001). The optimal cut- off value of RV LPSS to reveal an mPAP >= 45 mmHg defined based on the receiver operating characteristic curve analysis was -19.26% with a sensitivity of 83.9% and a specificity of 73.4%. Distinguishing the degree of RV dysfunction by 2D- STI may help physicians to determine the state of cardiac function and degree of PH in patients and offer a basis for subsequent clinical diagnosis and therapy. Our study demonstrates the superiority of RV LPSS for uncovering severe PH over the traditional echocardiographic parameters.