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Right ventricular speckle tracking assessment for differentiation of pressure- versus volume-overloaded right ventricle

Werther Evaldsson, Anna LU ; Ingvarsson, Annika LU ; Waktare, Johan; Smith, Gustav J LU ; Thilén, Ulf LU ; Stagmo, Martin LU ; Roijer, Anders LU ; Rådegran, Goran LU and Meurling, Carl LU (2017) In Clinical Physiology and Functional Imaging2002-01-01+01:00
Abstract

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... (More)

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.

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Journal Article
in
Clinical Physiology and Functional Imaging2002-01-01+01:00
publisher
Wiley Online Library
ISSN
1475-0961
DOI
10.1111/cpf.12477
language
English
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yes
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a350ef7a-7fea-49bf-93d9-aabcb6795dd4
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2018-01-12 09:51:29
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2018-01-12 10:36:05
@article{a350ef7a-7fea-49bf-93d9-aabcb6795dd4,
  abstract     = {<p>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.</p><p>METHODS AND RESULTS: The study enrolled 89 patients with an echocardiographic trans-tricuspid gradient &gt;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&lt;0·05). TAPSE and S' were lower in the pressure group (P&lt;0·05, P&lt;0·01). RVFAC was lower in the pressure group (P&lt;0·001) as well as RVGLS (-12·1 ± 3·3% versus -20·2 ± 3·4%, P&lt;0·001) and RV-free (-12·9 ± 3·3% versus -19·4 ± 3·4%, P&lt;0·001).</p><p>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.</p>},
  author       = {Werther Evaldsson, Anna and Ingvarsson, Annika and Waktare, Johan and Smith, Gustav J and Thilén, Ulf and Stagmo, Martin and Roijer, Anders and Rådegran, Goran and Meurling, Carl},
  issn         = {1475-0961},
  keyword      = {Journal Article},
  language     = {eng},
  month        = {10},
  publisher    = {Wiley Online Library},
  series       = {Clinical Physiology and Functional Imaging2002-01-01+01:00},
  title        = {Right ventricular speckle tracking assessment for differentiation of pressure- versus volume-overloaded right ventricle},
  url          = {http://dx.doi.org/10.1111/cpf.12477},
  year         = {2017},
}