Top

The International Journal of Cardiovascular Imaging

Published in:

01-06-2018 | Original Paper

Echocardiographic assessment of regional right ventricular systolic function using two-dimensional strain echocardiography and evaluation of the predictive ability of longitudinal 2D-strain imaging for pulmonary arterial hypertension in systemic sclerosis patients

Authors: Vedat Hekimsoy, Ergun Barıs Kaya, Ali Akdogan, Levent Sahiner, Banu Evranos, Ugur Canpolat, Kudret Aytemir, Necla Özer, Lale Tokgozoglu

Published in: The International Journal of Cardiovascular Imaging | Issue 6/2018

Abstract

Systemic sclerosis (SSc) is a generalized connective tissue disorder, and SSc patients are at risk of developing pulmonary arterial hypertension (PAH). The aims of this study are to evaluate the right ventricular regional systolic function using two-dimensional speckle-tracking echocardiography (2D STE) and to determine the predictive ability of peak longitudinal systolic strain (PLSS) at the RV lateral wall for PAH in SSc patients. 80 SSc patients (mean age 51 ± 12 years) were included in the study. Echocardiography and 2D STE were performed at baseline and after 12 months. RHC was performed only in SSc patients with clinical indications. PLSS at the apical segment of the RV free wall was significantly impaired in PAH patients compared with non-PH patients (–14.6 ± 5.9 vs. − 22.2 ± 7.5%, p = 0.034). PLSS at the basal, mid, and apical segments of the RV free wall was lower in both groups at follow-up compared to baseline, but the drop in strain values was statistically significant only in the non-PH group (p < 0.05). Right atrial area (OR 1.758; p = 0.023), peak tricuspid regurgitation velocity (OR 24.23; p = 0.011) and PLSS at the apical segment of the RV lateral wall (OR 2.47; p = 0.005) were independent predictors of PAH. A cut-off value of − 14.48% PLSS at the apical segment of the RV lateral wall resulted in 100% specificity for predicting PAH in SSc patients. RV pressure overload affects RV systolic function as manifested by impaired RV longitudinal deformation. Evaluating RV regional systolic function with 2D STE could be useful as an additional echocardiographic parameter for screening PAH in SSc patients.

Available only for authorised users

Liakouli V, Cipriani P, Marrelli A, Alvaro S, Ruscitti P, Giacomelli R (2011) Angiogenic cytokines and growth factors in systemic sclerosis. Autoimmun Rev 10(10):590–594. https://doi.org/10.1016/j.autrev.2011.04.019 CrossRefPubMed

Bhattacharyya S, Wei J, Varga J (2011) Understanding fibrosis in systemic sclerosis: shifting paradigms, emerging opportunities. Nat Rev Rheumatol 8(1):42–54. https://doi.org/10.1038/nrrheum.2011.149 CrossRefPubMedPubMedCentral

Yaqub A, Chung L (2013) Epidemiology and risk factors for pulmonary hypertension in systemic sclerosis. Curr Rheumatol Rep 15(1):302. https://doi.org/10.1007/s11926-012-0302-2 CrossRefPubMed

Gashouta MA, Humbert M, Hassoun PM (2014) Update in systemic sclerosis-associated pulmonary arterial hypertension. Presse Med 43(10 Pt. 2):e293–e304. https://doi.org/10.1016/j.lpm.2014.06.007 CrossRefPubMed

Denton CP, Cailes JB, Phillips GD, Wells AU, Black CM, Bois RM (1997) Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosis. Br J Rheumatol 36(2):239–243CrossRefPubMed

Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62(25 Suppl):D42–D50. https://doi.org/10.1016/j.jacc.2013.10.032 CrossRefPubMed

Sweiss NJ, Hushaw L, Thenappan T, Sawaqed R, Machado RF, Patel AR, Gomberg-Maitland M, Husain AN, Archer SL (2010) Diagnosis and management of pulmonary hypertension in systemic sclerosis. Curr Rheumatol Rep 12(1):8–18. https://doi.org/10.1007/s11926-009-0078-1 CrossRefPubMedPubMedCentral

Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barbera J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol C, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Voller H, Luis Zamorano J (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119. https://doi.org/10.1093/eurheartj/ehv317 CrossRefPubMed

Chaisson NF, Hassoun PM (2013) Systemic sclerosis-associated pulmonary arterial hypertension. Chest 144(4):1346–1356. https://doi.org/10.1378/chest.12-2396 CrossRefPubMedPubMedCentral

10.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463. https://doi.org/10.1016/j.echo.2005.10.005 CrossRefPubMed

11.

Jamal F, Bergerot C, Argaud L, Loufouat J, Ovize M (2003) Longitudinal strain quantitates regional right ventricular contractile function. Am J Physiol Heart Circ Physiol 285(6):H2842–H2847. https://doi.org/10.1152/ajpheart.00218.2003 CrossRefPubMed

12.

Pellerin D, Sharma R, Elliott P, Veyrat C (2003) Tissue Doppler, strain, and strain rate echocardiography for the assessment of left and right systolic ventricular function. Heart 89(Suppl 3):iii9–i17PubMedPubMedCentral

13.

Artis NJ, Oxborough DL, Williams G, Pepper CB, Tan LB (2008) Two-dimensional strain imaging: a new echocardiographic advance with research and clinical applications. Int J Cardiol 123(3):240–248. https://doi.org/10.1016/j.ijcard.2007.02.046 CrossRefPubMed

14.

Perk G, Tunick PA, Kronzon I (2007) Non-Doppler two-dimensional strain imaging by echocardiography–from technical considerations to clinical applications. J Am Soc Echocardiogr 20(3):234–243. https://doi.org/10.1016/j.echo.2006.08.023 CrossRefPubMed

15.

Masi AT, Subcommittee For Scleroderma Criteria of the American Rheumatism Association Diagnostic, Therapeutic Criteria Committee (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590. https://doi.org/10.1002/art.1780230510 CrossRef

16.

Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15(2):167–184CrossRefPubMed

17.

Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107(3):526–531CrossRefPubMed

18.

Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713. https://doi.org/10.1016/j.echo.2010.05.010 (quiz 786–688)CrossRefPubMed

19.

Puwanant S, Park M, Popovic ZB, Tang WH, Farha S, George D, Sharp J, Puntawangkoon J, Loyd JE, Erzurum SC, Thomas JD (2010) Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 121(2):259–266. https://doi.org/10.1161/CIRCULATIONAHA.108.844340 CrossRefPubMedPubMedCentral

20.

Li Y, Xie M, Wang X, Lu Q, Fu M (2013) Right ventricular regional and global systolic function is diminished in patients with pulmonary arterial hypertension: a 2-dimensional ultrasound speckle tracking echocardiography study. Int J Cardiovasc Imaging 29(3):545–551. https://doi.org/10.1007/s10554-012-0114-5 CrossRefPubMed

21.

Pirat B, McCulloch ML, Zoghbi WA (2006) Evaluation of global and regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol 98(5):699–704. https://doi.org/10.1016/j.amjcard.2006.03.056 CrossRefPubMed

22.

Deswal A, Follansbee WP (1996) Cardiac involvement in scleroderma. Rheum Dis Clin N Am 22(4):841–860CrossRef

23.

Follansbee WP, Miller TR, Curtiss EI, Orie JE, Bernstein RL, Kiernan JM, Medsger TA Jr (1990) A controlled clinicopathologic study of myocardial fibrosis in systemic sclerosis (scleroderma). J Rheum 17(5):656–662PubMed

24.

Kahan A, Coghlan G, McLaughlin V (2009) Cardiac complications of systemic sclerosis. Rheumatology (Oxford) 48(Suppl 3):iii45–i48. https://doi.org/10.1093/rheumatology/kep110 CrossRef

25.

Piccione MC, Zito C, Bagnato G, Oreto G, Di Bella G, Bagnato G, Carerj S (2013) Role of 2D strain in the early identification of left ventricular dysfunction and in the risk stratification of systemic sclerosis patients. Cardiovasc Ultrasound 11(1). https://doi.org/10.1186/1476-7120-11-6

26.

Spethmann S, Rieper K, Riemekasten G, Borges AC, Schattke S, Burmester GR, Hewing B, Baumann G, Dreger H, Knebel F (2014) Echocardiographic follow-up of patients with systemic sclerosis by 2D speckle tracking echocardiography of the left ventricle. Cardiovasc Ultrasound 12:13. https://doi.org/10.1186/1476-7120-12-13 CrossRefPubMedPubMedCentral

27.

Aithala R, Alex AG, Danda D (2017) Pulmonary hypertension in connective tissue diseases: an update. Int J Rheum Dis. https://doi.org/10.1111/1756-185x.13001 CrossRefPubMed

28.

Coghlan JG, Denton CP, Grunig E, Bonderman D, Distler O, Khanna D, Muller-Ladner U, Pope JE, Vonk MC, Doelberg M, Chadha-Boreham H, Heinzl H, Rosenberg DM, McLaughlin VV, Seibold JR (2014) Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis 73(7):1340–1349. https://doi.org/10.1136/annrheumdis-2013-203301 CrossRefPubMed

29.

Kowal-Bielecka O, Avouac J, Pittrow D, Huscher D, Behrens F, Denton CP, Foeldvari I, Humbert M, Matucci-Cerinic M, Nash P, Opitz CF, Rubin LJ, Seibold JR, Strand V, Furst DE, Distler O (2010) Echocardiography as an outcome measure in scleroderma-related pulmonary arterial hypertension: a systematic literature analysis by the EPOSS group. J Rheumatol 37(1):105–115. https://doi.org/10.3899/jrheum.090661 CrossRefPubMed

30.

Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, Corretti MC, Hassoun PM (2009) Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 179(7):615–621. https://doi.org/10.1164/rccm.200811-1691OC CrossRefPubMedPubMedCentral

31.

Mukerjee D, St George D, Knight C, Davar J, Wells AU, Du Bois RM, Black CM, Coghlan JG (2004) Echocardiography and pulmonary function as screening tests for pulmonary arterial hypertension in systemic sclerosis. Rheumatology 43(4):461–466. https://doi.org/10.1093/rheumatology/keh067 CrossRefPubMed

32.

Parent F, Bachir D, Inamo J, Lionnet F, Driss F, Loko G, Habibi A, Bennani S, Savale L, Adnot S, Maitre B, Yaici A, Hajji L, O’Callaghan DS, Clerson P, Girot R, Galacteros F, Simonneau G (2011) A hemodynamic study of pulmonary hypertension in sickle cell disease. N Engl J Med 365(1):44–53. https://doi.org/10.1056/NEJMoa1005565 CrossRefPubMed

33.

Selby VN, Scherzer R, Barnett CF, MacGregor JS, Morelli J, Donovan C, Deeks SG, Martin JN, Hsue PY (2012) Doppler echocardiography does not accurately estimate pulmonary artery systolic pressure in HIV-infected patients. AIDS (London England) 26(15):1967–1969. https://doi.org/10.1097/QAD.0b013e3283579653 CrossRef

Title: Echocardiographic assessment of regional right ventricular systolic function using two-dimensional strain echocardiography and evaluation of the predictive ability of longitudinal 2D-strain imaging for pulmonary arterial hypertension in systemic sclerosis patients
Authors: Vedat Hekimsoy
Ergun Barıs Kaya
Ali Akdogan
Levent Sahiner
Banu Evranos
Ugur Canpolat
Kudret Aytemir
Necla Özer
Lale Tokgozoglu
Publication date: 01-06-2018
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 6/2018
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-018-1299-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Echocardiographic assessment of regional right ventricular systolic function using two-dimensional strain echocardiography and evaluation of the predictive ability of longitudinal 2D-strain imaging for pulmonary arterial hypertension in systemic sclerosis patients

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2018

Scan–rescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss and vorticity assessment using 4D flow MRI: analysis in healthy subjects

Incremental predictive value of carotid arterial strain in patients with stroke

Myocardial perfusion in patients with non-ischaemic systolic heart failure and type 2 diabetes: a cross-sectional study using Rubidium-82 PET/CT

Superficial wall stress: the long awaited comprehensive biomechanical parameter to objectify and quantify our intuition

Value of CT pulmonary angiography to predict short-term outcome in patient with pulmonary embolism

Normal pulmonary artery and branch pulmonary artery sizes in children