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Cardiovascular Ultrasound
Published in: Cardiovascular Ultrasound 1/2015

Open Access 01-12-2015 | Research

Deformation pattern and predictive value of right ventricular longitudinal strain in children with pulmonary arterial hypertension

Authors: Iolanda Muntean, Theodora Benedek, Mihaela Melinte, Carmen Suteu, Rodica Togãnel

Published in: Cardiovascular Ultrasound | Issue 1/2015

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Abstract

Background

Right ventricular function has been identified as an important prognostic factor in children with pulmonary arterial hypertension. The aim of the study was to assess the deformation pattern and prognostic value of right ventricular longitudinal strain in children with pulmonary arterial hypertension.

Methods

We prospectively evaluated 46 children (25 with pulmonary arterial hyperetension and 21 age and sex matched controls) using conventional and speckle-tracking echocardiography, brain natriuretic peptide levels and clinical status expressed by WHO functional class and 6-min walking test. According to the clinical status after 12 months of follow-up, the pulmonary arterial hypertension patients were divided in two groups: non-worsening (13) and worsening (12).

Results

Right ventricular free wall longitudinal strain and strain rate were significantly lower in children with PAH compared with controls (−24.72 ± 3.48 vs −15.60 ± 3.40, p = 0.0001 and −1.44 ± 0.09 vs −1.09 ± 0.15, p = 0.0001, respectively). There was a more expressed decrease of basal than apical region of right ventricular free wall longitudinal strain/strain rate in pulmonary arterial hypertension patients compared with controls (strain: p = 0.0001 vs p = 0.07 and strain rate: p = 0.0001 vs p = 0.002). Comparing worsening and non-worsening pulmonary arterial hypertension patients there was a significant difference in Mid right ventricular free wall longitudinal strain (−14.00 ± 3.13 vs. −20.76 ± 4.62, p = 0.0001). In multivariable logistic regression analysis Mid right ventricular free wall longitudinal strain was an independent predictor of worsening in pulmonary arterial hypertension children (OR 0.45; 95 % CI: 0.21–0.96, p = 0.041). In ROC curve analysis a cut-off value of Mid right ventricular free wall longitudinal strain of −18.50 % predicted clinical worsening in pulmonary arterial hypertension children, with a sensitivity and specificity of 91.7 and 30.8 %, respectively (area under curve = 0.88 ± 0.06, 95 % CI: 0.75–1.00, p = 0.001).

Conclusions

Two-dimensional speckle-tracking echocardiography is a complementary non-invasive tool for assessment of right ventricular function in children with severe pulmonary arterial hypertension, allowing also clinical prediction and segmental analysis of right ventricular myocardial performance in these patients.
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Metadata
Title
Deformation pattern and predictive value of right ventricular longitudinal strain in children with pulmonary arterial hypertension
Authors
Iolanda Muntean
Theodora Benedek
Mihaela Melinte
Carmen Suteu
Rodica Togãnel
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Cardiovascular Ultrasound / Issue 1/2015
Electronic ISSN: 1476-7120
DOI
https://doi.org/10.1186/s12947-016-0074-3

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