Right ventricular function in patients with pulmonary arterial hypertension associated with congenital heart disease with repaired and unrepaired defects; correlation of speckle tracking, conventional echocardiography and clinical parameters

Abstract

Objective: The purpose of this study is to compare the analysis of right ventricular (RV) free wall strain via 2D speckle tracking echocardiography with conventional echocardiography and clinical parameters in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) receiving specific treatment. This study also aims to describe the differences between patients with repaired and unrepaired defects. Methods: This prospective study included 44 adult patients with PAH-CHD who were receiving PAH-specific treatment in a single center. This study excluded patients with complex congenital heart disease. The authors studied the conventional echocardiographic parameters, such as RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), right atrial (RA) area, Tricuspid S', and hemodynamic parameters, such as functional class, 6-minute walking distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Results: The mean age of participants was 33.8±11.6 years, and 65.9% of participants were female. The mean RV free wall strain was −14.8±4.7%. Majority of the patients belonged to WHO functional class 2 (61.4%) with a mean NT-proBNP level of 619.2±778.4 and mean 6MWD of 400.2±86.9 meters. During the follow-up of 30.8±9.0 months, 6 patients (13.6%) developed clinical right heart failure, whereas 9 (20.5%) of them died. There was a positive and significant correlation between RV free wall strain and WHO functional class (r=0.320, p=0.03), whereas there was a negative correlation between RV free wall strain and FAC (r=−0.392, p=0.01), TAPSE (r=−0.577, p=0.0001), and Tricuspid S' (r=−0.489, p=0.001). There was no significant correlation of RV free wall strain with either RA area or 6MWD. Patients with repaired congenital heart defects had worse RV functional parameters and RV free wall strain than patients with unrepaired defects. Conclusion:The assessment of RV free wall strain via 2D speckle tracking echocardiography is a feasible method and correlates well with conventional echocardiography and clinical parameters in patients with PAH-CHD receiving specific treatment.

Assessment of Biventricular Myocardial Function with 2-Dimensional Strain and Conventional Echocardiographic Parameters: A Comparative Analysis in Healthy Infants and Patients with Severe and Critical Pulmonary Stenosis

“…Furthermore, LVpGLS and MAPSE adjusted for baseline values vary in the same direction (Table 6). The negative correlation between TAPSE and RV free wall has been described in adult patients with RV dysfunction in the context of secondary pulmonary hypertension by Kemal et al [22]. Kempny et al capture similar variability between MAPSE, LVpGLS, and TAPSE, respectively, and RV longitudinal strain in adults with RV dysfunction after surgical correction of Fallot's tetralogy [23].…”

Simulation of Cardiac Flow under the Septal Defect Based on Lattice Boltzmann Method

“…In addition, it is expensive and with radiation. Echocardiography provides non-invasive imaging data in pediatric cardiology and with a low cost of inspection [ 10 ]. Echocardiography can visualize complicated flow with a heart chamber or valve motion, however, with limitations in temporal and spatial resolutions.…”