Speckle-Tracking Echocardiographic Measures of Right Ventricular Function Correlate With Improvement in Exercise Function After Percutaneous Pulmonary Valve Implantation

Abstract

Background Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve (TPV) implantation. Measures of exercise function, such as ventilatory efficiency (the VE/VCO2 slope), have been shown to be prognostic of mortality in patients that may require TPV. Our objective was to evaluate the correlation between STE measures of RV function and changes in VE/VCO2 after TPV placement. Methods STE and cardiopulmonary exercise testing were performed at baseline and 6 months after TPV placement in 24 patients from 4 centers. Conventional echocardiographic measures of RV function were also assessed. Echocardiograms and exercise stress tests were interpreted by single blinded observers at separate Core laboratories. Results All patients demonstrated relief of pulmonary regurgitation and stenosis after TPV implantation. Improvements in RV longitudinal strain (−16.9±3.5% vs. −19.7±4.3%, p<0.01) and strain rate (−0.9±0.4s−1 vs. −1.2±0.4s−1, p<0.01) were noted. The VE/VCO2 slope improved (32.4±5.7 vs. 31.5±8.8, p=0.03). No other significant echo or exercise changes were found. Upon multivariable regression, the change in VE/VCO2 was independently associated with change in RV longitudinal early diastolic strain rate (p<0.001) and tricuspid A velocity (p<0.001). Pre-intervention RV longitudinal strain was found to be a predictor of change in VE/VCO2 after TPVI (r = −0.60, p<0.001). Conclusion STE measures of RV function appear to hold the potential for being used as predictors of improved outcomes in patients requiring TPV implantation. Future studies should directly assess the prognostic significance of STE measures of RV function in this population.

Decreased biventricular longitudinal strain shortly after congenital heart defect surgery

“…who identified a GLS ≤14.2% to predict preserved RV function in D‐TGA patients after atrial switch procedure. Another study by Chowdhury et al . discovered that RV GLS could predict the improvement in exercise tolerance after percutaneous pulmonary valve implantation.…”

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

“…4 ) [ 28 ]. Clinical data suggests that the restoration of pulmonary valve function may have a beneficial effect on RV longitudinal function [ 29 ].

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Stress ECHO beyond coronary artery disease. Is it the holy grail of cardiovascular imaging?

“…Exercise and dobutamine SE seem to be of significant importance for detection of CAD and assessment of RV or LV‐CR in adult patients with CHD . Furthermore, SE may be a useful tool for evaluation of post‐operative pulmonary regurgitation or after percutaneous pulmonary valve implantation in young patients with repaired Tetralogy of Fallot . Exercise SE is the preferred method and PASP, TAPSE, RV fractional area change or RV diastolic function with TDI and E/e′ during stress are very useful parameters for the evaluation of RV function and CR .…”

“…In addition, Δ in LVEF, SV with VTI in LVOT during dobutamine SE for patients late after Fontan operation offers important information for LV‐CR. Finally, subaortic pressure gradient for patients with subaortic membrane or pressure gradient at descending aorta for patients with aortic coarctation should be assessed at rest, low workload and peak exercise …”