Right Ventricular Function Assessed By Two-Dimensional Strain In Patients With Pulmonary Arterial Hypertension

Objective To assess the relationship between right ventricular RVPCA and ejection fraction(EF),to estimate the right ventricular myocardium strain(S) and strain rate(SR) in patients with pulmonary hypertension using two-dimensional speckle tracking imaging(STI),then discuss the effect of varying degrees of pulmonary hypertension on right ventricular peak systolic S and peak SR.Methods 1.65 patients with pulmonary arterial hypertension(PAH),in a accordance with pulmonary arterial systolic pressure(PASP) further division.Mild group:(PASP 35～45mmHg)included 24 patients;moderate group:(PASP 46～59mmHg) included 22 patients;severe group:(PASP≥60mmHg) included 19 patients.Control group included 35 subjects.2.To comprehensive assessment the pulmonary arterial pressure using tricuspid regurgitation,pulmonary regurgitation and the size of right atrium,to evaluate the RVPCA and EF in the apical four-chamber view.3.Peak myocardial systolic strain(S),strain rate(SR) were measured respectively in right ventricular basal,mid and apical segments of free wall and ventricular septum in 65 patients with PAH and 35 normal subjects.To compare the differences of S and SR between the PAH group and control group,the differences among the mild,moderate, severe and control group.Results 1.PAH group and control group:Compared with the control group,the EF and RVPCA were significantly reduction,RA and RV were significantly increased in PAH group(p＜0.01).S of basal,mid of free wall and interventricular septum(IVS) were significantly reduction,SR of basal,mid of IVS and basal of free wall were significantly reduction in PAH group(p＜0.01).Mid,apical of free wall and apical of IVS were no significant difference between the two group.2.Mild,moderate,severe groups and control groups RVPCA and EF were significantly reduction in mild,moderate,severe groups compared with control group,those of severe group was significantly reduction compared with mild and moderate groups (p＜0.01).There was no significant difference between mild and moderate group. Compared with control group,S of basal and mid free wall of mild group were significantly reduction;basal,mid,apical free wall and basal,mid IVS of moderate group were significantly reduction;free wall and IVS all segments of severe group were significantly reduction compared with both control group and mild group.S of basal and mid free wall were significantly reduction in severe group compared with moderate group(p＜0.01 reletively).SR of mid free wall were significantly reduction in mild,moderate,severe groups compared with control group;those of severe group were significantly reduction compared with mild and moderate groups(p＜0.01).It was showed that SR was more sensitive than S.S and SR were significantly reduction in PAH patients compare with normal subjects.3.EF was correlated with S of mid,basal free wall in control and PAH groups;EF was correlated with S of mid,basal IVS in PAH group;EF was correlated with SR of basal free wall in PAH group.Conclusions1.Two-dimensional RVPCA and EF can reflect the right ventricular global function, the higher the PASP,the more serious damage of the right ventricular global function.EF positively correlate with S and SR PAH groups.2.PAH patients peak systolic S of RV were damaged,the higher the PASP,the more serious damage of the peak systolic S of RV,the SR was more sensitive than S.3.Two-dimensional STI can quantitatively assess RV regional function,proving another useful modality for evaluating RV function.