The Effect Of Fasudil To Right Ventricular Systolic Function Assessed By Speckle Tracking Imaging In Patients With Pulmonary Arterial Hypertension

Objective To quantitatively analyse the peak systolic strain(S) and peak strain rate(SR) of the right ventricular free wall and ventricular septum,and the tricuspid annular plane systolic excursion (TAPSE) in patients with pulmonary arterial hypertension (PAH) using speckle tracking imaging(STI), then discuss the effect of Rho kinase inhibitor Fasudil to right ventricular systolic function in PAH patients.Methods1. The PAH group, consisted of 17 PAH patients, who were diagnosed by echocardiography(PASP>35mmHg, is PAH). A gender and age-matched control group of 20 healthy volunteers was assessed with echocardiography.2.Philips iE33 color Doppler ultrasonic diagnostic apparatus together with Q-Lab 6.0 quantitative analysis software was applied. To measure the inner diameter of right atrium(RA),right ventricle(RV),main pulmonary artery(MPA)and the right ventricular wall thinkness(RVWT), to evaluate the RVEF using single plane Simpson method.Select high frame rate images recorded from the apical four-chamber view (frame rate>60Hz) and move into TMQA mode, peak myocardial systolic strain (S),strain rate(SR) were measured respectively in basal and mid segments of the free wall of right ventricle and ventricular septum;move into TMAD mode, the displacement from the tricuspid annular of septum and right ventricular free wall and the mid-point of the two to the right verntricular apex would be illustrated by the system.3. To compare the differences in strain, strain rate of basal and mid segments of right ventricular free wall and ventricular septum and TAPSE, RVEF between the PAH group and control group. To compare the differences in strain, strain rate of basal and mid segments of right ventricular free wall and ventricular septum and TAPSE,RVEF in patients before and after fasudil therapy.Results1. Comparison between PAH group and control group:Compared with the control group, RA,RV,MPA and RVWT in the PAH group were significantly increased (P< 0.01), TAPSEfw, TAPSEsep, TAPSEmid was significantly reduced in the PAH group (P<0.01). In PAH group,S of basal and mid segments of right ventricular free wall and basal, mid segments of septum were lower than those in control group (P <0.01), SR of basal and mid segments of free wall and basal segment of septum were lower than those in control group (P<0.01 or P<0.05)2.Comparison in patients before and after Rho-kinase inhibitor fasudil:The patients who got treatment of Fasudil 60mg,bid,have significant reduction in PASP, RA, RV (P<0.01);and have significant improvement in RVEF,TAPSEfw, TAPSEsep, TAPSEmid (P<0.05). S and SR of basal, mid segments of free wall were significantly increased (P<0.01 or P<0.05),S of basal, mid segments of septum were increased (P<0.05), comfirmed that this drug could improve RV function in PAH patients.Conclusions 1.RV regional and global systolic function are impair in patient with pulmonary arterial hypertension (PAH)2.After Rho-kinase inhibitor Fasudil therapy,systolic peak strain and strain rate of basal, mid segments of right ventricular free wall measured by STI are significantly increased, systolic peak strain of basal, mid segments of interventricular septum measured by STI are increased,illustrating that the regional systolic function of right ventricular were improved after fasudil therapy.3. After Fasudil therapy, tricuspid annular systolic excursion of septum and right ventricular free wall and the mid-point of the two measured by speckle tracking imaging(STI) are significantly increased,hinting that the global systolic function of right ventricular were improved after fasudil therapy.4. S and SR of basal, mid segments of right ventricular free wall and TAPSE measured by STI can be used to evaluate the improvement of right ventricular regional and global systolic function after fasudil therapy sensitively and exactly. It is a beneficial addition of conventional parameters which are used to evaluate the whole systolic function of right ventricle.