• Augusto Alberto da Costa Junior, Jaquelina Sonoe Ota-Arakaki, Roberta Pulcheri Ramos, Marly Uellendahl, Frederico José Neves Mancuso, Manuel Adan Gil, Cláudio Henrique Fischer, Valdir Ambrosio Moises, Antonio Carlos de Camargo Carvalho, and Orlando Campos.
• Echocardiography Laboratory, Cardiology Division, Escola Paulista de Medicina, Federal University of São Paulo - UNIFESP, Alameda Lorena 1246 apto 1301, São Paulo, 01424-001, Brazil. augustoacostajrtrab@globo.com.
• Int J Cardiovasc Imaging. 2017 Jan 1; 33 (1): 39-46.

AbstractRight ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional two-dimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. The diagnostic and prognostic impact of 2DE speckle-tracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Sixty-six group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMR-RVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMR-RVEF (r = 0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤-14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25-17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable non-geometric 2DE surrogate of CMR-RVEF in PAH patients, constituting a powerful independent predictor of long-term outcome in this cohort with relatively preserved functional capacity.

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