Right ventricular function in pulmonary arterial hypertension: The influence of longitudinal strain on hemodynamic measurements

Right ventricular longitudinal strain (RVLS) is a new parameter of right ventricular (RV) function. The aim of this study was to evaluate RVLS to detect subtle RV dysfunction and its correlation with hemodynamic measurements in patients with pulmonary arterial hypertension (PAH). Thirty-five PAH patients were enrolled in this study. Right heart catheterization and echocardiography were performed in all patients. RV free wall strain (RV FWS) and RV global longitudinal strain (RV GLS) were measured using 2D speckle-tracking echocardiography (STE). The correlations between RVLS and invasive hemodynamics were analyzed. Of the 35 subjects, 85.7% were classified as WHO functional class I/II, with a mean age of 34.7 ± 12.9 years. RV systolic function conventional parameters remained in the normal range despite a high mean RV systolic pressure (RVSP) of 87.2 ± 42.4 mmHg. However, mean RV GLS and RV FWS exhibited lower values (-17.0 ± 5.8% and -18.6 ± 6.2%, respectively). RV GLS and RV FWS showed significant correlation with mean pulmonary arterial pressure (mPAP) and PVR (r=0.493, P = 0.003, r = 0.518, P = 0.008, r = 0.575, P = < 0.05, r = 0.485, P = 0.003, respectively). Conclusions: Despite normal conventional right ventricular (RV) function assessment, RV strain in this study showed decreased values. Right ventricular strain also demonstrated a significant correlation with invasively assessed mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with pulmonary arterial hypertension (PAH). This correlation may be useful in clinical practice for assessing the impact of pre-capillary pulmonary hypertension (PH) on early myocardial right heart dysfunction.