Researchers Testing Right Ventricular Longitudinal Strain To Predict Pulmonary Arterial Hypertension Prognosis

A new study published in the Journal of Cardiovascular Ultrasound revealed a new parameter linked to right ventricular function as a good prognostic tool for pulmonary arterial hypertension (PAH). The study is entitled “Impaired Global Right Ventricular Longitudinal Strain Predicts Long-Term Adverse Outcomes in Patients with Pulmonary Arterial Hypertension,” and was developed by researchers at The Cleveland Clinic Foundation and the Northwestern Memorial Hospital in the United States, and the Chungnam National University Hospital in Korea.

PAH is a life-threatening condition characterized by the increase of blood pressure in the pulmonary arteries that supply blood to the lungs. The disorder is progressive and features vascular remodeling of the pulmonary arteries that causes an increased pulmonary vascular resistance, which can lead to difficulties in breathing, right ventricular heart failure and eventually premature death. PAH has a poor prognosis and is associated with a high mortality rate.

Right ventricular function is considered the main determinant of PAH symptoms and survival. New 2-dimensional strain echocardiography allows an accurate assessment of the cardiac structures. Global longitudinal strain of right ventricular (GLSRV) can be evaluated through 2-dimensional strain analysis providing a more direct evaluation of the right ventricular mechanisms. However, the prognostic value of an impaired GLSRV has not been established.

In the study, researchers assessed GLSRV in PAH patients and evaluated its prognostic significance. In total, 51 PAH patients were analyzed through echocardiography.

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Researchers found that there was a significant correlation between GLSRV and right ventricular parameters. GLSRV was also found to be correlated to pulmonary vascular resistance. Of the cohort analyzed, 20 patients were found to experience at least one adverse event (death, lung transplantation or heart failure), and an impaired GLSRV was found to be associated with an increased mortality. The team reported that both GLSRV and age were linked to adverse clinical events being relevant predictors of death.

The research team concluded that GLSRV had a significant correlation with echocardiographic parameters linked to right ventricular function, and that a GLSRV equal or higher than -15.5% was significantly associated with adverse clinical events in PAH patients, including death. The authors suggest that a study involving a larger number of participants should be conducted to confirm the correlations found and the clinical relevance of GLSRV measurement.