Abstract 12121: Right Ventricular Free-Wall Longitudinal Speckle-Tracking Strain in Patients With Pulmonary Arterial Hypertension Under Specific Treatment

Introduction: Pulmonary arterial hypertension (PAH) is a devastating disease of pulmonary vascular remodelling, right heart failure and limited survival. Although right ventricular (RV) dysfunction is a major determinant of outcome in patients with PAH, the optimal measure of RV function is poorly defined. Hypothesis: The objectives of this study were to test the utility of RV free wall speckle-tracking strain (RV-free) as an assessment tool for RV function in patients with PAH who are already under specific medical treatment compared with conventional echocardiographic parameters and to investigate the relationship of the findings obtained with RV-free with hemodynamic parameters of RV performance. Methods: Prospective RV- free measurement was performed on 92 PAH patients of different etiologies (49 PAH associated with congenital heart disease, 21 idiopathic PAH, 11 PAH associated with connective tissue disease and 11 chronic thromboembolic pulmonary hypertension) who were on PAH spesific treatment for at least 3 months. RV-free was calculated by averaging each of 3 regional peak systolic strain values. The mean follow-up was 222±133 days. Conventional echocardiographic parameters-RV FAC, TAPSE and Tricuspid S-, hemodynamic parameters -functional class, 6-min. walking distance, and NT-proBNP- were also studied. Results: The mean age was 41± 16 years and 67.4% were female. Mean RV- free of the study population was %-13.16 ± 6.3. There was a significant positive correlation between RV-free and functional class (r=0.312, p=0.01), NT-proBNP (r=0.423, p=0.0001), whereas negative correlation with FAC (r=-0.637, p=0.0001), TAPSE (r=-0.524, p=0.0001), Tricuspid S (r=-0.450, p=0.0001), 6-min. walking distance (r=-0.333, p=0.002). RV-free significantly correlated with all follow-up adverse events, death and clinical right heart failure (p=0.04, p=0.03, p=0.02, respectively). According to the ROC analysis, the cut-off value for the development of clinical right heart failure was -13.8% (sensitivity: 71%, specificity: 60%) for RV-free. Conclusions: Assessment of RV-free is a feasible, easy to perform method and maybe used as a predictor of right heart failure, clinical deterioration and mortality in patients under PAH specific treatment.