Method
Evaluation of Global and Regional Right Ventricular Systolic Function in Patients With Pulmonary Hypertension Using a Novel Speckle Tracking Method

https://doi.org/10.1016/j.amjcard.2006.03.056Get rights and content

This study sought to demonstrate that a novel speckle-tracking method can be used to assess right ventricular (RV) global and regional systolic function. Fifty-eight patients with pulmonary arterial hypertension (11 men; mean age 53 ± 14 years) and 19 age-matched controls were studied. Echocardiographic images in apical planes were analyzed by conventional manual tracing for volumes and ejection fractions and by novel software (Axius Velocity Vector Imaging). Myocardial velocity, strain rate, and strain were determined at the basal, mid, and apical segments of the RV free wall and ventricular septum by Velocity Vector Imaging. RV volumes and ejection fractions obtained with manual tracing correlated strongly with the same indexes obtained by the Velocity Vector Imaging method in all subjects (r = 0.95 to 0.98, p <0.001 for all). Peak systolic myocardial velocities, strain rate, and strain were significantly impaired in patients with pulmonary arterial hypertension compared with controls and were most altered in patients with the most severe pulmonary arterial hypertension (p <0.05 for all). Pulmonary artery systolic pressure and a Doppler index of pulmonary vascular resistance were independent predictors of RV strain (r = −0.61 and r = −0.65, respectively, p <0.05 for both). In conclusion, the new automated Velocity Vector Imaging method provides simultaneous quantitation of global and regional RV function that is angle independent and can be applied retrospectively to already stored digital images.

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Methods and Results

Patients with pulmonary hypertension (pulmonary artery systolic pressure >35 mm Hg) on 2-dimensional echocardiography and Doppler and age- and gender-matched control subjects (3:1 ratio) who underwent complete conventional echocardiographic examinations from July 2003 to April 2005 using digital acquisition on an Acuson ultrasound system (Siemens Medical Solutions USA, Inc., Mountain View, California) were screened for inclusion. The study was approved by the Institutional Review Board of

Discussion

The present study demonstrates that global and regional systolic function of the right ventricle can be quantitated simultaneously by a novel automated speckle-tracking method. Along with the determination of global indexes, this method provides 2-dimensional-derived regional tissue velocity, strain, and strain rate that are angle independent, allowing the differentiation of normal controls from patients with various degrees of pulmonary hypertension. To our knowledge, the right ventricle has

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This study was supported by an investigator-initiated research grant received from Siemens Medical Solutions USA, Inc., Mountain View, California.

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