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Deformation pattern and predictive value of right ventricular longitudinal strain in children with pulmonary arterial
Iolanda Muntean1, Theodora Benedek2, Mihaela Melinte3
1Clinic of Paediatric Cardiology, Institute of Cardiovascular Diseases and Transplantation, University of Medicine and Pharmacy, Tîrgu-Mures, Romania.
Insights
Right ventricular longitudinal strain assessed by echocardiography can predict clinical worsening in children with pulmonary arterial hypertension (PAH). Lower strain values indicate poorer right ventricular function and increased risk in pediatric PAH patients.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Right ventricular (RV) function is a critical prognostic indicator in pediatric pulmonary arterial hypertension (PAH).
- Assessing RV deformation patterns is essential for understanding disease progression and outcomes.
Purpose of the Study:
- To evaluate the deformation pattern of the right ventricle using longitudinal strain.
- To determine the prognostic value of RV longitudinal strain in children diagnosed with PAH.
Main Methods:
- Prospective evaluation of 46 children (25 with PAH, 21 controls) using echocardiography and speckle-tracking.
- Assessment included brain natriuretic peptide levels, WHO functional class, and 6-minute walking test.
- Patients were categorized into non-worsening and worsening groups based on 12-month clinical follow-up.
Main Results:
- Children with PAH exhibited significantly lower RV free wall longitudinal strain and strain rate compared to controls.
- A more pronounced reduction in basal and mid-ventricular segments was observed in PAH patients.
- Mid RV free wall longitudinal strain independently predicted clinical worsening (OR 0.45, p=0.041) with a cutoff of -18.50% showing 91.7% sensitivity.
Conclusions:
- Two-dimensional speckle-tracking echocardiography is a valuable non-invasive tool for assessing RV function in pediatric PAH.
- This technique enables segmental analysis of RV myocardial performance.
- RV longitudinal strain can aid in predicting clinical outcomes in children with severe PAH.
Background:
Right ventricular function has been identified as an important prognostic factor in children with pulmonary arterial hypertension. The aim of the study was to assess the deformation pattern and prognostic value of right ventricular longitudinal strain in children with pulmonary arterial hypertension.
Methods:
We prospectively evaluated 46 children (25 with pulmonary arterial hyperetension and 21 age and sex matched controls) using conventional and speckle-tracking echocardiography, brain natriuretic peptide levels and clinical status expressed by WHO functional class and 6-min walking test. According to the clinical status after 12 months of follow-up, the pulmonary arterial hypertension patients were divided in two groups: non-worsening (13) and worsening (12).
Results:
Right ventricular free wall longitudinal strain and strain rate were significantly lower in children with PAH compared with controls (-24.72 ± 3.48 vs -15.60 ± 3.40, p = 0.0001 and -1.44 ± 0.09 vs -1.09 ± 0.15, p = 0.0001, respectively). There was a more expressed decrease of basal than apical region of right ventricular free wall longitudinal strain/strain rate in pulmonary arterial hypertension patients compared with controls (strain: p = 0.0001 vs p = 0.07 and strain rate: p = 0.0001 vs p = 0.002). Comparing worsening and non-worsening pulmonary arterial hypertension patients there was a significant difference in Mid right ventricular free wall longitudinal strain (-14.00 ± 3.13 vs. -20.76 ± 4.62, p = 0.0001). In multivariable logistic regression analysis Mid right ventricular free wall longitudinal strain was an independent predictor of worsening in pulmonary arterial hypertension children (OR 0.45; 95 % CI: 0.21-0.96, p = 0.041). In ROC curve analysis a cut-off value of Mid right ventricular free wall longitudinal strain of -18.50 % predicted clinical worsening in pulmonary arterial hypertension children, with a sensitivity and specificity of 91.7 and 30.8 %, respectively (area under curve = 0.88 ± 0.06, 95 % CI: 0.75-1.00, p = 0.001).
Conclusions:
Two-dimensional speckle-tracking echocardiography is a complementary non-invasive tool for assessment of right ventricular function in children with severe pulmonary arterial hypertension, allowing also clinical prediction and segmental analysis of right ventricular myocardial performance in these patients.
