Comparison of Right Ventricular Speckle Tracking with Cardiac Catheterisation in Children with Pulmonary Hypertension

ORIGINAL RESEARCH, February 2013, VOL II ISSUE III, ISSN 2042-4884
10.5083/ejcm.20424884.87 , Cite or Link Using DOI
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Niti Dham MD, Lowell H Frank MD, Craig A Sable MD, Robert McCarter ScD, John T Berger MD

Objective:
Find the association between 2D strain and right heart catheterisation in children with pulmonary arterial hypertension (PAH).

Background:
Two-dimensional (2D) strain echocardiography, a non-invasive procedure, offers advantages for pulmonary arterial hypertension (PAH) evaluation, especially subtle aspects of right ventricular deformation. Invasive cardiac catheterisation is considered the gold standard for the diagnosis and assessment of PAH. The degree of association between 2D strain and right heart catheterisation results in children with PAH has not been previously reported.

Methods:
We performed a review of pediatric patients with known PAH that had a cardiac catheterisation and echocardiogram within 30 days of each other. Pulmonary vascular resistance (PVR), right ventricle to femoral artery pressure ratio (RVFA), right ventricle end diastolic pressure (RVEDP), and cardiac index were compared with 2D strain echo parameters of the right ventricle using the Siemens Velocity Vector Imaging (VVI), a commercially available strain package. All correlations were derived from model r-squares.

Results:
Nine patients met inclusion criteria. PVR correlated with global right ventricular peak systolic longitudinal strain, strain rate and velocity in a curvilinear fashion. RVFA correlated with right ventricular peak systolic longitudinal strain and velocity in a curvilinear pattern. Right ventricular end diastolic pressure and cardiac index did not correlate with any strain parameters.

Conclusions:
In conclusion, deformation measurements of the right ventricle as measured by right ventricular longitudinal strain may be a useful adjunct in the diagnosis and management of PAH. Further evaluation with a larger study is warranted.