Timing and Magnitude of Regional Right Ventricular Function: A Speckle Tracking-Derived Strain Study of Normal Subjects and Patients with Right Ventricular Dysfunction

Meris, Alessandra; Faletra, Francesco; Conca, Cristina; Klersy, Catherine; Regoli, François; Klimusina, Julia; Penco, Maria; Pasotti, Elena; Pedrazzini, Giovanni B.; Moccetti, Tiziano; Auricchio, Angelo

doi:10.1016/j.echo.2010.05.009

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 8 , Pages 823-831, August 2010

Timing and Magnitude of Regional Right Ventricular Function: A Speckle Tracking-Derived Strain Study of Normal Subjects and Patients with Right Ventricular Dysfunction

Alessandra Meris, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
- Reprint requests: Alessandra Meris, MD, Fondazione Cardiocentro Ticino, Division of Cardiology, Via Tesserete 48, CH-6900 Lugano, Switzerland.
Francesco Faletra, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Cristina Conca, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Catherine Klersy, MD
- Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
François Regoli, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Julia Klimusina, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Maria Penco, MD
- Division of Cardiology, Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
Elena Pasotti, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Giovanni B. Pedrazzini, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Tiziano Moccetti, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Angelo Auricchio, MD
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland

published online 21 June 2010.

Background

The aim of this study was to evaluate the timing and magnitude of global and regional right ventricular (RV) function by means of speckle tracking–derived strain in normal subjects and patients with RV dysfunction.

Methods

Peak longitudinal systolic strain (PLSS) and time to PLSS in 6 RV segments (the basal, mid, and apical segments of the RV free wall and septum) were obtained in 100 healthy volunteers and 76 patients with RV dysfunction by tracking speckles inside the myocardium using grayscale images. Global PLSS and time to PLSS were based on the average of the 6 regional values.

Results

There was a significant and close correlation between RV contractility as measured by PLSS and tricuspid annular plane systolic excursion (r = −0.83, P < .001). In normal subjects, PLSS was significantly greater in the free wall than in the septum (−28.7 ± 4.1% vs −19.8 ± 3.4%, P < .001), whereas time to PLSS was similar in the different regions of the right ventricle. In patients with RV dysfunction, global and regional PLSS was significantly less than in normal subjects (−13.7 ± 3.6% vs −24.2 ± 2.9%, P < .001), and a global PLSS cutoff value of −19% was helpful in distinguishing the two groups. Furthermore, time to PLSS in all of the RV septal segments and dispersion in RV contraction timing were significantly longer. Global PLSS in the patients with RV dysfunction was also significantly less in the presence of moderate to severe pulmonary hypertension (−12.7 ± 3.6% vs −14.4 ± 3.4%, P = .038).

Conclusions

Speckle tracking not only makes it possible to quantify global RV function but also illustrates the physiology of RV contraction and the pattern of activation at regional level. Speckle tracking–derived strain could become an important new means of assessing and following up patients with impaired RV function and increased pulmonary pressure.

Keywords: Strain, Speckle tracking, Right ventricular function, Pulmonary hypertension

Abbreviations: CAD, Coronary artery disease, FAC, Fractional area change, LV, Left ventricular, PLSS, Peak longitudinal systolic stress, RV, Right ventricular, TAPSE, Tricupsid annular plane systolic excursion