Valor diagnóstico e impacto prognóstico da deformação miocárdica (strain) do ventrículo direito em pacientes com hipertensão arterial pulmonar e capacidade funcional relativamente preservada. Um estudo com ecocardiografia e ressonância magnética cardíaca

• Autor(a) principal: Costa Junior, Augusto Alberto da [UNIFESP]
• Data de Publicação: 2018
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6531979; https://repositorio.unifesp.br/handle/11600/52136
• topic: Pulmonary arterial hypertension; Right ventricular dysfunction; Speckle-tracking echocardiography; Right ventricular longitudinal strain; Hipertensão arterial pulmonar; Disfunção sistólica do ventrículo direito; Marcadores acústicos do eco bidimensional; Deformação do ventrículo direito

Background: Right ventricular (RV) dysfunction harbingers adverse prognosis in pulmonary arterial hypertension (PAH). Although conventional twodimensional echocardiography (2DE) is limited for RV systolic function quantitation, RV strain can be a useful tool. Objectives: The diagnostic and prognostic impact of 2DE speckletracking RV longitudinal strain was evaluated, including other 2DE systolic indexes, in a group of PAH patients without severe impairment of functional capacity, chronic pulmonary thromboembolism or left ventricular dysfunction. Patients and Methods: Sixtysix group I PAH patients, 67 % NYHA functional class I or II (none in IV) were studied by 2DE to obtain: RV fractional area change, tricuspid annular plane systolic excursion, RV myocardial performance index, tissue Doppler tricuspid annulus systolic velocity. Global, free wall (RVFreeWSt) and septal RV longitudinal systolic strain were obtained. RV ejection fraction by cardiac magnetic resonance (CMRRVEF) was also assessed. All patients were followed up to 3.9 years (mean 3.3 years). Combined endpoints were hospitalization for worsening PAH or cardiovascular death. Results and Conclusion: Among all the 2DE indexes of RV systolic function, RVFreeWSt exhibited the best correlation with CMRRVEF (r = 0.83; p < 0.005). Combined endpoints occurred in 15 (22.7 %) patients (6 hospitalizations and 9 deaths). Multivariate analysis identified RVFreeWSt ≤−14 % as the only 2DE independent variable associated with combined endpoints [HR 4.66 (1.25–17.37); p < 0.05]. We conclude that RVFreeWSt may be a suitable nongeometric 2DE surrogate of CMRRVEF in PAH patients, constituting a powerful independent predictor of longterm outcome in this cohort with relatively preserved functional capacity.