BACKGROUND We aimed to evaluate associations of right atrial (RA) and right ventricular (RV) strain parameters assessed by 2D speckle tracking echocardiography (2D STE) with invasively measured hemodynamic parameters in patients with and without pulmonary hypertension (PH). METHODS In this study, we analyzed 78 all-comer patients undergoing invasive hemodynamic assessment by left and right heart catheterization. Standard transthoracic echocardiographic assessment was performed under the same hemodynamic conditions. RA and RV longitudinal strain parameters were analyzed using 2D STE. PH was defined as invasively obtained mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest and was further divided into pre-capillary PH (pulmonary capillary wedge pressure [PCWP] ≤ 15 mmHg), post-capillary PH (PCWP > 15 mmHg) and combined PH (PCWP > 15 mmHg and difference between diastolic PAP and PCWP of ≥7 mmHg). Correlation analyses between variables were calculated with Pearson's or Spearman's correlation coefficient as applicable. RESULTS Out of 78 patients, 45 presented with PH. Within the PH group, 39 had post-capillary, five had combined pre- and post-capillary PH, and one had pre-capillary PH. Patients with PH had a significantly increased RA area (PH 22.0 ± 9.2 cm2, non-PH 17.3 ± 10.7 cm2; p = 0.003) and end-systolic RV area (PH 14.7 ± 6.1, non-PH 11.9 ± 4.8 cm2; p = 0.022). RV mid strain was significantly reduced in PH (PH -17.4 ± 7.8, non-PH: - 21.6 ± 5.5; p = 0.019). Average peak systolic RA strain (RAS) and average peak systolic RV strain (RVS) showed a significant association with mPAP (r = - 0.470, p = 0.001 and r = 0.490, p = 0.001, respectively) and with PCWP (r = - 0.296, p = 0.048 and r = 0.365, p = 0.015, respectively) in patients with PH. Furthermore, RV apical, mid and basal strain as well as RV free wall strain showed moderate associations with mPAP. In patients without PH, there were no associations detectable between RA or RV strain parameters and mPAP and PCWP. CONCLUSION In an all-comer cohort, RA and RV strain parameters showed significant associations with invasively assessed mPAP and PCWP in patients with predominantly post-capillary PH. These associations may be useful in clinical practice to assess the impact of post-capillary PH on myocardial right heart function.

中文翻译：

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基于2D散斑跟踪超声心动图的右心变形参数与肺动脉高压患者的侵入性评估血流动力学指标的关联。

背景技术我们旨在评估通过2D斑点跟踪超声心动图（2D STE）评估的右心房（RA）和右心室（RV）应变参数与有无肺动脉高压（PH）的患者的侵入性测量的血液动力学参数之间的关系。方法在本研究中，我们分析了78位通过左心导管和右心导管插入术进行血流动力学评估的全科患者。在相同的血液动力学条件下进行标准的经胸超声心动图评估。使用2D STE分析RA和RV纵向应变参数。PH值定义为在静息状态下侵入性获得的平均肺动脉压（mPAP）≥25 mmHg，并进一步分为毛细血管前PH（肺毛细血管楔压[PCWP]≤15 mmHg），毛细血管后PH（PCWP> 15 mmHg）和合并的PH（PCWP> 15 mmHg，舒张压PAP与PCWP之差≥7 mmHg）。使用适用的Pearson或Spearman相关系数计算变量之间的相关分析。结果在78例患者中，有45例出现了PH。在PH组中，毛细血管化后有39个，毛细血管化前后有5个合并，毛细血管化前有1个。PH患者的RA面积（PH 22.0±9.2 cm2，非PH 17.3±10.7 cm2; p = 0.003）和收缩末期RV区域（PH 14.7±6.1，非PH 11.9±4.8 cm2; p = 0.022）。RV中毒的PH值显着降低（PH -17.4±7.8，非PH：-21.6±5.5; p = 0.019）。平均收缩期RA峰值（RAS）和平均收缩期RV峰值（RVS）与mPAP显着相关（r =-0.470，p = 0.001和r = 0.490，p = 0.001，PH患者的PCWP（分别为r =-0.296，p = 0.048和r = 0.365，p = 0.015）。此外，RV顶端，中部和基底应变以及RV无壁应变均与mPAP呈中等关联。在没有PH的患者中，RA或RV菌株参数与mPAP和PCWP之间没有可检测到的关联。结论在所有人群中，RA和RV应变参数与以毛细血管后PH为主的患者的侵入性评估mPAP和PCWP显着相关。这些关联在临床实践中可能有助于评估毛细血管后PH对心肌右心功能的影响。在没有PH的患者中，RA或RV株参数与mPAP和PCWP之间没有可检测到的关联。结论在所有人群中，RA和RV应变参数与以毛细血管后PH为主的患者的侵入性评估mPAP和PCWP显着相关。这些关联在临床实践中可能有助于评估毛细血管后PH对心肌右心功能的影响。在没有PH的患者中，RA或RV株参数与mPAP和PCWP之间没有可检测到的关联。结论在所有人群中，RA和RV应变参数与以毛细血管后PH为主的患者的侵入性评估mPAP和PCWP显着相关。这些关联在临床实践中可能有助于评估毛细血管后PH对心肌右心功能的影响。