P275Regional wall motion variations in right ventricular systolic impairment in patients with pulmonary hypertension as assessed by three dimensional speckle tracking

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Purpose: Two-dimensional speckle tracking (2DST) imaging of the right ventricle (RV) has been used to demonstrate reduced longitudinal strain (LS) in the basal, mid and distal segments in patients with pulmonary hypertension (PHT) when compared to healthy controls. Thus far only LS has been measured in these populations with the transverse directions almost entirely ignored, and only in 2D. The advent of three-dimensional speckle tracking (3DST) allows for the analysis of longitudinal, radial (RS) and circumferential (CS) strain from the same 3D full volume capture, and eliminates the effect of out-of-plane data loss.Methods: N=28 patients with PHT (59.5±15.9y, RVSP 89.9±26.5mmHg) with satisfactory imaging for 3DST and N=10 healthy volunteers (38.0±16.8y, RVSP 27.8±4.7mmHg) were included in the study. In addition to standard 2D and Doppler studies, a 3D full volume capture of the RV was acquired. The RV free wall was divided equally into basal, mid and distal segments and analysed by 3DST for RS, LS and CS.Results: LS was reduced in the basal (-35.9±7.4 vs. -23.3±7.2, p<0.001) and mid (-10.3±6.0 vs. -5.5±4.3, p=0.009) segments but not the distal segment, and only the mid-level demonstrated a statistically significant difference between groups for RS (22.9±15.7 vs. 12.5±8.9, p=0.027). There were no significant differences in regional CS between groups. When divided into groups according to the subjective assessment of RV systolic function, there were significant differences between groups for basal and mid LS, and basal RS (see picture). When comparing between regions, basal LS was significantly greater than mid and distal LS (p<0.001, both).Conclusions: 3DST is able to demonstrate differences in regional wall motion for the RV in normal subjects and patients with PHT.

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