P475Three dimensional speckle tracking of the right ventricle: a method for quantifying global right ventricular systolic dysfunction in patients with pulmonary hypertension

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Purpose: Routine echocardiography is useful in the assessment of pulmonary hypertension (PHT) and right ventricular (RV) systolic function. RV strain is decreased longitudinally in PHT when using two-dimensional methods, but has not been measured in three dimensions or in the transverse direction. Three dimensional speckle tracking (3DST) can measure myocardial deformation (strain) longitudinally (LS), radially (RS) and circumferentially (CS) from a single 3D full-volume capture.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 assessed. In addition to standard 2D and Doppler studies, two 3D full volume captures of the RV were acquired and the right ventricular free wall (RVFW) was analysed for RS, LS and CS.Results: Global RS (16±9.5% vs. 26.2±16.7%, p=0.022) and LS (-14.7±3.4% vs. -22.1±4.1%, p<0.001) but not CS (-11.5±6.6% vs. -11.1±3.8%, p=0.813), were reduced in patients with PHT when compared to healthy controls. When divided into three groups according to the subjective assessment of RV systolic function, there were significant differences between groups for RS and LS, but not CS (see Table). When the two repeated measures were compared there was an agreement with a mean bias of 1.75% and a SD of 12.36 (95%CI: -22.5 to 26.0) for RS, mean bias of 0.82±2.23% (95%CI: -3.5 to 5.2) for LS, and a mean bias of 0.94±4.35% (95%CI: -7.6 to 9.5) for CS.Conclusion: 3DST is a robust and reproducible method for measuring RS, LS and CS in the RV, demonstrating global reduction in RV myocardial deformation associated with elevated pulmonary pressures and RV systolic dysfunction.

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