What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension, chest pain, or dyspnea without coronary artery disease (n=38). Intervention: Treadmill exercise vs. Baseline (pre-exercise). Primary outcome: Systolic strain of right ventricular free wall apex (p=0.010).

January 1, 2016Open Access

2-Dimensional Strain Analysis of Regional Change in Right Ventricular Function after Treadmill Exercise

SYSe‐Jung YoonNational Health Insurance Service Ilsan Hospital HSHye–Sun SeoSoonchunhyang University Hospital Seoul SPSujung ParkUlsan College

Key Result

Treadmill exercise significantly increased systolic strain of the right ventricular free wall apex (-18.2% to -22.3%) and mid portion (-14.1% to -22.6%) immediately post-exercise.

Study Design

Type

Observational (n=38)

Multicenter

PICO

Population

38 adult patients evaluated for hypertension, chest pain, or dyspnea, free of heart failure and coronary artery disease, who underwent pre- and post-treadmill exercise echocardiography.

Exposure / Comparator

Treadmill exercise vs Baseline (pre-exercise)

Primary Outcome

Systolic strain of right ventricular free wall apex, p=0.010

Main Result

Absolute Event Rate: -22.3% vs -18.2%

p-value: p=0.010

Limitations

Small number of patients enrolled.
Excluded patients in whom suitable echocardiographic views could not be obtained.
Feasibility of 2D strain analysis software applied to the right ventricle remains unclear.
Does not include long-term follow-up data.

Abstract

BACKGROUND: Function of right ventricle (RV) influences on symptoms and prognosis in various diseases. However the regional RV function analyzed with 2-dimensional (2D) strain echocardiography before and just after treadmill test has not been evaluated. The aim of this study was to show the change of regional RV function just after treadmill exercise with strain analysis. METHODS: A total of thirty eight patients who visited hospital for hypertension, chest pain or dyspnea between January 2007 and December 2010 were retrospectively analyzed (men, 47.4%; mean age, 54.9 ± 7.2 years). Treadmill exercise test and pre and post echocardiography were performed. 2D strain echocardiography was analyzed off line in RV free wall and septum. RESULTS: Mean exercise duration was 737 ± 132 sec. Tissue velocity in lateral tricuspid annulus is significantly increased in post exercise (initial, 10.5 ± 2.4 cm/sec vs. post exercise, 12.2 ± 1.8 cm/sec, p = 0.006). Systolic strain of RV free wall apex and mid portion were significantly changed in post exercise stage (free wall apex, -18.2 ± 7.6% vs. -22.3 ± 5.8%, p = 0.010; free wall mid, -14.1 ± 6.7% vs. -22.6 ± 6.8%, p = 0.022). CONCLUSION: 2D strain imaging provides a precise tool to quantify regional RV function and reveals a characteristic regional pattern of RV after treadmill exercise.

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