Key result
High filling pressures in systemic RVs are linked to ~35% worse LA reservoir strain.
Why the study?
Systolic dysfunction of the systemic right ventricle is common in adults with transposition of the great arteries and systemic right ventricle, but non-invasive assessment of filling pressures is less established than in acquired heart disease.
Can Echo-Doppler and strain analysis accurately estimate filling pressures in adults with systemic right ventricles?
Observational (n=47)
No
Can Echo-Doppler and strain analysis accurately estimate filling pressures in adults with systemic right ventricles?
Strain analysis, including left atrial reservoir strain and sRV global longitudinal strain, is a helpful adjunct for non-invasively estimating filling pressures in adults with systemic right ventricles, where standard Doppler algorithms have limited applicability.
Left atrial reservoir strain may aid non-invasive filling pressure estimation in systemic right ventricles; leaves open prospective validation before clinical use.
AIMS: Systolic dysfunction of the systemic right ventricle (sRV) is common in adults with transposition of the great arteries and sRV. In acquired disease, diastology analysis for assessment of filling pressures (FP) is paramount in patient care. METHODS AND RESULTS: Retrospective analysis of 47 adults with sRV without prior systemic tricuspid valve surgery undergoing catheterization and echocardiography within 7 days (median -2 [-1, -3]) from January 2000 to February 2021 at our institution. Median age was 48 (31, 55) years, and 16 (34.0%) patients were female. FPs were normal in 21 patients (44.7%). Left atrial size was enlarged in most patients (83.0%) with mean indexed value 58.3 ± 23.4 mL/m2. Tissue Doppler e' was not significantly different between those with high FPs vs. normal (medial 0.07 ± 0.03 vs. 0.08 ± 0.03 m/s, P = 0.63; lateral 0.08 ± 0.04 vs. 0.08 ± 0.04 m/s, P = 0.88). E velocity and subpulmonic mitral regurgitant velocity were higher in those with high FPs (0.9 ± 0.3 vs. 0.6 ± 0.2 m/s, P = 0.005; 3.8 ± 1.1 vs. 2.8 ± 0.9 m/s, P = 0.004). Left atrial reservoir strain, sRV global longitudinal strain, and subpulmonic left ventricular strain were worse in those with high FP (18.0 ± 7.6 vs. 27.9 ± 10.2%, P = 0.0009; -13.0 ± 4.4 vs. -17.9 ± 5.0%, P = 0.002; -16.8 ± 5.7 vs. -23.0 ± 3.8%, P = 0.001). CONCLUSION: Despite the complex anatomy, FPs can be assessed non-invasively in adults with sRV without prior systemic tricuspid valve surgery. The current guideline algorithm for diastolic dysfunction in acquired heart disease has limited applicability in this population. Given the limitations of Doppler in this heterogeneous population, strain analysis can be a helpful adjunct for estimation of FPs.
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Jain et al. (2022) conducted an observational in Systemic right ventricle (sRV) in adults (n=47). Echocardiography and strain analysis vs. Catheterization-derived filling pressures was evaluated on Left atrial reservoir strain in high vs. normal filling pressures (p=0.0009). Left atrial reservoir strain was significantly worse in adults with a systemic right ventricle and high filling pressures compared to those with normal filling pressures (18.0% vs 27.9%, P=0.0009).
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