Right atrial and ventricular strain detects subclinical changes in right ventricular function in precapillary pulmonary hypertension

Fig. 1. Depiction of the different strain parameters using Medis Qstrain software. a Right ventricular longitudinal strain parameters. Depiction of right ventricular (RV) longitudinal strain (%, y-axis) in time (ms, x-axis) in a precapillary pulmonary hypertension patient. Global, free wall and septal strain is measured at the time of eS (‘systolic strain’). eD is used as a reference to measure TTP. b Right atrial strain parameters. Depiction of right atrial (RA) strain (%, y-axis) in time (ms, x-axis). Reservoir strain measures the expansion of the RA (during RV systole) from the central venous return. Conduit strain is the passive filling of blood from the RA to the RV during early and mid-diastole. Booster strain measures the atrial contraction, in the late-diastolic, active, RV filling phase. end-diastole; end-systole; TTP time to peak strain

Fig. 2. Representative images of right ventricular longitudinal and circumferential strain, and right atrial strain in a healthy control and a precapillary pulmonary hypertension patient. Representative images of the different strain parameters (%, y-axis) in time (ms, x-axis). Compared to the healthy controls, RV longitudinal (upper pictures) and circumferential strain (middle pictures) are lower in pPH patients. In addition, RA reservoir and conduit strain are lower in pPH patients compared to healthy controls, whereas there were no significant differences in RA booster strain (lower pictures). pPH pulmonary hypertension RA right atrial, RV right ventricular

Fig. 3. Right ventricular longitudinal and circumferential strain, and right atrial strain in healthy controls and precapillary pulmonary hypertension patients (stratified in groups by right ventricular ejection fraction). a Right ventricular global longitudinal and global circumferential strain. Compared to healthy controls, all pPH patient groups had lower global longitudinal strain, whereas circumferential strain was only lower in the pPH patient group with RVEF < 40%. b Right ventricular basal, mid, and apical circumferential strain. In pPH patients with preserved RVEF (≥ 50%) basal circumferential strain was better in comparison to healthy controls. In pPH patients with severely reduced RVEF (< 40%), circumferential strain was reduced on all levels. c Compared to healthy controls, patients with RVEF between 40 and 50% had a higher ratio between circumferential and longitudinal strain, in the other pPH patient groups no significant differences were found. d Right atrial strain. Compared to healthy controls, pPH patients had altered RA strain: all pPH patients had impaired conduit strain, and pPH patients with reduced RVEF (< 50%) had impaired reservoir strain. Booster strain was only…