What is the clinical evidence from this study?

Study design: Cohort. Population: Pulmonary hypertension (n=315). Intervention: Right ventricular global longitudinal strain (RVGLS) vs. TAPSE and FAC. Primary outcome: All-cause mortality at 5 years (OR 1.66, 95% CI 1.10-2.57, p=0.02).

What does this research mean for the field?

Right ventricular global longitudinal strain is independently associated with 5-year mortality in pulmonary hypertension, showing a 66% increase in mortality odds per unit worsening, and provides superior prognostic value for hospitalization compared to traditional metrics like TAPSE. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 30, 2025Open Access

Predicting outcomes in patients with pulmonary hypertension using right ventricular global longitudinal strain versus tricuspid annular plane systolic excursion (TAPSE) and fractional area change: a retrospective analysis

Key Result

Right ventricular global longitudinal strain was independently associated with 5-year mortality in pulmonary hypertension, showing a 66% increase in mortality odds per unit worsening (OR 1.66).

Study Design

Type

Cohort (n=315)

Multicenter

Structured PICO

Does right ventricular global longitudinal strain (RVGLS) predict adverse outcomes better than tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) in patients with pulmonary hypertension?

Population

315 adult patients with pulmonary hypertension (mPAP > 20 mmHg) of diverse etiologies (61.6% WHO group 2), mean age 64 ± 14 years, 58.7% female, followed at the University of Virginia. Key inclusion: right heart catheterization and echocardiography within 1 month. Key exclusion: congenital heart disease-associated PAH, poor echocardiographic image quality.

Intervention

Right ventricular global longitudinal strain (RVGLS) measured via speckle-tracking echocardiography

Comparator

Tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC)

Outcome

All-cause mortality at 5 years and all-cause hospitalizationhard clinical

Right ventricular global longitudinal strain (RVGLS) is a superior echocardiographic marker compared to TAPSE for predicting 5-year mortality and hospitalizations in patients with pulmonary hypertension.

Main Result

Effect estimate: OR 1.66 (95% CI 1.10-2.57)

p-value: p=0.02

Limitations

Retrospective analysis with potential missing data
Three-dimensional speckle-tracking echocardiography was not accessible for all participants
Time-to-event analysis was not feasible due to unavailability of a consistent index date and follow-up data
Hospitalizations were modeled as a continuous outcome using linear regression instead of negative binomial regression
Did not include follow-up assessments after adjusting for pulmonary vasodilator therapies

Abstract

BACKGROUND: Pulmonary hypertension (PH) is a progressive clinical condition that eventually leads to right ventricular (RV) failure. RV function is the primary determinant of morbidity and mortality in patients with PH. RV global longitudinal strain (RVGLS) is a promising echocardiographic metric used to assess RV function in this setting. Our study aimed to compare the ability of RVGLS, tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) to predict adverse outcomes in patients with PH. METHODS: We retrospectively evaluated 315 patients with PH of diverse etiologies with 62% constitute of WHO group 2 disease, who were followed at the PH clinic at the University of Virginia, from March 2012 to December 2018. We included all adult patients who met the hemodynamic definition of PH with right heart catheterization and who underwent echocardiography within 1 month of each other. RESULTS: Approximately half of the cohort was female, with a mean age of 64 ± 14 years. We found a strong correlation between RVGLS and FAC (r = - 0.55, P < 0.001). Furthermore, there was a significant correlation between RVGLS and invasive hemodynamics. Compared with the TAPSE, the RVGLS stratified by quartiles was associated with mortality at 5 years and hospitalization. CONCLUSION: RVGLS is an echocardiographic marker that correlates closely with FAC and invasive pulmonary hemodynamics. In this study, both RVGLS and FAC were associated with 5-year mortality, whereas TAPSE was not. Notably, only RVGLS showed a significant association with hospitalization, suggesting that it may provide additional prognostic value in patients with PH.

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