Clinical Impact of Right Ventricular Diastolic Patterns in Idiopathic Pulmonary Arterial Hypertension by Speckle Traiking

Purpose Aim of this study was to describe strain-derived right ventricular (RV) diastolic patterns by speckle-tracking echocardiography (STE) and its clinical impact in idiopathic pulmonary arterial hypertension (IPAH).STE of the RV has been extensively described in PAH. However, diastolic function has been yet underlooked (neglected) for no reason. Methods In 108 consecutive IPAH patients we identified three distinct strain-derived patterns from the mid-basal RV free wall segments. Each patient underwent baseline clinical, hemodynamic and complete echocardiographic evaluation and followed-up for clinical worsening occurrence. Results The three strain-derived diastolic patterns were characterized by high reproducibility (Cohen's κ=0.64, p=0.0001). Pattern 1 was associated with mild pulmonary hypertension and preserved clinical and RV function (preserved RV phenotype). This pattern was repetitively found in a cohort of 30 healthy subjects. Pattern 2 was associated with moderate to severe pulmonary hypertension, WHO functional class II and III, still preserved RV function (RV adaptive phenotype). Pattern 3 was associated with advanced stage of IPAH, characterized by high right atrial pressure, low cardiac index and severe RV remodeling (RV maladaptive phenotype). Multivariable models for clinical worsening (CW) prediction demonstrated that the addition of RV diastolic patterns to clinical and hemodynamic variables significantly increased the prognostic power of the model (0.79 vs 0.66; p Conclusion The results of the present study suggest that using speckle tracking echocardiography we can identify three phenotypically distinct, reproducible and clinically meaningful RV strain-derived diastolic patterns.