Right Ventricular Strain in Normal Healthy Adult Filipinos: A Retrospective, Cross- Sectional Pilot Study

Transcription

1 Right Ventricular Strain in Normal Healthy Adult Filipinos: A Retrospective, Cross- Sectional Pilot Study By Julius Caesar D. de Vera, MD Jonnah Fatima B. Pelat, MD

2 Introduction Right ventricle contributes a significant part in the morbidity and mortality of patients with signs and symptoms of cardiopulmonary disease Increasing role of the right ventricle in CHF, SCD and arrhythmias Complete assessment of the right ventricle is not being done This is due to: Complex geometry Wider loading conditions Greater heterogeneity of regional function Emphasis on the left ventricle

3 Introduction Evaluation of the right ventricle has been difficult due to the lack of reliable assessment methods. Strain involves measurement of the length change from baseline length It is load and angle independent 1 Strain determination was first developed for the left ventricle, but it can also be applied to the right ventricle Can be assessed in the following dimensions: longitudinal, circumferential and radial With the inherent difficulty of assessing the right ventricle, determination of regional strain will be an advantage because it is angle independent 1 La Gerche et al. Right Ventricular Function by Strain Echocardiograpy. Current Opinion in Cardiology :

4 Objectives General Objective: to determine the normative data on the right ventricular lateral free wall (RVLFW) strain of healthy adult patients of Filipino descent Specific Objective: to correlate the right ventricular lateral free wall strain with the following demographic parameters: tricuspid annular plane systolic excursion (TAPSE) and Sm

5 Methodology This was a retrospective, cross-sectional descriptive pilot study of presumably normal, healthy adult patients of Filipinos This study was approved by the institutional review board Inclusion Criteria: Patients of Filipino descent with ages between years old with: (1) no history of hypertension, with normal blood pressure at the time of examination (2) no history of diabetes mellitus, hyperlipidemia, or cardiovascular disease (3) no history of cardiac medication use (4) no risk factors for cardiovascular disease (e.g. chronic kidney disease, obstructive sleep apnea, smoking or history of smoking) and other diseases such as connective tissue disease; pulmonary diseases, malignancy active or in remission.

6 Exclusion Criteria: Pregnant patients History of cardiovascular intervention Body mass index (BMI) of > 30 kg/m 2 Admitted because of an illness at the time of echocardiographic examination Initial echocardiographic findings: diastolic dysfunction, abnormal cardiac chamber sizes, significant regurgitations or any valvular stenoses, abnormal relative wall thickness or left ventricular mass index, pulmonary hypertension and low ejection fraction (<55%)

7 Description of Study Procedure Patients who underwent two-dimensional echocardiographic examination from April 2015 to February 2016 and was found to have a normal study and appropriately eligible based on the eligibility criteria with optimal image of the right ventricle were included Data gathered: Demographics (age, body mass index, gender, blood pressure), echocardiographic parameters (ejection fraction, left ventricular mass index, relative wall thickness, Sm, TAPSE), strain values of the right ventricular lateral free wall segments

8 Two-dimensional echocardiograph/speckle Tracking Analysis Two-dimensional echocardiogram using Philips ie33 machine Measurements made from modified apical 4 chamber-rv focused view Images of the right ventricle with 3 definite points (RV apex, medial and lateral tricuspid annulus) The software were able to automatically trace the endocardial and epicardial borders

9 Final Results 66 subjects Age/Gender Age Male Female Body Mass Index/Blood Pressure BMI SBP (mmhg) DBP (mmhg) Echocardiographic Parameters LV ejection fraction (Simpson s) TAPSE (cm) Sm (cm/s)

10 Final Results RV lateral free wall segment strain BIL MIL ApL % % %

11 Right ventricular lateral free wall strain by gender Right Male Female Total P value ventricular segment Mean + SD Mean + SD Basal Lateral % % % Mid Lateral % % % 0.54 Apical Lateral % % % 0.03 Right ventricular lateral free wall strain % % % 0.01

12 Discussion 432 patients were initially screened 366 were excluded Reasons for exclusion: Poor echocardiographic image of the RV Presence of diabetes, significant comorbidities 66 patients composed the final study population 35 male = 53% Right ventricular free wall segments showed: Highest value in the mid segment at % By gender, the female population had the higher value compared with males: % vs %, p value= 0.01

13 Discussion Our study results showed higher values in females which was comparable in a study done by Meris. Other studies would show otherwise Our study results showed highest value in the mid segments which was comparable in a study done by Weidemann 10. The same was not seen in a study by Fine 11. The results, taken with other studies done before, could not establish the definite ranges of normal values of the right ventricular free wall strain. This is the first study done to determine the strain values of the right ventricular lateral free wall in normal Filipino adults. 10Weidemann et al. Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound-based strain rate and strain imaging. J Am SocEchocardiogr 2002;15: Fine et al. Left and right ventricular strain and strain rate measurement in normal adults using velocity vector imaging: an assessment of reference values and intersystem agreement. Int J Cardiovasc Imaging 2013;29:

14 Conclusion The mean right ventricular lateral free wall strain for normal adult Filipinos is %