Assessment of Right Ventricular Function in Patients with Cor Pulmonale: Strain Imaging Study

Background: Cor pulmonale is one of the leading causes of heart failure. Speckle tracking echocardiography is a potential modality for evaluation of systolic and diastolic functions, myocardial mechanics and other cardiac pathophysiological processes. Objective: This study aims to assess the right ventricular (RV) function in patients with cor pulmonale using Strain Imaging and conventional echocardiography. Methods: Fifty patients with cor pulmonale compared to twenty age and sex matched controls selected for echocardiographic examination for assessment of RV indices; Pulmonary Artery Systolic Pressure (PASP), Tricuspid Annular systolic Excursion (TAPSE), Fractional Area Change (FAC), Tissue Doppler Imaging (TDI), Strain and Strain rate of RV free wall in addition to conventional left ventricular data. Results: TAPSE (1.4±0.16 vs 2.3±0.31 cm), RV FAC (30.5±4.3% vs 47.2±4.5%), PASP (60.98±15.6 vs 18.9±5.41 mmHg) and Systolic velocity of tricuspid annulus S' (8.9±1.4 vs 13.4±1.9 cm/sec) were significantly impaired in patients vs controls respectively with p<0.001 for all. Also, The global RV free wall peak systolic longitudinal strain (e sys) for patients was 16.9±3.4% vs 25.2±2.9%, The RV free wall systolic strain rate (S-1 s) was 0.98±0.18 vs 1.7±0.18, RV free wall early diastolic strain rate (S-1 e) was 1.2±0.25 vs 1.92±0.28 and RV free wall late diastolic strain rate (S-1 a) was 1.11±0.27 vs 1.8±0.21 with (p<0.001 for all). The RV free wall systolic Longitudinal Strain (e sys) was negatively correlated with PASP (r=-0.950, p<0.001) and positively correlated with TAPSE, RV FAC and Systolic velocity of tricuspid annulus S' (r=0.635, r=0.919, r=0.890 respectively with p<0.001 for all). Conclusion: Strain and Strain Rate are reliable tools to assess systolic and diastolic functions of the RV in patients with cor pulmonale even at early disease stages and correlate well with other conventional echo parameters for RV assessment.