Right ventricular strain and strain rate and pulmonary function before and after percutaneous baloon mitral valvuloplasty in patients with severe rheumatic mitral stenosis

This study aimed to establish feasibility for myocardial speckle tracking (MST) and intra-observer reliability of both MST and tissue velocity imaging (TVI)-derived right ventricular (RV) strain (ε) and strain rate (SR) at rest and during upright incremental exercise. RV ε and SR were derived using both techniques in 19 healthy male participants. MST-derived ε and SR were feasible at rest (85% of segments tracked appropriately). Feasibility reduced significantly with progressive exercise intensity (3% of segments tracking appropriately at 90% maximum heart rate (HRmax)). Coefficient of variations (CoVs) of global ε values at rest was acceptable for both TVI and MST (7–12%), with low bias and narrow limits of agreement. Global SR data were less reliable for MST compared with TVI as demonstrated with CoV data (systolic SR=15 and 61%, early diastolic SR=16 and 17% and late diastolic SR=26 and 31% respectively). CoVs of global RV ε and SR obtained at 50% HRmax were acceptable using both techniques. As exercise intensity increased to 70 and 90% HRmax, reliability of ε and SR values reduced with larger variability in MST. We conclude that RV global and regional ε and SR data are feasible, comparable and reliable at rest and at 50% HRmax using both MST and TVI. Reliability was reduced during higher exercise intensities with only TVI acceptable for clinical and scientific use.

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Right ventricular strain rate during exercise accurately identifies male athletes with right ventricular arrhythmias

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez228 ◽

2019 ◽

Cited By ~ 2

Author(s):

Mathias Claeys ◽

Guido Claessen ◽

Piet Claus ◽

Ruben De Bosscher ◽

Christoph Dausin ◽

...

Keyword(s):

Right Ventricular ◽

Strain Rate ◽

Exercise Intensity ◽

Left Ventricular ◽

Moderate Intensity ◽

Moderate Exercise ◽

Deformation Imaging ◽

Strain And Strain Rate ◽

Right Ventricular Strain ◽

Moderate Exercise Intensity

Abstract Aims Athletes with right ventricular (RV) arrhythmias, even in the absence of desmosomal mutations, may have subtle RV abnormalities which can be unmasked by deformation imaging. As exercise places a disproportionate stress on the right ventricle, evaluation of cardiac function and deformation during exercise might improve diagnostic performance. Methods and results We performed bicycle stress echocardiography in 17 apparently healthy endurance athletes (EAs), 12 non-athletic controls (NAs), and 17 athletes with RV arrhythmias without desmosomal mutations (EI-ARVCs) and compared biventricular function at rest and during low (25% of upright peak power) and moderate intensity (60%). At rest, we observed no differences in left ventricular (LV) or RV function between groups. During exercise, however, the increase in RV fractional area change (RVFAC), RV free wall strain (RVFWSL), and strain rate (RVFWSRL) were significantly attenuated in EI-ARVCs as compared to EAs and NAs. At moderate exercise intensity, EI-ARVCs had a lower RVFAC, RVFWSL, and RVFWSRL (all P < 0.01) compared to the control groups. Exercise-related increases in LV ejection fraction, strain, and strain rate were also attenuated in EI-ARVCs (P < 0.05 for interaction). Exercise but not resting parameters identified EI-ARVCs and RVFWSRL with a cut-off value of >−2.35 at moderate exercise intensity had the greatest accuracy to detect EI-ARVCs (area under the curve 0.95). Conclusion Exercise deformation imaging holds promise as a non-invasive diagnostic tool to identify intrinsic RV dysfunction concealed at rest. Strain rate appears to be the most accurate parameter and should be incorporated in future, prospective studies to identify subclinical disease in an early stage.

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