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

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.