Echo-Derived Right Ventricular Strain Identifies Pulmonary Hypertension in Pediatric Ventricular Assist Device Patients

Identifying pulmonary hypertension in pediatric patients with continuous-flow ventricular assist device (cf-VAD) remains challenging, often relying on invasive hemodynamic assessment. We hypothesized that echocardiography-derived right ventricular global longitudinal strain (RV-GLS) may correlate with invasive pulmonary pressures, potentially guiding the timing of cardiac catheterization. We retrospectively reviewed pediatric cf-VAD patients (<21 years) implanted at our institution from 2011 to 2023 who underwent cardiac catheterization with concurrent echocardiography, excluding those with congenital heart disease. Uniplanar RV-GLS was measured from RV-focused views and compared with invasive hemodynamics, including mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVRi). Associations were evaluated by Spearman correlation and binomial logistic regression. Twenty-five patients were included (median age 14.8 years, weight 68 kg, VAD support duration 5 months). Right ventricular global longitudinal strain was measurable in 23 studies (median -13.3, interquartile range [IQR] [-14.3, -9.3]). Worse RV-GLS correlated with higher mPAP (p = 0.001) and higher PVRi (p = 0.014). Right ventricular global longitudinal strain was also associated with mPAP >20 mm Hg (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.10-2.90). An RV-GLS cutoff of -10.6% identified pulmonary hypertension (mPAP >20 mm Hg) with 88% sensitivity and 80% specificity. Right ventricular global longitudinal strain may be useful in noninvasively identifying residual pulmonary hypertension and optimal catheterization timing for pediatric cf-VAD patients. Prospective studies are needed to validate these findings.