Abstract 4367857: Left ventricular peak early diastolic strain rate detected by two-dimensional speckle tracking echocardiography and prognosis in pre-capillary pulmonary hypertension

Background: We investigated the prognostic value of two-dimensional speckle tracking echocardiography (2D-STE) detected left ventricular (LV) diastolic function (global peak early diastolic strain rate, LV-GSRe) in patients with pre-capillary pulmonary hypertension. Methods: Sixty-five pre-capillary PH patients were consecutively enrolled in our study, among which, 4 patients were lost to follow-up, and finally 61 patients were included. (22 males and 39 females, 36±13 years). Conventional echocardiography and 2D-STE were performed in all participants. Medical records were reviewed to obtain clinical data. Patients underwent follow-up assessments through structured clinic visits or standardized telephone interviews. The primary endpoint was all-cause mortality. Results: Linear regression analyses showed a significant but weak correlation between LV-GSRe and Peak oxygen consumption (r =0.509, P＜0.001), and N-terminal pro-brain natriuretic peptide (r=-0.526, P＜0.001). In addition, LV-GSRe significantly correlated with conventional echocardiographic RV parameters: peak early diastolic velocity of trans-tricuspid flow/early diastolic velocities (E/E’, r=-0.395, P=0.002 ), tricuspid annular plane systolic excursion (TAPSE, r=0.399, P=0.002), peak systolic velocities (S’, r=-0.44, P＜0.001) and fractional area change (FAC, r=-0.469, P＜0.001). During a median follow-up of 24.2 months [IQR 15.8-30.1], 6 deaths were recorded (9.83%). Receiver-operator characteristic curve showed LV-GSRe had the potential to predict all-cause mortality in pre-capillary PH patients (area under the curve=0.689, P=0.02). Optimal cut-offs found LV-GSRe＞1.06s -1 had a 80.8% sensibility and 62.3% specificity to predict all-cause mortality. Conclusions: 2D-STE detected LV-GSRe significantly correlated with clinical data and RV function, and had the potential to predict prognosis in pre-capillary PH patients.