In patients (pts) with pulmonary hypertension (PH) different right ventricular (RV) function parameters predict outcome. Data regarding the prognostic value of averaged 6-segments RV longitudinal strain (RV-GLS) in PH pts are scarce.

To assess the predictive value of 6-segments RV-GLS in PH pts receiving vasodilator therapy.

Forty-seven pts (40±15 years, 36 women) with PH treated with either bosentan, sildenafil, or both and 33 controls with similar age and gender (40±11 years, 21 women) were studied. Clinical parameters and biologic (B-type natriuretic peptide, BNP), invasive and echocardiographic parameters of RV function (TAPSE, TDI-derived free-RV wall S- and e’-wave, RV fractional area change (FAC), Tei index, I/H, RV isovolumic acceleration-IVA) were assessed. 6-segments RV-GLS was measured from the apical 4-chamber view by STE. PH pts were followed-up for 23 months (2–49). An endpoint of cardiac death was defined.

PH pts had larger right chambers size, PA size and pressures, impaired RV function than controls (all P<0.001), including RV-GLS (−14.0±4.8% vs. −23.3±2.7%, P<0.001). During follow-up, 8 pts died. At univariable analysis, predictors of death were: TAPSE (15±3mm in deceased pts vs. 18±3mm in surviving pts, P=0.011), RV-S (9.1±2.1cm/s vs. 11.5±1.9cm/s, P=0.002), FAC (25±9% vs. 36±8%, P=0.001), RV-GLS (−9.6±4.2% vs. −14.9±4.5%, P=0.003), IVA (0.16±0.07cm/s² vs. 0.24±0.10cm/s², P=0.041) and BNP levels (lnBNP, 5.8±1.0 vs. 4.7±1.5, P=0.05). ROC curve analysis showed that RV-GLS had the highest predictive value for cardiac death (AUC 0.82, P=0.005). Cutoff value for RV-GLS derived from ROC curve analysis was used to construct Kaplan-Meier survival curves. A value of −13.2% for RV-GLS predicted cardiac death with 87% sensitivity and 62% specificity.

In PH pts, RV function parameters have prognostic value. Six-segments RV-GLS emerged as the strongest predictor of cardiac death with a cutoff value of −13.2% in this setting.