BACKGROUND: Increased systolic pulmonary artery pressure (sPAP) could lead to mechanical dysfunction and myocardial fibrosis of right heart chambers. Echocardiographic strain analysis has not been adequately studied in patients living with pulmonary hypertension (PH). METHODS AND RESULTS: A cross-sectional cohort of patients with suspected PH and echocardiographic strain evaluation was recruited. Cut-off values of peak tricuspid regurgitation velocity with low probability of PH (≤ 2.8 m/s), intermediate probability (2.9-3.4 m/s, without other echo PH signs) and high probability of PH (2.9-3.4 m/s with other echo PH signs and >3.4 m/s) categories were studied by right ventricular and right atrial strain analysis in a sample of 236 patients, 58 (56.9%) had low, 15 (14.7%) intermediate, and 29 (28.4%) high probability of PH. We observed a negative association between right ventricular free wall strain and atrial global strain with sPAP. As PH severity increased, right atrial reservoir, conduit, and contraction (booster) strain values decreased. Identified cut-off values of strain parameters had an adequate ability to detect PH severity categories In addition, post-mortem biopsies of right heart chambers from subjects with known severe pulmonary hypertension were analyzed to quantify myocardial fibrosis. Our sample of right heart biopsies (n=12) demonstrated an association between increased sPAP before death and right ventricular and right atrial fibrosis. CONCLUSIONS: Mechanical dysfunction and fibrosis in right chambers is associated with increased sPAP. Right ventricular and atrial strain could provide enhancement in the diagnosis and categorization of subjects with suspected PH.

Background: Left ventricular hypertrophy is associated with poor prognosis and ad-verse events. Left ventricular and left atrial global strain and left atrial reservoir strain (LV-GS; LA-GS; LA-RS) could be used as markers for myocardial function in different forms of ventricular remodeling. The aim of this study was to evaluate LV-GS and LA-GS scores in different ventricular remodeling variants and identify risk factors for myo-cardial dysfunction. Methods and Results: This cross-sectional study was divided into four groups of ventricular remodeling: normal geometry, eccentric hypertrophy (EH), concentric hypertrophy (CH) and concentric remodeling (CR). Strain analysis was obtained using standardized protocols. We included 121 subjects, 33 with previous myocardial infarction (MI). We found that EH had the lowest LV-GS and CH the lowest LA-GS and LA-RS. Atrial and ventricular dysfunction was present in 40 (33%) and 14 (11.5%) subjects, respectively. Smoking, male sex and previous MI were associated with LV dysfunction and smoking and dyslipidemia with LA dysfunction. EH was closely associated with LV dysfunction and CH with LA dysfunction. Conclusions: We conclude that different types of ventricular geometry had echocardiographic profiles associated with different risk factors for dysfunction assessed by strain. The assessment of ventricular remodeling by global strain could be used as a complementary tool in the echocardiographic evaluation of ventricular and atrial function.