Geert Kleinnibbelink

Chapter 10 212 Hulshof et al. 2017 JACC CVI Hulshof et al. 2020 EHJ CVI This thesis Peak RV longitudinal strain has independent prognostic value for a combined end-point and all-cause mortality. A strong correlation between RV myocardial contractility assessed with the non-invasive strain-area loop and the invasive pressure-area loop. Di erent loop in PH patients who died accross 5-year follow- up compared to survivors. Loop score predicts 5-year all- cause mortality and improves risk strati cation in high-risk population. Distinct loop characteristics in PH compared to controls. Better distinction between PH patients with di erent levels of PVR compared to traditional echocardiographic measures, i.e. association with afterload. This thesis This thesis Future directions Clinical responders to Selexipag show an increase in peak RV longitudinal strain and uncoup- ling while clinical non-respond- ers show a further detoriation in RV function. Future studies should further explore the clinical potential of the strain-area loop including risk assessment, evaluation and adjusting pharmacological therapy. Development of a semi- automated method to produce strain-area loops would accelarate incorporation in daily clinical practice. Figure 5. Outline of current evidence of the right ventricular strain-area loop in pulmonary hypertension patients.