Strengths and limitations
Our study has some limitations. Our patients were recruited at a
referral hospital, which may represent a population bias in terms of
disease prevalence and severity. Despite this, our population had a
significant cohort without PH and had various degrees of pulmonary
hypertension. There was, however, only a small number of patients with
moderate PH, potentially affecting our ability to see significantly
different measurements between the moderate and severe PH categories.
Additionally, we included a small cohort of patients with PH and with
biopsies evaluated postmortem to determine the presence and percentage
of fibrosis associated with an increase in systolic pulmonary artery
pressure. We did not have strain values in these patients. Accordingly,
while fibrosis has been associated with reduced echocardiographic
derived strain, we consider the relationship between pathology-derived
fibrosis and reduced strain as a measurement of decreased RV function
and possibly of fibrosis as exploratory. Finally, the assessment at
follow-up to evaluate possible adverse outcomes is left as an area of
opportunity for further research.