Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Abstract

Assessment of right ventricular (RV) systolic function in patients with significant secondary tricuspid regurgitation (STR) remains challenging. In patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI), STR and RV enlargement have been associated with poor outcomes. In these patients, speckle tracking echocardiography (STE) may detect RV systolic dysfunction better than 3-dimensional (3D) RV ejection fraction (EF). The purpose of this study was to investigate the prevalence of RV dysfunction when assessed with STE in patients with significant STR (≥3+) compared with patients without significant STR (<3+) matched for 3D RV dimensions and RVEF on dynamic computed tomography (CT). Patients with dynamic CT data before TAVI were evaluated retrospectively. To assess the performance of RV-free wall strain (RVFWS) for identifying patients with impaired RV systolic function, patients were subsequently matched 1:1 based on age, gender, indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RVEF, and left ventricular ejection fraction (LVEF). In a total 267 patients (80 § 8 years, 48% male), significant STR (≥3+) was observed in 67 patients. Patients with STR≥3+ had larger RVEDVi, larger RVESVi, lower LVEF, and more impaired RVFWS compared with patients with STR<3+ (n = 200). After propensity score matching, patients with STR≥3+ (n = 53) had significantly more impaired RVFWS compared with patients with STR<3+ (n = 53): À18.2 § 5.0% versus À21.1 § 3.7%, p = 0.001. In conclusion, patients with significant STR have more pronounced RV systolic dysfunction as assessed with STE than the patients without significant STR despite having similar 3D RV dimensions and RVEF on dynamic CT.

The prognostic value of right ventricular longitudinal strain and 3D ejection fraction in patients with dilated cardiomyopathy

“…In our cohort, the mean values of GLS-RV and RVFW-LS were severely impaired, while mean RVEF was only mildly decreased. This suggests that longitudinal RV strain detects more subtle myocardial abnormalities than RVEF, a finding consistent with previous data [23].…”

Right ventricular longitudinal strain in the clinical routine: a state-of-the-art review

“…RVLS has been intensively studied in the past years to find better parameters for patient management. In a study in 267 TAVR, Hirasawa confirmed that the severity of TR was related to reduced RV function, and that free wall RVLS by echo was more predictive than RVEF by CT (81). Reduced RV function may also facilitate the development of TR; in 175 patients with lone atrial fibrillation, those who had low free wall RVLS were most likely to develop TR during follow-up (82).…”

Echocardiographic Advances in Dilated Cardiomyopathy

“…RV strain derived from 2D STE detects subtle myocardial abnormalities and is only relatively angle- and load-independent [ 101 ]. STE could allow the reclassification from normal RV function (based on traditional parameters) to impaired RV function [ 102 ]. Moreover, RV strain has an important prognostic value in patients with HFrEF [ 103 , 104 ] and a better mortality prediction in HFrEF than conventional echocardiographic parameters, CMR-derived RVEF and CMR-derived RV strain [ 105 ].…”