Prognostic Value of Right Ventricular Strains Using Novel Three-Dimensional Analytical Software in Patients With Cardiac Disease

Abstract

BackgroundRight ventricular (RV) three-dimensional (3D) strains can be measured using novel 3D RV analytical software (ReVISION). Our objective was to investigate the prognostic value of RV 3D strains.MethodsWe retrospectively selected patients who underwent both 3D echocardiography (3DE) and cardiac magnetic resonance from January 2014 to October 2020. 3DE datasets were analyzed with 3D speckle tracking software and the ReVISION software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, or ventricular tachyarrhythmia.Results341 patients were included in this analysis. During a median of 20 months of follow-up, 49 patients reached a composite of cardiac events. In univariate analysis, 3D RV ejection fraction (RVEF) and three 3D strain values [RV global circumferential strain (3D RVGCS), RV global longitudinal strain (3D RVGLS), and RV global area strain (3D RVGAS)] were significantly associated with cardiac death, ventricular tachyarrhythmia, or heart failure hospitalization (Hazard ratio: 0.88 to 0.93, p < 0.05). Multivariate analysis revealed that 3D RVEF, three 3D strain values were significantly associated with cardiac events after adjusting for age, chronic kidney disease, and left ventricular systolic/diastolic parameters. Kaplan-Meier survival curves showed that 3D RVEF of 45% and median values of 3D RVGCS, 3D RVGLS, and 3D RVGAS stratified a higher risk for survival rates. Classification and regression tree analysis, including 22 clinical and echocardiographic parameters, selected 3D RVEF (cut-off value: 34.5%) first, followed by diastolic blood pressure (cut-off value: 53 mmHg) and 3D RVGAS (cut-off value: 32.4%) for stratifying two high-risk group, one intermediate-risk group, and one low-risk group.ConclusionsRV 3D strain had an equivalent prognostic value compared with 3D RVEF. Combining these parameters with 3D RVEF may allow more detailed stratification of patient's prognosis in a wide array of cardiac diseases.

Superior prognostic value of three-dimensional echocardiography-derived right ventricular ejection fraction: a meta-analysis

“…The mean (±SD) age of the patient population was 63±15 years, 46% were females, and the follow-up duration ranged from 3 to 44 months. Three studies included patients with pulmonary hypertension exclusively (14, 16, 20), one included patients with COVID-19 only (23), one included patients with dilated cardiomyopathy only (22), one included patients with aortic stenosis only (18), one included heart failure patients with preserved left ventricular (LV) EF (HFpEF) only (19), and the remaining three studies included populations with a mixture of cardiovascular diseases (12, 17, 21).…”

“…In three instances (including 3-3 studies), there was an apparent overlap between the patient cohorts; 9,13-17 therefore, studies with a higher number of participants were included. 13,15,17 Overall, ten 13,15,[17][18][19][20][21][22][23][24] independent studies were included in the final quantitative analysis (Figure 1), which reported the impact of unit change of RVEF and TAPSE (n=8), 13,16,18,[20][21][22][23][24] or FAC (n=7), 13,[19][20][21][22][23][24] or FWLS (n=7), 17,[19][20][21][22][23][24] on clinical outcomes (all-cause mortality and/or cardiopulmonary adverse events) as HRs. Four studies were prospective, while six were retrospective.…”

“…Three studies included patients with pulmonary hypertension exclusively, 15,17,21 one included patients with COVID-19 only, 24 one included patients with dilated cardiomyopathy only, 23 one included patients with aortic stenosis only, 19 one included heart failure patients with preserved left ventricular (LV) EF (HFpEF) only, 20 and the remaining three studies included populations with a mixture of cardiovascular diseases. 13,18,22 Outcomes Table 1 contains the definitions of endpoints assessed in each included study. Among the 1928 patients, 394 (20.4%) reached the endpoint of all-cause mortality and/or adverse cardiopulmonary events.…”

“…In three instances (including 3-3 studies), there was an apparent overlap between the patient cohorts (8,(12)(13)(14)(15)(16); therefore, studies with a higher number of participants were included (12,14,16). Overall, ten (12,14,(16)(17)(18)(19)(20)(21)(22)(23) independent studies were included in the final quantitative analysis (Figure 1), which reported the impact of unit change of RVEF and TAPSE [n=8] (12,15,17,(19)(20)(21)(22)(23), or FAC…”

There is more than just longitudinal strain: Prognostic significance of biventricular circumferential mechanics

“…Longitudinal strain (LS) of the left (LV) and right ventricles (RV) is a well-established biomarker of ventricular dysfunction, having a robust predictive power to future adverse outcomes in numerous cardiac diseases ( 1 , 2 ). In contrast to ejection fraction (EF), a global measure of pump function, LS enables the quantification of ventricular deformation along their long axis.…”