Right Ventricular Longitudinal Strain Measures Independently Predict Chronic Heart Failure Mortality

Abstract

The assessment of right ventricular (RV) function still remains a challenge. Two-dimensional (2D) speckle tracking has recently been proposed to evaluate right ventricular function by analyzing myocardial deformation. The aim of this study was to evaluate the role of 2D systolic strain measures of RV in predicting mortality in patients with chronic heart failure (HF). We enrolled 332 outpatients in a stable clinical condition and in conventional therapy. A right ventricular-focused four-chamber view was analyzed by 2D speckle tracking to evaluate the global longitudinal strain of RV (RV-GLS) and the strain of RV free wall (RV-fwLS). During a mean follow-up of 36 AE 26 months, 64 patients died. Both RV-GLS and RV-fwLS were associated with all-cause mortality in univariate (HR: 1.16; 95% CI: 1.10-1.23; P < 0.001; C-index: 0.72; and HR: 1.10; 95% CI: 1.06-1.15; P < 0.001; C-index: 0.68, respectively) as well as multivariate analysis (HR: 1.13; 95% CI: 1.05-1.21; P:0.001; C-index: 0.85; and HR: 1.07; 95% CI: 1.02-1.12; P:0.004; C-index: 0.84, respectively). In conclusion, our findings demonstrate the role of RV 2D strain measures to independently predict mortality. These data highlight the clinical usefulness of this echocardiographic approach in the daily management of HF outpatients. (Echocardiography 2016;33:992-1000)

Right Ventricular Function in Heart Failure

“…Previous studies have demonstrated the superior prognostic use of RVFWS compared with TAPSE and other conventional echocardiographic parameters in patients with pulmonary arterial hypertension and other causes of HF. 7,8 The current study by Carluccio et al 4 in HF with reduced ejection fraction (HFrEF) patients with preserved TAPSE adds to this body of evidence, demonstrating RVFWS to be a more discriminating prognostic tool than other echocardiographic measures of RV function in HF patients.…”

More than 10 years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice?

“…64 Furthermore, RV-GLS showed prognostic relevance when used together with standard indexes of LV function. 65,66 In HF with preserved EF (HFpEF), LV-GLS is able to predict hospital admission rate, cardiovascular mortality, and cardiac arrest, independently from the other clinical predictors. 67 At 3-…”

Right heart imaging in patients with heart failure

“…Primarily developed in the LV, several studies have explored the value of longitudinal shortening of the RV-free wall in patients with advanced HF referred for heart transplant (23) and outpatients with HF (26). The software used for speckle tracking have mainly been developed for the LV.…”