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

Abstract

Several studies showed that right ventricular (RV) dysfunction is a powerful predictor in heart failure (HF). Advanced echocardiographic techniques such as speckle-tracking imaging and three-dimensional (3D) echocardiography proved to be accurate tools for RV assessment, but their clinical significance remains to be clarified. The aim of this study was to evaluate the role of two-dimensional (2D) RV strain and 3D ejection fraction (RVEF) in predicting adverse outcome in patients with non-ischemic dilated cardiomyopathy (DCM). We prospectively screened 81 patients with DCM and sinus rhythm, 50 of whom were enrolled and underwent comprehensive echocardiography, including RV strain and 3D RV volumetric assessment. Patients were followed for a composite endpoint of cardiac death, nonfatal cardiac arrest and acute worsening of HF requiring hospitalization. After a median follow-up of 16 months, 29 patients reached the primary endpoint. Patients with events had more impaired RV global longitudinal strain (− 10.5 ± 4.5% vs. − 14.3 ± 5.2%, p = 0.009), RV free wall longitudinal strain (− 12.9 ± 8.7% vs. − 17.5 ± 7.1%, p = 0.046) and 3D RVEF (38 ± 8% vs. 47 ± 9%, p = 0.001). By Cox proportional hazards multivariable analysis, RV global longitudinal strain and RVEF were independent predictors of outcome after adjustment for age and NYHA class. RVEF remained the only independent predictor of events after further correction for echocardiographic risk factors. By receiver-operating characteristic analysis, the optimal RVEF cut-off value for event prediction was 43.4% (area under the curve = 0.768, p = 0.001). Subjects with RVEF > 43.4% showed more favourable outcome compared to those with RVEF < 43.4% (log-rank test, p < 0.001). In conclusion, 3D RVEF is an independent predictor of major adverse cardiovascular events in patients with DCM.

Prognostic Significance of Feature-Tracking Right Ventricular Global Longitudinal Strain in Non-ischemic Dilated Cardiomyopathy

“…It's well-known that echocardiography is the first choice method to study systolic and diastolic function, due to his wide availability and reproducibility. Recent data suggested a possible link between RV-GLS measured with speckle tracking echocardiography and adverse outcome in NICM ( 23 , 24 ). However, it is also known that RV evaluation in echocardiography can suffer from limitations such as poor acoustic window and RV anatomical position ( 25 ).…”

Non-invasive right ventriculo-arterial coupling as a rehospitalization predictor in dilated cardiomyopathy: A comparison of five different methods

“…After tracing the endocardial surface of the RV at both end-systole and end-diastole, the software generated the RV stroke volume (SV), ejection fraction (RVEF), end--diastolic and end-systolic volume (ESV) (Figure 1). Interand intra-observer reproducibility for RV strain and RVEF in our laboratory has been recently published [5].…”

“…The prognostic role of right ventricular (RV) dysfunction in various cardiovascular diseases is well established [1][2][3]. While impaired RV performance is a recognized outcome predictor in left-sided heart disease [4,5], there is growing interest regarding the role of right ventriculo-vascular interplay in patients with heart failure (HF) [6,7]. RV-pulmonary artery coupling (RVPAC) characterizes the interaction between ventricular contractility and its afterload, thus allowing the evaluation of the RV and pulmonary circulation as an anatomically and functionally interconnected system [8].…”

Right Ventricular Longitudinal Strain in Patients with Heart Failure

“…The current findings of RV longitudinal strain in non-ischemic dilated cardiomyopathy are depicted in Table 5 . Vîjîiac et al [ 97 ] assessed the extent of RV dysfunction and assessed the ability of 2D-RVLS to predict the prognosis in 50 patients with NIDCM. 2D-RVGLS, 2D-RVFWLS and 3D-RVEF of patients with adverse cardiovascular events were obviously more impaired.…”