Subclinical myocardial dysfunction that is characterized by impaired LV GLS is often present in patients with asymptomatic severe AS with preserved LVEF. Left ventricular global longitudinal strain further deteriorates over time and impaired LV GLS at baseline is associated with an increased risk for progression to the symptomatic stage and the need for aortic valve intervention.

The assessment of LA reservoir strain and PA-TDI on echocardiography after initial CHA2DS2-VASc scoring provides additional risk stratification for stroke and may be useful to guide decisions regarding anticoagulation for patients upon first diagnosis of AF.

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Background In patients with significant functional tricuspid regurgitation, timely detection of right ventricular (RV) dysfunction with conventional 2-dimensional echocardiography is challenging, whereas speckle-tracking echocardiography RV free wall longitudinal strain has been proposed as better prognosticator. We evaluated the prevalence and prognostic value of impaired RV free wall longitudinal strain in patients with significant functional tricuspid regurgitation, in comparison with tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). Methods Eight hundred ninety-six patients (51.3% men, 71 years [62–78 years]) with significant functional tricuspid regurgitation were divided according to the presence of RV dysfunction (defined as TAPSE <17 mm, FAC <35%, and RV free wall longitudinal strain >−23%) and were followed for the occurrence of all-cause mortality. Results RV free wall longitudinal strain identified the highest percentage of RV dysfunction (84.9%), in comparison to FAC (48.5%) and TAPSE (71.7%). During a median follow-up of 2.8 years (1.3–5.4 years), 443 (49.4%) patients died. Compared with survivors, nonsurvivors showed worse RV systolic dysfunction (FAC=36.5±12.7% versus 33.9±11.8%, P =0.001; TAPSE=15.4±5.0 versus 14.0±4.5 mm, P <0.001; RV free wall longitudinal strain=−15.9±7.5% versus −12.9±6.8%, P <0.001). Cumulative event-free survival was significantly worse in patients with decreased FAC, decreased TAPSE, and impaired RV free wall longitudinal strain. On multivariate analysis, RV free wall longitudinal strain was independently associated with all-cause mortality and incremental to FAC and TAPSE. Conclusions In significant tricuspid regurgitation, impaired RV free wall longitudinal strain identifies higher rates of RV dysfunction and is associated with worse outcome beyond conventional echocardiographic parameters of RV systolic function.

By identifying patients at increased risk of developing significant TR, close echocardiographic surveillance can be indicated permitting effective therapy at an earlier stage to improve survival.

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Aims Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure–strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease. Methods and results Non-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59–67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardiovascular disease to allow for comparison between groups. None of the conventional echocardiographic parameters of RV systolic function were significantly correlated with stroke volume or stroke volume index. In contrast, one of the novel indices derived non-invasively by pressure–strain loops, RVGCW, demonstrated a moderate correlation with invasively measured stroke volume and stroke volume index (r = 0.63, P = 0.002 and r = 0.59, P = 0.004, respectively). RVGWI, RVGCW, and RVGWE were significantly lower in patients with HFrEF compared to a healthy cohort, while values of RVGWW were significantly higher. Conclusion RVGCW is a novel parameter that provides an integrative analysis of RV systolic function and correlates more closely with invasively measured stroke volume and stroke volume index than other standard echocardiographic parameters.

The prevalence of impaired LV GLS despite preserved LVEF in pre-dialysis and dialysis patients is relatively high. Patients with preserved LVEF but impaired LV GLS have an increased risk of HF hospitalization and all-cause mortality.