Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure

Abstract

Background:Normal values and the prognostic significance of right ventricle (RV)-2D strain in chronic heart failure (CHF) patients are unknown. Methods and Results:Between 2005 and 2010, we prospectively enrolled 43 controls and 118 stable CHF patients. Standard echocardiographic variables, tricuspid annular plane systolic excursion, peak systolic velocity of tricuspid annular motion using tissue Doppler imaging, and RV and left ventricle (LV) 2D-strain were measured. The primary outcome was death or emergency transplantation or emergency ventricular assist device implantation or acute heart failure. RV-2D strain was measurable in 39 controls (58±17 years, 50% men), whose median value was −30% (95% confidence interval [95%CI], −39%; −20%); and in 104 CHF patients (80% men, mean age 57±11 years, and mean LV ejection fraction 29%±8%), whose median value was −19% (95%CI, −34%; −9%). During the mean follow-up of 37±14 months, 44 experienced the primary outcome. By Cox proportional hazards multivariate analysis, only RV-2D strain and log B-type natriuretic peptide independently predicted experiencing the primary outcome within the first year. The best RV-2D strain cut-off by receiver-operating characteristics analysis was −21%, and patients with values >−21% were at greatest risk ( χ2 -log-rank test=14.1, P<0.0001).Conclusions: RV-2D strain is a strong independent predictor of severe adverse events in patients with CHF and may be superior to other systolic RV or LV echocardiographic variables. (Circ J 2012; 76: 127 - 136)

Echocardiographic Evaluation of the Right Ventricle: a 2014 Perspective

“…Tissue Doppler and speckle tracking strain parameters have been shown to be superior to conventional echo parameters in identifying ARVC [31]. In several conditions such as heart failure [32], pulmonary hypertension, acute myocardial infarction [4], and amyloidosis [33], peak global longitudinal RV strain has prognostic value. In a recent prospective study of 575 patients, RV strain was prognostic in pulmonary arterial hypertension and correlated well with several clinical measures such as WHO functional class, right-sided heart failure, 6-min walk test, and NT-proBNP.…”

Right Ventricular Reverse Remodeling, but not Subjective Clinical Amelioration, Predicts Long-Term Outcome After Surgery for Isolated Severe Tricuspid Regurgitation

“…Speckle tracking-based RV strain assessment might be helpful for the assessment of RV systolic function, which should be evaluated in a future study. 24 Finally, our results cannot be extrapolated to structural tricuspid valve disease. 25 …”

Prognostic significance of the right ventricular function in patients with CHF

“…Работы последних лет показали, что оцен-ка диастолической функции ЛЖ может проводиться с помощью различных показателей как на основе анали-за транстрикуспидальных потоков и распространения их в полости ПЖ, так и движения стенок ПЖ [10,11]. Показано, что они могут иметь различное клиническое значение в выявлении нарушений наполнения ПЖ [12], однако их относительное прогностическое значение пока мало изучено. Имеет значение и тот факт, что суще-ствующие прогностические модели могут зависеть в том числе от региональных и национальных особенностей.…”