Prognostic Value of Right Ventricular Dysfunction in Heart Failure With Reduced Ejection Fraction

Abstract

Background-In heart failure (HF) with reduced ejection fraction, right ventricular (RV) impairment, as defined by reduced tricuspid annular plane systolic excursion, is a predictor of poor outcome. However, peak longitudinal strain of RV free wall (RVFWS) has been recently proposed as a more accurate and sensitive tool to evaluate RV function. Accordingly, we investigated whether RVFWS could help refine prognosis of patients with HF with reduced ejection fraction in whom tricuspid annular plane systolic excursion is still preserved. Methods and Results-A total of 200 patients with HF with reduced ejection fraction (age, 66±11 years; ejection fraction, 30±7%) with preserved tricuspid annular plane systolic excursion (>16 mm) underwent RV function assessment using speckle-tracking echocardiography to measure peak RVFWS.

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

“…The presence of RV dysfunction is unequivocally associated with worse outcomes. Carluccio et al investigated and followed up 200 patients with HFrEF but normal TAPSE [ 40 ]. RV free wall strain provided incremental prognostic value compared to the conventional measurement.…”

Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

“…RV-GLS showed a slightly greater prognostic power, probably due to the effect of systolic interventricular dependence, which greatly contributes to RV longitudinal shortening [30]. In addition, further studies have demonstrated the independent and incremental prognostic value of strain measures [32,33], even in patients who have undergone cardiac resynchronization therapy (CRT) [34], and in those with normal TAPSE [35]. These findings strengthen the clinical usefulness of these parameters in routine clinical practice.…”

Imaging and Patient Selection for Transcatheter Tricuspid Valve Interventions

“…Using 2D spackle tracking, the longitudinal strain can be derived in all RV segments. This measure correlates well with the RV ejection fraction by CMR (74) and has been validated in patients with various cardiovascular conditions (75,76) Recent studies have confirmed the high sensitivity of RV strain for the identification of RV dysfunction in the context of severe TR (77,78). The right ventricular change in pressure over time (dP/dT), as assessed by echocardiography has been proposed as a novel parameter reflecting RV contractility and correlates well with CMR RV ejection fraction (77)(78)(79).…”