Right ventricular strain in heart failure: Clinical perspective

Abstract

The number of studies demonstrating the importance of right ventricular remodelling in a wide range of cardiovascular diseases has increased in the past two decades. Speckle-tracking imaging provides new variables that give comprehensive information about right ventricular function and mechanics. In this review, we summarize current knowledge of right ventricular mechanics in heart failure with reduced ejection fraction and preserved ejection fraction. We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 2000 to December 2016 in the English language using the following keywords: "right ventricle"; "strain"; "speckle tracking"; "heart failure with reduced ejection fraction"; and "heart failure with preserved ejection fraction". Investigations showed that right ventricular dysfunction is associated with higher cardiovascular and overall mortality in patients with heart failure, irrespective of ejection fraction. The number of studies investigating right ventricular strain in patients with heart failure with reduced ejection fraction is constantly increasing, whereas data on right ventricular mechanics in patients with heart failure with preserved ejection fraction are limited. Given the high feasibility, accuracy and clinical implications of right ventricular strain in the population with heart failure, it is of great importance to try to include the evaluation of right ventricular strain as a regular part of each echocardiographic examination in patients with heart failure. However, further investigations are necessary to establish right ventricular strain as a standard variable for decision-making.

Morphologic and Functional Changes in Right‐Sided Cardiac Chambers in Patients With Chronic Liver Disease and Normal Pulmonary Artery Pressure

“…Our subgroup analysis showed that patients using beta blockers had reduced RV systolic contractility compared to patients not using them. This latter finding could be secondary to negative inotropic effects of beta blockers and can offer a mechanistic explanation for the harm associated with beta blockers in patients with severe CLD, since reduction of RV contractility is associated with adverse cardiovascular outcomes in other cardiovascular disorders such as congestive heart failure . However, it must be reminded that patients treated with beta blockers could have additional unaccounted‐for factors (such as the presence of portal hypertension or more severe CLD) that can affect RV contractility, and the clinical importance of reduced RV strain in patients with CLD is unclear.…”

“…This latter finding could be secondary to negative inotropic effects of beta blockers and can offer a mechanistic explanation for the harm associated with beta blockers in patients with severe CLD, since reduction of RV contractility is associated with adverse cardiovascular outcomes in other cardiovascular disorders such as congestive heart failure. 31 However, it must be reminded that patients treated with beta blockers could have additional unaccounted-for factors (such as the presence of portal hypertension or more severe CLD) that can affect RV contractility, and the clinical importance of reduced RV strain in patients with CLD is unclear. Neither the design nor the power of this study was adequate to make a detailed analysis of coexisting conditions or outcomes, so these findings must be regarded as hypothesis generating rather than definite.…”

Right ventricular strain

“…RVFWS is feasible in 88% to 94% of patients (24). The RVFWS's coefficients of variation for intraobserver and interobserver variability were 2-7% and 3-10%, respectively (24).…”

“…The 2015 guideline about cardiac chamber quantification reported RVFWS mean (SD) value as −29.0(4.5)% with abnormality threshold of > −20 (13). RVFWS is feasible in 88% to 94% of patients (24). The RVFWS's coefficients of variation for intraobserver and interobserver variability were 2-7% and 3-10%, respectively (24).…”

Multimodality Imaging of the Right Ventricle

“…It provides a sensitive and rapid measure of segmental, mechanical changes within the RV as well as global longitudinal RV function. 30 Evaluation of the RV is performed in a two-chamber view. Speckle tracking is an angle-independent method, which is based upon routine 2D images.…”