The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases

Abstract

Right ventricular (RV) systolic function has an important role in the prediction of adverse outcomes, including mortality, in a wide range of cardiovascular (CV) conditions. Because of complex RV geometry and load dependency of the RV functional parameters, conventional echocardiographic parameters such as RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), have limited prognostic power in a large number of patients. RV longitudinal strain overcame the majority of these limitations, as it is angle-independent, less load-dependent, highly reproducible, and measure regional myocardial deformation. It has a high predictive value in patients with pulmonary hypertension, heart failure, congenital heart disease, ischemic heart disease, pulmonary embolism, cardiomyopathies, and valvular disease. It enables detection of subclinical RV damage even when conventional parameters of RV systolic function are in the normal range. Even though cardiac magnetic resonance-derived RV longitudinal strain showed excellent predictive value, echocardiography-derived RV strain remains the method of choice for evaluation of RV mechanics primarily due to high availability. Despite a constantly growing body of evidence that support RV longitudinal strain evaluation in the majority of CV patients, its assessment has not become the part of the routine echocardiographic examination in the majority of echocardiographic laboratories. The aim of this clinical review was to summarize the current data about the predictive value of RV longitudinal strain in patients with pulmonary hypertension, heart failure and valvular heart diseases.

Myocardial Deformation Parameters Assessed By CMR Feature Tracking In Chronic Heart Failure: The Influence of An Optimal Medical Therapy On Myocardial Remodeling

“…Interestingly, an improvement in RV GLS both in the overall cohort and in the HFrEF and HFpEF cohorts was observed on follow-up CMR examination. RV GLS has shown to be an independent predictor of major adverse cardiac events [9,10]. This effect was also independent of left ventricular volumetry and function [21].…”

“…Feature tracking strain analysis is well validated for many diseases and brings excellent inter-and intra-observer reliabilities. It is easy to perform and offers important prognostic data in various entities [7][8][9][10]. The strain analysis is in principle comparable to echo strain although not in absolute terms, which is why our investigation could be transferred to a certain extent to follow-up examinations using echocardiography [11].…”

Right Ventricular Dysfunction Predicts Outcome in Acute Heart Failure

“…RV longitudinal deformation obtained from the speckle-tracking technique has already been proven to be of prognostic importance despite load dependency ( 37 ) across a range of pathologies ( 38 ). RV strain proved to be a feasible and reproducible echocardiographic technique available in 83.5% of our cohort, all of whom were acutely unwell and breathless.…”

Right Ventricular Longitudinal Strain in Patients with Heart Failure

“…2D-STE allows a precise quantification of RV strain and an early detection of the subclinical RV dysfunction, providing comprehensive diagnostic and prognostic information in patients with a variety of cardiovascular diseases [ 16 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. RVLS is measured in the RV-focused apical four-chamber view, which provides better visualization of the whole right ventricle, and avoids foreshortening of the RV apex [ 22 ]. The frame rate is between 60 and 80 frames per second.…”

“…The conventional echocardiographic parameters of RV function recommended, such as RV fractional area change (RVFAC) [19], tricuspid annular plane systolic excursion (TAPSE) [20] and the systolic Diagnostics 2022, 12, 445 2 of 22 velocity of the tricuspid annulus (S') [21] have been verified for their utilities in patients with HF. Nevertheless, there exist limitations in evaluating RV function by conventional echocardiography parameters because of the complex geometry of right ventricle [22]. In recent years, myocardial strain measured by speckle tracking echocardiography (STE) has become an established echocardiographic parameter for the diagnosis and prognostic assessments of patients with cardiovascular diseases [23].…”