Right Ventricular Longitudinal Strain Correlates Well With Right Ventricular Stroke Work Index in Patients With Advanced Heart Failure Referred for Heart Transplantation

doi:10.1016/j.cardfail.2011.12.002

Journal of Cardiac Failure

Volume 18, Issue 3, March 2012, Pages 208-215

https://doi.org/10.1016/j.cardfail.2011.12.002 Get rights and content

Abstract

Background

Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S′ and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation.

Methods and Results

Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S′ and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S′ with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = −0.75; r = −0.82; respectively; both P < .0001). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy (area under the receiver operating characteristic (ROC) curve 0.90) and good sensitivity and specificity of 92% and 86%, respectively, to predict depressed RVSWI using a cutoff value of less than −11.8%.

Conclusions

In a group of patients referred for heart transplantation, TAPSE and tricuspid S′ did not correlate with invasively obtained RVSWI. RV longitudinal deformation analysis by STE correlated well with RVSWI, providing a better estimation of RV systolic performance.

Section snippets

Study Population

Fifty-nine consecutive patients with advanced systolic HF, referred for cardiac transplant evaluation, were enrolled. All were in sinus rhythm and hemodynamically stable, without any episodes of acute decompensated state in the preceding month. They underwent simultaneous transthoracic echocardiographic imaging and right-side heart catheterization. Previous cardiac resynchronization therapy with defibrillator (CRT-D) was not an exclusion criteria. Patients were excluded if they had no sinus

Patient Characteristics

Of 59 patients screened, 41 patients (18 women, 23 men) met eligibility criteria during the study period. The admitting diagnoses were coronary artery disease (33 patients) and nonischemic cardiomiopathy (8 patients). All patients were classified as New York Heart Association functional class III–IV with LVEF ≤30%. Five were excluded for nonsinus rhythm, 3 for severe mitral valve disease, 9 for poor echocardiographic window, and 1 for difficulties in heart catheterization. Table 1 presents the

Discussion

In this study we analyzed for the first time the correlation between RVSWI and a novel speckle-tracking index, the RVLS, comparing it with other echocardiographic indices currently used in clinical practice to evaluate RV function in patients referred for cardiac transplantation. RVSWI is an invasive measurement of RV performance and plays a critical role in the prediction of right ventricular dysfunction that may occur after LVAD implantation.8, 9, 11, 12

Using simultaneous measured

Conclusion

In patients with refractory systolic HF referred for cardiac transplantation, TAPSE and TDI tricuspid S′ measurements are not useful indexes to evaluate RV systolic function; instead, the measurement of RVLS, especially free-wall RVLS, provides a better estimation of RVSWI and could be considered to be a promising noninvasive parameter to identify a depressed RV systolic function in this kind of patient.

Disclosures

None.

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clinical cohort study. Dogs diagnosed with American college of veterinary internal medicine (ACVIM) stage B2, C or D between April 2014 and March 2017 were enrolled. Long-term outcomes were assessed by telephone or from the medical record. The primary end-point was defined as cardiac-related death. Echocardiographic indices of RV function, including the RV Tei index, free wall and septal RV longitudinal strain, were obtained. Univariable and multivariable Cox proportional hazard analyses were used to identify variables predictive of cardiac-related death.
Twenty-four dogs died during the follow-up period. The median follow-up time was 482 days, and the median survival time for dogs with cardiac-related death was 230 days. For cardiac-related death, peak early diastolic mitral inflow velocity, ACVIM stage C or D, tricuspid regurgitation velocity, RV Tei index and RV end-diastolic area were predictors in univariable Cox proportional hazard analysis. In multivariable Cox proportional analysis adjusted for the left atrial to aorta ratio, peak early diastolic mitral inflow velocity and ACVIM stage, an increase in the Tei index by 0.1 increased the hazard ratio of cardiac-related death by 33% (95% confidence interval, 16–70%; P = 0.002).
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Right ventricular function after a first episode of pulmonary embolism: Contribution of longitudinal 2D strain
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L’analyse de la fonction ventriculaire droite au cours de la phase aiguë de l’embolie pulmonaire (EP) a été largement étudiée dans la littérature. Toutefois, l’étude des propriétés fonctionnelles ventriculaires droites à distance de cet épisode n’a été qu’exceptionnellement rapportée et ceci malgré l’importance de la morbi-mortalité de l’EP.
Évaluer la fonction ventriculaire droite après un premier épisode d’EP.
Dans notre étude, nous avons comparé les paramètres échocardiographiques de la fonction ventriculaire droite (VD) chez 25 patients ayant eu un premier épisode d’EP non grave datant de plus de 6 mois avec ceux de 25 sujets témoins sains.
Dans l’étude de la fonction VD, nous avons noté que les valeurs moyennes des paramètres standards étaient significativement plus basses dans le groupe EP par rapport au groupe témoin mais leurs valeurs sont restées dans les limites de la normale. La valeur moyenne du strain global VD était significativement plus basse chez les patients par rapport aux témoins (−21 ± 4,8 vs −25 ± 2,4 % ; p < 0,01). Le strain longitudinal de la paroi libre du VD était altéré chez le groupe EP, Cependant il n’y avait pas de différence significative entre le groupe EP et le groupe témoins (−19,4 ± 16 vs −24 ± 17 % ; p = 0,28).
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Analysis of right ventricular (RV) function during the acute phase of pulmonary embolism (PE) was widely reported in the literature. However, few studies analysed its function long term after the acute phase. Our aim was to evaluate the RV function long term after a first episode of PE.
In this study, we compared echocardiographic parameters of right ventricular function in 25 patients with a first episode of non-severe PE for more than six months with 25 healthy controls subject.
In the study of RV function, we noted that the mean values of the standard parameters were significantly lower in the EP group compared to the control group but their values remained within the normal range. The global RV longitudinal strain had a mean value lower than the control group statistically significant (−21 ± 4,8% vs. −25 ± 2,4%; P = 0,28). The longitudinal strain of the free wall of the RV was altered in the EP group, however, there was no significant difference between the EP group and the control group (−19,4 ± 16% vs. −24 ± 17%; P = 0,28).
This study has shown that there is a systolic dysfunction late after a first episode of PE and this despite the absence of the symptoms and pulmonary hypertension.
Superior Prognostic Value of Right Ventricular Free Wall Compared to Global Longitudinal Strain in Patients With Heart Failure
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Global right ventricular (RV) longitudinal strain (RVGLS) and free wall RV longitudinal strain (RVFWS) have both been advocated as sensitive tools to evaluate RV function and predict prognosis in patients with heart failure and reduced ejection fraction (HFrEF). However, because the interventricular septum is an integral part of the left ventricle (LV) also, RVGLS might be influenced by LV dysfunction. Thus, we compared the prognostic performance of either RV strain parameter in HFrEF patients, also taking into account the degree of LV systolic dysfunction.
In 288 prospectively enrolled outpatients with stable HFrEF, RVGLS and RVFWS were assessed by speckle-tracking and LV systolic function by global longitudinal strain and LV ejection fraction. Patients were followed up for 30.2 ± 23.0 months; the primary endpoint was all-cause death/heart failure-related hospitalization. Prognostic performance was assessed by C-statistic and net reclassification improvement.
There were 95 events during follow-up. By univariable analysis, both RVGLS (hazard ratio × 1 SD, 1.60; 95% CI, 1.29-1.99; P < .0001) and RVFWS (hazard ratio × 1 SD, 1.82; 95% CI, 1.45-2.29; P < .0001) were associated with outcome, and both remained significant after correction for EMPHASIS risk score, New York Heart Association class, natriuretic peptides, and therapy. However, after further correction for LV systolic function parameters, only RVFWS remained significantly associated with outcome (P < .01). A basic prediction model was improved by adding RVFWS (net reclassification improvement 0.390; P < .05), but not RVGLS.
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Comparison Between Four-Chamber and Right Ventricular–Focused Views for the Quantitative Evaluation of Right Ventricular Size and Function
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Citation Excerpt :
FWLS has the additional advantage of being angle and overall heart motion independent compared with other traditional parameters of RV longitudinal motion, such as TAPSE or S′-wave velocity.20,22 Moreover, FWLS has shown added diagnostic and prognostic value in myocardial infarction,23 heart failure,24-27 patients with left ventricular assist devices,28,29 pulmonary hypertension,30-33 and cardiac amyloidosis.34 Although normal ranges for RV strain have been recently published, the heterogeneity of data acquisition in these studies hampers the applicability of these normal ranges in clinical practice.13,21,35
Right ventricular (RV) function plays a pivotal prognostic role in multiple cardiac diseases. Echocardiography guidelines recommend that RV quantification be performed in the RV-focused view, which is theoretically more reproducible than the four-chamber (4Ch) view. However, differences between views in RV size and function measurements have never been systematically studied. Accordingly, the aim of this study was to compare (1) RV size and function parameters obtained from the RV-focused and 4Ch views and (2) test-retest variability between these two views.
Fifty patients (26 men; mean age, 63 ± 18 years) undergoing clinically indicated transthoracic echocardiography were prospectively enrolled. Each patient underwent three repeated acquisitions of the 4Ch and RV-focused views by two sonographers. The first operator performed two acquisitions at the beginning and the end of the clinical transthoracic echocardiographic study, and the second operator performed the third acquisition afterward. RV size and function measurements were obtained from the two views and compared using paired t-test analysis and Bland-Altman analysis. Intra- and interoperator test-retest and intra- and interreader variability for both views were assessed using intraclass correlations and coefficients of variation.
All RV size parameters were significantly larger when measured in the RV-focused view compared with the 4Ch view. Also, all RV function parameters, including RV free wall and global longitudinal strain, were larger in magnitude when measured in the RV-focused view. Measurements variability was consistently better for the RV-focused view.
RV size and function measurements obtained from the RV-focused and 4Ch views are not interchangeable. RV size and function parameters measured from the RV-focused view are more reproducible than from 4Ch acquisitions. Therefore, only the RV-focused view should be used for quantitative assessment of the right ventricle.
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Clinical InvestigationRight Ventricular Longitudinal Strain Correlates Well With Right Ventricular Stroke Work Index in Patients With Advanced Heart Failure Referred for Heart Transplantation

Abstract

Background

Methods and Results

Conclusions

Section snippets

Study Population

Patient Characteristics

Discussion

Conclusion

Disclosures

J Am Coll Cardiol

J Am Coll Cardiol

Int J Cardiol

J Heart Lung Transplant

J Heart Lung Transplant

J Am Coll Cardiol

Ann Thorac Surg

J Am Soc Echocardiogr

J Heart Lung Transplant

Heart Fail Clin

J Am Soc Echocardiog

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiog

Am J Cardiol

Clinical Investigation
Right Ventricular Longitudinal Strain Correlates Well With Right Ventricular Stroke Work Index in Patients With Advanced Heart Failure Referred for Heart Transplantation