The prognostic value of right ventricular longitudinal strain and 3D ejection fraction in patients with dilated cardiomyopathy

Several studies showed that right ventricular (RV) dysfunction is a powerful predictor in heart failure (HF). Advanced echocardiographic techniques such as speckle-tracking imaging and three-dimensional (3D) echocardiography proved to be accurate tools for RV assessment, but their clinical significance remains to be clarified. The aim of this study was to evaluate the role of two-dimensional (2D) RV strain and 3D ejection fraction (RVEF) in predicting adverse outcome in patients with non-ischemic dilated cardiomyopathy (DCM). We prospectively screened 81 patients with DCM and sinus rhythm, 50 of whom were enrolled and underwent comprehensive echocardiography, including RV strain and 3D RV volumetric assessment. Patients were followed for a composite endpoint of cardiac death, nonfatal cardiac arrest and acute worsening of HF requiring hospitalization. After a median follow-up of 16 months, 29 patients reached the primary endpoint. Patients with events had more impaired RV global longitudinal strain (− 10.5 ± 4.5% vs. − 14.3 ± 5.2%, p = 0.009), RV free wall longitudinal strain (− 12.9 ± 8.7% vs. − 17.5 ± 7.1%, p = 0.046) and 3D RVEF (38 ± 8% vs. 47 ± 9%, p = 0.001). By Cox proportional hazards multivariable analysis, RV global longitudinal strain and RVEF were independent predictors of outcome after adjustment for age and NYHA class. RVEF remained the only independent predictor of events after further correction for echocardiographic risk factors. By receiver-operating characteristic analysis, the optimal RVEF cut-off value for event prediction was 43.4% (area under the curve = 0.768, p = 0.001). Subjects with RVEF > 43.4% showed more favourable outcome compared to those with RVEF < 43.4% (log-rank test, p < 0.001). In conclusion, 3D RVEF is an independent predictor of major adverse cardiovascular events in patients with DCM.

Prognostic Value of Right Ventricular Function Assessed by Echocardiography in Patients Presenting With a First Acute ST Elevation Myocardial Infarction Treated By Primary PCI

AIMS

Informations regarding the prognostic value of right ventricular function changes in the setting of a first acute ST elevation myocardial infarction irrespective of the site of the necrosis and of the left ventricular systolic function are scarce. Purpose of the study was to assess the relation between parameters reflecting global and systolic right ventricular function assessed by conventional, speckle tracking and three-dimensional echocardiography and in hospital major cardiac events (MACE).

MATERIALS AND METHODS

We have prospectively analyzed a cohort of 44 consecutive patients (mean age 62,71 years, 70.5 % males) presenting with a first STEMI (2,3 % Topol 1, 38 ,6 % Topol 2, 20,6 % Topol 3, 31,8 % Topol 4, 6,8 % Topol5) treated by primary angioplasty. Patients with previous history of cardiac or pulmonary diseases were excluded. All patients underwent during hospitalization conventional 2D echocardiography and special techniques ( 2D speckle tracking echocardiography and also 3D echocardiography) RV global function was quantified by RV myocardial performance index (RV MPI) determined by PW Doppler ,whereas RV systolic function was studied using regional parameters like TAPSE , pulsed Doppler S wave and RV free wall 2D strain and global parameters like RV fractional area change (RV FAC) or RV ejection fraction ( RVEF) determined by 3D echocardiography . LV systolic function was described by LV ejection fraction (LVEF). The combined endpoint of major adverse cardiovascular events (MACE) was defined by all cause mortality, reinfarction, need for revascularization and occurrence of heart failure during hospitalization. The association between MACE and RV functional parameters was assessed by bivariate correlation analysis followed by binary logistic regression.

RESULTS

Initially, regardless of the site of necrosis, the only RV functional parameter correlated with MACE was RV MPI (OR 9.17; 95% CI: 1.03 -83.7). After adjustment for LVEF all RV functional parameters were correlated with MACE: TAPSE (OR: 1.83; 95% CI : 0.41- 8.23), RV MPI (OR: 8.07; 95% CI : 0.9- 72.07), RVFAC (OR: 1.22; 95% CI : 0.25- 5.98) , RV free wall strain (OR : 1.04; 95% CI : 0.21- 5.08) , S wave (OR: 2.46 ; 95% CI : 0.14- 42.82), RVEF (OR: 0.83 ; 95% CI : 0.20- 3.43).

CONCLUSIONS

Our study reveals that RV functional parameters are predictive for in hospital MACE beyond LV systolic function and regardless of the culprit coronary artery. Among these parameters, RV MPI seems to have the greatest predictive value for short term MACE in STEMI patients.