Abstract
Background: Evolvement in speckle-tracking echocardiography (STE) enable a detailed layer-specific analysis of the right ventricular (RV), which has shown to be a promising way of quantifying RV systolic function. We aimed to evaluate the usefulness layer-specific RV free wall strain (RVFWS) for predicting cardiovascular outcome in patients undergoing coronary artery bypass grafting (CABG). Methods: We studied 317 patients scheduled for CABG, with echocardiography prior to surgery. RV STE was performed to acquire endocardial, midmyocardial, and epicardial RVFWS. The endpoint was a composite of heart failure (HF) or cardiovascular death (CVD). Cox proportional hazards regression were used to assess the prognostic value. The multivariable adjustments included among other age, sex, hypertension and LVEF. Restricted cubic spline models were created to visualize the incidence rate for each RVFWS. Results: Of 317 patients, 30 (9.5%) reached the endpoint at a median follow-up of 3.5 years. The mean age was 67 years, 83% were men, and the mean LVEF was 50%. In univariable analyses all three layers were associated with a higher risk of the outcome (figure). All three layers remained independently associated with the outcome after multivariable adjustment (endo: HR 1.07 (1.01-1.13), mid: HR 1.06 (1.01-1.12), epi: HR 1.06 (1.01-1.11), per 1% absolute decrease). Reduced endo-RVFWS and mid-RVFWS posed a two-fold increased risk of developing HF and/or CV death as compared to those with preserved RVFWS (incidence rate of 3.7 (2.39-5.63) vs. 1.5 (0.76-2.82), events per 100 patient-years for reduced and preserved endo-RVFWS as well as reduced and preserved mid-RVFWS). Patients with reduced epi-RVFWS did not exhibit a higher risk of the outcome as compared to those with preserved epi-RVFWS. Conclusion: In patients undergoing CABG, RVFWS is a predictor of cardiovascular outcomes, and particularly reduced endocardial and midmyocardial RVFWS pose an increased risk of outcome.
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