Abstract
Abstract Background: Right ventricular (RV) dysfunction is a well-known predictor of mortality in patients with valvular heart disease (VHD). The assessment of RV function is often difficult due to complex geometry and hemodynamic factors. We aim to analyze RV function in patients with severe mitral and/or aortic valve disease using two-dimensional strain (2DS) imaging and conventional echocardiographic parameters, comparing it with right ventricular ejection fraction (RVEF) measured by three-dimensional echocardiography (3DE). Methods: Fifty-three patients with severe mitral and/or aortic VHD underwent complete transthoracic echocardiogram in the preoperative setting for cardiac surgery, including conventional echocardiographic parameters of RV function and speckle-tracking derived 2DS indices: RV global longitudinal strain (RVGS) and RV free wall longitudinal strain (RVFWS). Conventional echocardiographic and 2DS parameters were compared with real-time 3DE RVEF using Spearman correlation test. For comparison between two groups of patients based on the presence of RV dysfunction (normal RVEF ≥ 44% - A, abnormal RVEF < 44% - B), we used nonparametric Mann-Whitney U test. ROC (receiver operating characteristic) curve analysis was used to assess the clinical utility of all RV function variables in defining RV dysfunction. P values <0,05 were considered statistically significant. Results: We found a significant correlation between all parameters and RVEF (p<0.05), with best results for RV fractional area change (FAC), RVGS, and RVFWS. Dividing the population into two-groups based on RVEF, we found 14 patients with RV dysfunction (27.4%), and significant differences between the groups for all RV function variables. For detection of RV dysfunction defined by 3DE, ROC curve analysis showed the best area under the curve (AUC) for RVGS (0.872), RVFWS (0.851) and FAC (0.932). Conclusions: We observed significant correlation between RVGS, RVFWS and RVEF, with good accuracy in detecting RV dysfunction, comparable to FAC and better than other conventional parameters of RV function assessment. The evaluation of RV myocardial deformation with 2DS may have additional diagnostic and prognostic value in patients with severe left-sided VHD. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0).
Highlights
Left ventricular (LV) ejection fraction (EF) was calculated using the biplane method of discs, and all the Doppler parameters necessary to quantitate the severity of valvular lesions and pulmonary artery systolic pressure (PASP) were obtained and analyzed in accordance with the criteria defined on the EAE/ASE/ EACVI guidelines.[19,20]
Two had severe tricuspid regurgitation (TR) and other two refused to participate, the final study group was comprised of 53 patients (31 women; mean age, 52,4 ± 15,9 years)
Most patients were in sinus rhythm; 14 patients (26.4%) with permanent atrial fibrillation (AF) were not excluded because we were able to analyze all echocardiographic parameters despite the presence of arrhythmia
Summary
In the last few years, studies have shown the applicability and clinical value of three-dimensional echocardiography (3DE) and two-dimensional strain (2DS) techniques in the evaluation of RV systolic function, with good accuracy for detecting RV dysfunction, and additional prognostic value in various diseases.[8] Speckletracking echocardiography (STE) derived techniques, specially 2DS, allows myocardial deformation analysis, is less dependent on angle and loading conditions, with great potential for RV evaluation (considering the complex geometry of the RV and great exposure to load changes), and has been shown to be a very sensitive technique, allowing early detection of subclinical RV involvement in a great variety of diseases.[9,10,11,12] Real-time 3DE is a well-established echocardiographic technique that has the great advantage of displaying the entire right ventricle in a single dataset, despite its irregular shape. The assessment of RV function is often difficult due to complex geometry and hemodynamic factors
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