Reference values of right ventricular longitudinal strain by speckle tracking echocardiography in 219 healthy volunteers

Abstract

Purpose: Right ventricular longitudinal strain (RVLS) by speckle-tracking echocardiography (STE) predicts outcome in patients with acute myocardial infarction, heart failure, pulmonary arterial hypertension and in those implanted with left ventricular assistance devices. However, the lack of normative reference values has limited the adoption of RVLS in the clinical routine. We aimed to assess RVLS in normal subjects and its relationship with age, gender and other established parameters of RV function. Methods and results: RV function was assessed by conventional, STE and three-dimensional echocardiography (3DE) in 219 healthy volunteers (43±14 years, range 18-76; 57% women). Feasibility of RVLS analysis was 75%, while for TAPSE, fractional area change and 3DE ejection fraction it was 98%, 94% and 89% respectively. RVLS at free wall was significantly higher than global (i.e. including both free wall and interventricular septum) RVLS (-29±4% vs -24±3%, p<0.0001). No relationship between age and RV LS was found. RVLS was higher in women than in men (-26±3% vs -24±3% for global RVLS, and -32±5% vs -29.2±4.3% for free wall RVLS, p<0.0001 for both). Segmental values of RVLS for each gender are reported in Table. Global RVLS showed a weak correlation with RV ejection fraction and RV fractional area change (r=0.31 and r=0.39, respectively, p<0.0001). Of note, neither TAPSE, nor tricuspid annular systolic velocity were correlated with RV ejection fraction. View this table: Regional distribution of RV longitudinal Conclusion: This prospective study provides global and regional, gender-specific normative values for RVLS measured by STE in a relatively large cohort of healthy volunteers with a wide age range. These data might support the assessment of RV myocardial deformation in clinical setting.