Abstract
Right ventricular (RV) systolic function represents an important independent predictor of adverse outcomes in many cardiovascular (CV) diseases. However, conventional parameters of RV systolic function (tricuspid annular plane excursion (TAPSE), RV myocardial performance index (MPI), and fractional area change (FAC)) are not always able to detect subtle changes in RV function. New evidence indicates a significantly higher predictive value of RV longitudinal strain (LS) over conventional parameters. RVLS showed higher sensitivity and specificity in the detection of RV dysfunction in the absence of RV dilatation, apparent wall motion abnormalities, and reduced global RV systolic function. Additionally, RVLS represents a significant and independent predictor of adverse outcomes in patients with dilated cardiomyopathy (CMP), hypertrophic CMP, arrhythmogenic RV CMP, and amyloidosis, but also in patients with connective tissue diseases and patients with coronary artery disease. Due to its availability, echocardiography remains the main imaging tool for RVLS assessment, but cardiac magnetic resonance (CMR) also represents an important additional imaging tool in RVLG assessment. The findings from the large studies support the routine evaluation of RVLS in the majority of CV patients, but this has still not been adopted in daily clinical practice. This clinical review aims to summarize the significance and predictive value of RVLS in patients with different types of cardiomyopathies, tissue connective diseases, and coronary artery disease.
Highlights
The assessment of right ventricular (RV) function may be challenging due to the anatomical shape and position of the RV
RV systolic function was proven to be an important independent predictor of adverse outcomes in a large number of cardiovascular (CV) diseases and new evidence indicated a higher predictive value of RV longitudinal strain (LS) over conventional parameters of RV systolic function (tricuspid annular plane excursion (TAPSE), systolic flow velocity across the lateral segment of tricuspid annulus obtained by tissue Doppler (s’), RV myocardial performance index (MPI), and fractional area change (FAC)) [2,3,4]
Similar results of the significant predictive value of RV free wall LS were found in patients with connective tissue diseases and patients with coronary artery disease [7,8]
Summary
The assessment of right ventricular (RV) function may be challenging due to the anatomical shape and position of the RV. RVLS was a significant and independent predictor of outcome (clinical worsening—hospitalizations and mortality) [2,3,4,5] This has recently been reported in patients with dilated cardiomyopathy (CMP), hypertrophic CMP, arrhythmogenic RV CMP and, amyloidosis [3,4,5,6]. Even though echocardiography remains the main imaging tool for RVLS assessment, cardiac magnetic resonance (CMR) became an important additional source of RVLG information in patients with different indications, primarily various CMPs [9,10,11]. These findings support the routine evaluation of RVLS in the majority of CV patients. This has not yet been adopted in the majority of echocardiographic and CMR laboratories
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