The Prognostic Value of Right Ventricle Strain In Patients With Heart Failure With Reduced Ejection Fraction (HFrEF)

Abstract

Background: RV dysfunction has been recognized as a powerful independent predictor of poor prognosis. Therefore, accurate evaluation of RV function is helpful for risk stratification in patients with HF, so as to guide clinicians to choose the best treatment and improve the prognosis of patients. Therefore, assessment of RV function is clinically important in almost all patients with heart disease. Objective: The main purpose of this study was to evaluate the prognostic value of right ventricular free wall longitudinal strain in patients with heart failure with reduced ejection fraction (HFrEF). Methods: We evaluated a prospective cohort of 126 patients with known or suspected HFrEF referred for echocardiographic evaluation. All underwent measurement of RV free-wall longitudinal strain (RVFWLS) by 2D transthoracic echocardiography. The primary study endpoint was the occurrence of death for any cause or hospitalization for heart failure. Results: From 126 eligible patients with chronic heart failure, 10 (8%) with RVFWLS not suitable for strain analysis were excluded, leaving a final study population of 116 patients. During the follow-up period of 24 months, 44 patients (38%) reached the composite end point: 18 patients died (15%), and 26 patients (22%) were hospitalized for worsening HF. Compared with patients without events, patients who reached the composite end point were older and prevalently men (P <0.05). Patients with events also showed higher LV volumes, lower LVEF%, increased left atrial volume index (LAVI), increased pulmonary artery systolic pressure, and higher prevalence of severe MR and TR than event-free patients. Diastolic RV diameter was also significantly greater in this group. In this study, we found that a RVFWLS less negative of -19.3% was associated to outcomes with 75% sensitivity and 67% specificity P < 0.001. A value of RVFWLS less than -19.3% was strongly associated to outcome with HR 1.9, 95% CI 1.487–2.7; P < 0.001. Conclusion: RV free wall longitudinal strain seems to be more sensitive and accurate for the diagnosis of RV systolic dysfunction in patients with HFrEF, therefore assessment of RV function should be implemented by analysis of RVFWLS in patients with HFrEF, to improve identification of patients who are at high risk for adverse events.