Right ventricular strain: A powerful prognostic indicator

Abstract

Introduction

Right ventricular (RV) characteristics are important for heart failure patients and especially in patients with a tricuspid regurgitation. Right heart catheterisation is advocated by guidelines as an adjunct assessment. Echocardiography alone is challenging due to complexity of the right heart. Speckle tracking allows the detection of subtle changes that may be missed by the naked eye. We sought to assess the utility of RV strain (free wall) to assess prognosis and build a multivariate prediction model based on clinical, echocardiographic and hemodynamic data.

Method

A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ± 11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. The echocardiograms were read at the corelab. The association between RV strain (free wall) and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death was recorded. A multivariate predictor model was computed using SAS 15.1.

Results

Over a median follow-up of 28 ± 16 months, there were 59 events. Main data are summarized in Table 1. Abnormal RV strain was independently associated with prognosis HR: 3.63 (1.43–9.22). This was the key echo parameter. The other key parameters were: creatinine clearance HR: 0.88 (0.79–0.98), TAPSE HR: 0.73 (0.57–0.93), RA area HR: 1.44 (1.19–1.75), RA pressure HR: 1.65 (1.34–2.04) and mean pulmonary artery pressure HR: 1.39 (1.08–1.78).

Conclusion

RV strain is a strong “predictor” and appears to perform better than traditional echocardiographic measurements. Prospective studies would support the utility of RV strain especially in patients with heart failure and tricuspid regurgitation.