ISSN 2996-8215
International Journal of Cardiology | Vol. 6, No. 10, October 2015 | pp. 73–80
DOI: 10.46882/2015/IJC/000079
Original Research Article
Predicting Prognosis in Dilated Cardiomyopathy Using Right Ventricular Strain
Vasily Smirnov¹, Elena Kuzmina², Dmitry Ivanov¹
¹Department of Cardiology, Almazov National Medical Research Centre, St. Petersburg, Russia
²Division of Cardiovascular Imaging, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
Abstract:
While left ventricular dimensions and ejection fractions are traditionally prioritized in dilated cardiomyopathy (DCM), right ventricular (RV) performance independently impacts mortality. This prospective study evaluated the long-term prognostic utility of right ventricular global longitudinal strain (RV-GLS) measured via two-dimensional speckle-tracking echocardiography in adult patients with DCM. We followed 185 stable DCM patients with a resting left ventricular ejection fraction (LVEF) less than 40%. Standard echocardiography quantified right ventricular fractional area change (FAC), and off-line deformation analysis measured baseline absolute RV-GLS. The primary endpoint was a composite of cardiac mortality, urgent heart transplantation, or heart failure hospitalization over a 3-year follow-up period. Over a median follow-up of 34 months, 54 patients (29.2%) reached the primary composite endpoint. An impaired absolute baseline RV-GLS (defined as less than 15.5%) was strongly associated with a higher rate of clinical events. Kaplan-Meier survival curves confirmed a significantly lower event-free survival rate in the low absolute RV-GLS cohort (log-rank p < 0.001). After adjusting for age, NYHA functional class, baseline LVEF, and serum NT-proBNP levels, multivariable Cox proportional hazards regression confirmed that an absolute RV-GLS less than 15.5% remained a potent independent predictor of long-term clinical worsening (hazard ratio: 2.14, 95% CI: 1.28–3.55, p = 0.003). Right ventricular global longitudinal strain serves as a powerful independent predictor of long-term clinical worsening in dilated cardiomyopathy, outperforming standard volumetric metrics.
Keywords: Dilated cardiomyopathy, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Heart failure worsening
Received: July 12, 2015; Revised: August 25, 2015; Accepted: September 10, 2015; Published: October 22, 2015