ISSN 2996-8215
International Journal of Cardiology | Vol. 16, No. 7, July 2025 | pp. 49–56
DOI: 10.46882/2025/IJC/000195
Original Research Article
Long-Term Diagnostic Efficacy of Two-Dimensional Speckle-Tracking derived RV Free-Wall Longitudinal Strain in Stable CHF
Alexei Volkov¹, Elena Sokolova¹, Nikolai Petrov²
¹Department of Cardiology, Almazov National Medical Research Centre, St. Petersburg, Russia
²Division of Cardiovascular Imaging, Research Institute of Cardiology, Tomsk, Russia
Abstract:
Right ventricular (RV) failure is a critical determinant of survival in patients with chronic heart failure (CHF). While conventional echocardiographic metrics like tricuspid annular plane systolic excursion (TAPSE) are widely used, they are limited by angle dependency and localized regional tracking. Two-dimensional speckle-tracking derived RV free-wall longitudinal strain (RV-FWS) offers a more sensitive method to quantify global RV myocardial function. This study evaluated the long-term prognostic value of baseline RV-FWS in patients with stable chronic heart failure. We prospectively followed 185 stable CHF patients with an LVEF less than 40%. Standard echocardiography and off-line speckle-tracking analyses were performed at enrollment to measure TAPSE, RV fractional area change (FAC), and RV-FWS. The primary endpoint was a composite of cardiovascular mortality or heart failure hospitalization over a 3-year follow-up period. During a median follow-up of 32 months, 54 patients (29.2%) reached the primary endpoint. Impaired RV-FWS (defined as an absolute value less than 16%) was strongly associated with a higher event rate. Kaplan-Meier analysis showed significantly reduced event-free survival in patients with impaired strain (log-rank p < 0.001). After adjusting for age, NYHA class, LVEF, and NT-proBNP levels, multivariable Cox regression confirmed that impaired RV-FWS remained an independent predictor of adverse outcomes (hazard ratio: 1.15 per 1% absolute reduction, 95% CI: 1.06–1.25, p = 0.001). Right ventricular free-wall longitudinal strain is a powerful independent predictor of long-term cardiovascular mortality and heart failure hospitalization.
Keywords: Chronic heart failure, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Cardiovascular mortality, Heart failure hospitalization
Received: April 05, 2025; Revised: May 18, 2025; Accepted: June 10, 2025; Published: July 24, 2025