ISSN 2996-8215
International Journal of Cardiology | Vol. 3, No. 7, July 2012 | pp. 49–56
DOI: 10.46882/2012/IJC/000040
Original Research Article
Prognostic Value of Right Ventricular Longitudinal Strain in Patients with Chronic Heart Failure
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 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). Conversely, TAPSE and FAC did not retain independent significance in the fully adjusted multivariable model. Right ventricular free-wall longitudinal strain is a powerful independent predictor of long-term cardiovascular mortality and heart failure hospitalization in stable CHF patients, outperforming conventional RV metrics.
Keywords: Chronic heart failure, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis, Cardiovascular mortality
Received: April 05, 2012; Revised: May 18, 2012; Accepted: June 10, 2012; Published: July 24, 2012
Citation: International Journal of Cardiology, 2012, Vol. 3, No. 7, pp. 49–56, DOI: 10.46882/2012/IJC/000040