ISSN 2996-8215
International Journal of Cardiology | Vol. 12, No. 7, July 2021 | pp. 49–56
DOI: 10.46882/2021/IJC/000148
Original Research Article
Two-Dimensional Right Ventricular Global Longitudinal Strain and Long-Term Survival in Dilated Cardiomyopathy Patients
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 parameters are traditionally prioritized in dilated cardiomyopathy (DCM), right ventricular (RV) function also independently impacts outcomes. This prospective study evaluated the long-term prognostic utility of right ventricular global longitudinal strain (RV-GLS) measured via 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 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, 52 patients (28.1%) reached the primary endpoint. An impaired absolute baseline RV-GLS (defined as less than 15.5%) was strongly associated with a higher event rate. Kaplan-Meier analysis confirmed a significantly lower event-free survival rate in the low RV-GLS group (log-rank p < 0.001). After adjusting for age, NYHA class, LVEF, and NT-proBNP levels, multivariable Cox proportional hazards regression confirmed that an absolute RV-GLS less than 15.5% remained an independent predictor of the composite clinical endpoint (hazard ratio: 2.12, 95% CI: 1.28–3.52, p = 0.003). Conventional RV FAC did not retain independent predictive value in the fully adjusted model. Right ventricular global longitudinal strain is 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
Received: April 02, 2021; Revised: May 15, 2021; Accepted: June 08, 2021; Published: July 24, 2021