title: RV Longitudinal Deformation Correlates With Myocardial Fibrosis in Patients With End-Stage Heart Failure.
abstract: OBJECTIVE
  This study was performed to determine the accuracy of right ventricular (RV) longitudinal strain (LS) in predicting myocardial fibrosis in patients with severe heart failure (HF) undergoing heart transplantation.
  
  
  BACKGROUND
  RVLS plays a key role in the evaluation of its systolic performance and clinical outcome in patients with refractory HF.
  
  
  METHODS
  We studied 27 patients with severe systolic HF (ejection fraction ≤25% and New York Heart Association functional class III to IV, despite full medical therapy and cardiac resynchronization therapy) using echocardiography before heart transplantation. RV free wall LS, right atrial LS, sphericity index (SI), and tricuspid annular plane systolic excursion (TAPSE) were all measured. Upon removal of the heart, from the myocardial histologic analysis, the ratio of the fibrotic to the total sample area determined the extent of fibrosis (%).
  
  
  RESULTS
  RV myocardial fibrosis correlated with RV free wall LS (r = 0.80; p < 0.0001), SI (r = 0.42; p = 0.01) and VO2 max (r = -0.41; p = 0.03), with a poor correlation with TAPSE (r = -0.34; p = 0.05) and right atrial LS (r = -0.37; p = 0.03). Stepwise multivariate analysis showed that RV free wall LS (β = 0.701, p < 0.0001) was independently associated with RV fibrosis (overall model R(2) = 0.64, p < 0.0001). RV free wall LS was the main determinant of myocardial fibrosis. In the subgroup of patients with severe RV fibrosis, RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (area under the curve = 0.87; 95% confidence interval: 0.80 to 0.94).
  
  
  CONCLUSIONS
  In late-stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate functional measure that correlates with the extent of RV myocardial fibrosis and functional capacity.
authors.affiliation: Department of Cardiovascular Disease, University of Siena, Siena, Italy; Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden. Electronic address: matteo.lisi@hotmail.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.affiliation: Department of Cardiovascular Disease, University of Siena, Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Department of Cardiovascular Disease, University of Siena, Siena, Italy.
authors.forename: Francesca Maria
authors.initials: FM
authors.lastname: Righini
authors.affiliation: Department of Cardiovascular Disease, University of Siena, Siena, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Malandrino
authors.affiliation: Department of Pathology, University of Siena, Siena, Italy.
authors.forename: Damiana
authors.initials: D
authors.lastname: Tacchini
authors.affiliation: Department of Cardiovascular Disease, University of Siena, Siena, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Focardi
authors.affiliation: Department of Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Charilaos
authors.initials: C
authors.lastname: Tsioulpas
authors.affiliation: Department of Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Bernazzali
authors.affiliation: Department of Pathology, University of Siena, Siena, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Tanganelli
authors.affiliation: Department of Cardiac Surgery, University of Siena, Siena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Maccherini
authors.affiliation: Department of Cardiovascular Disease, University of Siena, Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
mesh_terms: D019540:Area Under Curve; D001696:Biomechanical Phenomena; D001706:Biopsy; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005355:Fibrosis; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: heart failure; myocardial fibrosis; right ventricle