title: Prognostic value of RV isovolumic acceleration and tissue strain in moderate HFrEF.
abstract: BACKGROUND
  Right ventricular (RV) dysfunction in heart failure (HF) with reduced left ventricular ejection fraction (LVEF) is associated with a poorer prognosis. No studies to date have investigated the prognostic utility of RV isovolumic acceleration (IVA) measured at tissue Doppler imaging (TDI) in HF. RV strain instead has been already correlated to a poorer prognosis in these patients. We aimed to assess the predictive value of both parameters in this context.
  
  
  METHODS
  Sixty patients enrolled, NYHA II-III. Everyone underwent echocardiographic examination including TDI and strain analysis. Adverse event was defined as cardiovascular death or rehospitalization.
  
  
  RESULTS
  Follow-up was 32 ± 13 months. Sixteen patients (26·7%) had an adverse event. IVA and RV strain were significantly lower in these patients. At logistic regression, they were both related to adverse event and their receiver operating characteristic (ROC) curve predictive (area under ROC 0·916 and 0·952, respectively). Kaplan-Meier survival curves were significantly worse for both parameters inferior to their respective means (P < 0·001 for both). Univariate and multivariate analyses confirmed their better utility than tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) or S' at TDI.
  
  
  CONCLUSIONS
  our study demonstrated a useful prognostic role of RV strain and IVA, which are parameters of subclinical RV impairment. Patients with low values may benefit from a more aggressive therapy and a closer follow-up.
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*
keywords: Echocardiography; heart failure; isovolumic acceleration; right ventricle; strain; tissue Doppler imaging