title: Four chamber right ventricular longitudinal strain versus right free wall longitudinal strain. Prognostic value in patients with left heart disease.
abstract: BACKGROUND
  There is no consensus on which right ventricle (RV) strain parameter should be used in the clinical practice: four chamber RV longitudinal strain (4CH RV-LS) or free wall longitudinal strain (FWLS). The aim of this study was to analyze which RV strain parameter better predicts prognosis in patients with left heart disease.
  
  
  METHODS
  One hundred and three outpatients with several degrees of functional tricuspid regurgitation severity secondary to left heart disease were prospectively included. 4CH RV-LS and FWLS were assessed using speckle tracking. Left ventricular (LV) systolic function was determined using LV ejection fraction and RV systolic function using tricuspid annular plane systolic excursion (TAPSE). Patients were followed up for 23.1 ± 12.4 months for an endpoint of cardiac hospitalization due to heart failure.
  
  
  RESULTS
  The cutoff value related to RV dysfunction (TAPSE < 17 mm) was lower, in absolute value, for 4CH RV-LS (4CH RV-LS = -17.3%; FWLS = -19.5%). There were 33 adverse events during the follow-up. Patients with 4CH RV-LS > -17.3% (log rank [LR] = 22.033; p < 0.001); FWLS > -19.5% (LR = 12.2; p < 0.001), TAPSE < 17 mm (LR = 17.4; p < 0.001) and LV systolic dysfunction (LR = 13.3; p < 0.001) had lower event-free survival (Kaplan Meier). In Cox multivariate analysis, 4CH RV-LS > -17.3% (hazard ratio [HR] = 3.593; p < 0.002), TAPSE < 17 (HR = 2.093; p < 0.055) and LV systolic dysfunction (HR = 2.087; p < 0,054) had prognostic value, whereas FWLS did not reach significance.
  
  
  CONCLUSIONS
  Although both 4CH RV-LS and FWLS have prognostic value, 4CH RV-LS is a better predictor of episodes of heart failure in patients with left heart disease, providing additional information to that obtained by TAPSE.
authors.affiliation: Ramón y Cajal University Hospital, Madrid, Spain. aggarciamartin@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: García-Martín
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Moya-Mur
authors.forename: Sonsoles Alejandra
authors.initials: SA
authors.lastname: Carbonell-San Román
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Lledó
authors.forename: Paula
authors.initials: P
authors.lastname: Navas-Tejedor
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodríguez-Muñoz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Casas-Rojo
authors.forename: Jose-Julio
authors.initials: JJ
authors.lastname: Jiménez-Nacher
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfín
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: echocardiography; heart failure; right ventricle; right ventricular function; strain