title: Association of Decreased Right Ventricular Strain with Worse Survival in Non-Acute Coronary Syndrome Angina.
abstract: BACKGROUND
  Regional strain by speckle-tracking echocardiography can be used to detect occult right ventricular (RV) myocardial dysfunction. However, in patients with coronary artery disease, the impact of RV strain is unknown. The aim of this study was to validate the prognostic value of RV strain in patients with non-acute coronary syndrome angina.
  
  
  METHODS
  In total, 208 patients with coronary artery disease proved by coronary angiography were retrospectively identified (mean age, 63.81 ± 10.12 years; 161 men). In addition to clinical and traditional echocardiographic parameters, RV free wall longitudinal strain (RVLS_FW) was measured using speckle-tracking echocardiography from the apical four-chamber view. Cardiac mortality and major cardiovascular events were recorded.
  
  
  RESULTS
  During follow-up (23.1 ± 6.6 months), 27 patients (12.98%) died of cardiovascular causes. These patients were found to have lower left ventricular ejection fractions and greater reductions in the amplitudes of left ventricular peak systolic global longitudinal strain and RVLS_FW. Using -18% as a cutoff point for RV strain, patients with strain ≤ -18% had superior outcomes (log-rank χ(2) = 9.04 and 6.94 for cardiovascular mortality and arrhythmia, respectively, P = .003). In Cox multivariate regression analysis, RVLS_FW was an independent prognostic factor for both cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.03-1.72; P = .01) and hemodynamically unstable ventricular arrhythmia (hazard ratio, 1.72; 95% CI, 1.08-2.41; P = .01).
  
  
  CONCLUSIONS
  RVLS_FW is significantly related to cardiovascular outcomes and hemodynamically unstable ventricular arrhythmia in patients with non-acute coronary syndrome angina.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Wei-Ting
authors.initials: WT
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Ping-Yen
authors.initials: PY
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Ju-Yi
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Cheng-Han
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yi-Heng
authors.initials: YH
authors.lastname: Li
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Liang-Miin
authors.initials: LM
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: wctsai@seed.net.tw.
authors.forename: Wei-Chuan
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D000787:Angina Pectoris / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D017023:Coronary Angiography; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Arrhythmia; Cardiovascular mortality; Right ventricle; Speckle-tracking echocardiography