title: Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: a multicentre study.
abstract: OBJECTIVE
  The aim of the present multicentre study was to analyse a large cohort of healthy subjects and patients with a common condition such as heart failure (HF) with the purpose of determining the normal range and the usefulness of right ventricular (RV) systolic strain to detect subtle RV systolic abnormalities using 2D speckle-tracking echocardiography.
  
  
  RESULTS
  We analysed 238 healthy subjects and a cohort of 642 patients characterized by asymptomatic patients (n = 216) and patients with HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction (n = 218 and n = 208, respectively) prospectively included in 10 centres. The normal range of RV systolic strain analysing the healthy subjects was as follows: RV global strain -24.5 ± 3.8 and RV free wall strain -28.5 ± 4.8 (lowest expected value -17 and -19%, respectively). Concerning the ability of these myocardial parameters to detect subtle RV systolic abnormalities, RV global and free wall systolic strain were able to detect subtle RV longitudinal systolic abnormalities in a significant proportion of patients with HFrEF and to a lesser extent in HFpEF despite preserved tricuspid annular plane systolic excursion, tricuspid lateral annular peak systolic velocity by pulsed tissue Doppler imaging, and RV fractional area change. In addition, RV global and free wall systolic strain were significantly linked to the symptomatic status of the patients.
  
  
  CONCLUSIONS
  The findings from this study provide important data regarding the normal range of RV global and free wall systolic strain and highlight the clinical relevance of these RV myocardial parameters to detect subtle RV systolic abnormalities in patients with HF.
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany daniel-armando.morris@charite.de.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Morris
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Krisper
authors.affiliation: Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Köhncke
authors.affiliation: University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Belyavskiy
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Aravind K
authors.initials: AK
authors.lastname: Radha Krishnan
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kropf
authors.affiliation: Meoclinic, Berlin, Germany.
authors.forename: Engin
authors.initials: E
authors.lastname: Osmanoglou
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Leif-Hendrik
authors.initials: LH
authors.lastname: Boldt
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Blaschke
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Edelmann
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pieske-Kraigher
authors.affiliation: Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité -Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany.|German Heart Institute, Berlin, Germany.
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.affiliation: University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D015331:Cohort Studies; D016001:Confidence Intervals; D004452:Echocardiography; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007564:Japan; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D013599:Systole / Q000502:physiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: echocardiography; right ventricular; speckle tracking; strain