Long-Term Prognostic Value of Longitudinal Strain of Right Ventricle in Patients with Moderate Heart Failure

Introduction: Right ventricular (RV) systolic dysfunction is a strong prognostic predictor in chronic heart failure (HF). However, assessment of RV function remains difficult. We investigated the prognostic value of different echocardiographic parameters for evaluating RV function in 60 patients with chronic HF and a low left ventricular ejection fraction (<40%) who were on optimal medical treatment. Methods: RV function was assessed using standard and tissue Doppler echocardiography. The following parameters were measured: tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), right myocardial performance index (MPI), tissue Doppler peak myocardial velocity (Sm) and longitudinal strain of the right ventricular wall in the basal and middle segments. Results: During a mean follow-up of 32 ± 13 months, 6 patients died and 16 were hospitalised for HF. TAPSE, RVFAC, right MPI and Sm did not predict cardiovascular events. The only variable associated with either cardiac death or HF hospitalisation (p=0.002), or HF hospitalisation only (p<0.0001) was systolic longitudinal strain in the basal and middle segments of the RV wall. Conclusion: Our study demonstrates that longitudinal RV strain is a powerful prognostic variable for the prediction of major cardiac events in patients with chronic HF.