TY - JOUR

T1 - Prognostic value of right ventricular echocardiographic measures in patients with heart failure with reduced ejection fraction

AU - Lundorff, Ingrid Josefine

AU - Sengeløv, Morten

AU - Pedersen, Sune

AU - Modin, Daniel

AU - Bruun, Niels Eske

AU - Fritz-Hansen, Thomas

AU - Biering-Sørensen, Tor

AU - Godsk Jørgensen, Peter

N1 - Publisher Copyright: © 2021 Wiley Periodicals LLC.

PY - 2021

Y1 - 2021

N2 - Purpose: Right ventricular (RV) dysfunction is associated with poor outcome in patients with heart failure. In order to better predict mortality in this patient group we wanted to compare the prognostic value of conventional and advanced RV echocardiographic measures. Methods: Echocardiographic examinations were retrieved from 701 patients. End point was all-cause mortality and follow-up 100%. RV parameters were measured offline in accordance with current guidelines. Speckle tracking was derived using the algorithm originally designed for the left ventricle. Results: During follow-up (median: 39 months) 118 patients (16.8%) died. RV global longitudinal strain (GLS) and RV free wall strain (FWS) remained associated with mortality after multivariable adjustment independent of Tricuspid annular plane systolic excursion (TAPSE) (RV GLS: HR 1.07, 95%CI 1.02–1.13, p = 0.010, per 1% decrease) (RV FWS: HR 1.05, 95%CI 1.01–1.09, p = 0.010, per 1% decrease). This seemed to be caused by significant associations in men. All RV estimates provided prognostic information incremental to established risk factors and significantly increased C-statistics. Conclusions: RV GLS and FWS were associated with mortality in HFrEF patients after multivariable adjustment independent of TAPSE. TAPSE, however, remained as the strongest prognosticator in women. More research is needed to identify whether speckle tracking could be superior to conventional RV measures in identifying HFrEF patients with poor outcome.

AB - Purpose: Right ventricular (RV) dysfunction is associated with poor outcome in patients with heart failure. In order to better predict mortality in this patient group we wanted to compare the prognostic value of conventional and advanced RV echocardiographic measures. Methods: Echocardiographic examinations were retrieved from 701 patients. End point was all-cause mortality and follow-up 100%. RV parameters were measured offline in accordance with current guidelines. Speckle tracking was derived using the algorithm originally designed for the left ventricle. Results: During follow-up (median: 39 months) 118 patients (16.8%) died. RV global longitudinal strain (GLS) and RV free wall strain (FWS) remained associated with mortality after multivariable adjustment independent of Tricuspid annular plane systolic excursion (TAPSE) (RV GLS: HR 1.07, 95%CI 1.02–1.13, p = 0.010, per 1% decrease) (RV FWS: HR 1.05, 95%CI 1.01–1.09, p = 0.010, per 1% decrease). This seemed to be caused by significant associations in men. All RV estimates provided prognostic information incremental to established risk factors and significantly increased C-statistics. Conclusions: RV GLS and FWS were associated with mortality in HFrEF patients after multivariable adjustment independent of TAPSE. TAPSE, however, remained as the strongest prognosticator in women. More research is needed to identify whether speckle tracking could be superior to conventional RV measures in identifying HFrEF patients with poor outcome.

KW - 2DSTE

KW - echocardiography

KW - heart failure

KW - right ventricle

KW - speckle tracking

U2 - 10.1002/jcu.23050

DO - 10.1002/jcu.23050

M3 - Journal article

C2 - 34337754

AN - SCOPUS:85111642980

VL - 49

SP - 903

EP - 913

JO - Journal of Clinical Ultrasound

JF - Journal of Clinical Ultrasound

SN - 0091-2751

IS - 9

ER -