Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, 25100 Brescia, Italy.
Heart and Valve Center, University Heart Center of Zürich, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Eur Heart J Cardiovasc Imaging. 2020 Sep 1;21(9):1013-1021. doi: 10.1093/ehjci/jez246.
Right ventricular free wall longitudinal strain (RVFWLS) has been proposed as an accurate and sensitive measure of right ventricular function that could integrate other conventional parameters such as tricuspid annulus plane systolic excursion (TAPSE) and fractional area change (FAC%). The aim of the present study was to evaluate the relationship between RVFWLS and outcomes in stable asymptomatic outpatients with left-sided structural heart disease.
We enrolled 458 asymptomatic patients with left-side heart diseases and any ejection fraction who were referred for echocardiography to two Italian centres. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome of this analysis. After a mean follow-up of 5.4 ± 1.2 years, 145 patients (31%) reached the combined endpoint. Most of echocardiographic parameters were related to outcomes, including right ventricular functional parameters. Mean value of RVFWLS in our cohort was -21 ± 8% and it was significantly related to the combined endpoint and in multivariable Cox-regression model; when tested with other echocardiographic parameters that were significantly related to outcome at univariate analysis, RVFWLS maintained its independent association with outcome (hazard ratio 0.963, 95% confidence interval 0.948-0.978; P = 0.0001). The best cut-off value of RVFWLS to predict outcome was -22% (area under the curve 0.677; P < 0.001; sensitivity 70%; 65% specificity).
RVFWLS may help clinicians to identify patients with left-sided structural heart disease at higher risk for first heart failure hospitalization and death for any cause.
右心室游离壁纵向应变（RVFWLS）已被提出作为一种准确和敏感的右心室功能测量方法，可整合其他常规参数，如三尖瓣环平面收缩位移（TAPSE）和分数面积变化（FAC%）。本研究旨在评估在左侧结构性心脏病的稳定无症状门诊患者中，RVFWLS 与结局之间的关系。
我们招募了 458 名左侧心脏疾病且射血分数任意的无症状患者，这些患者因超声心动图检查被转诊至两个意大利中心。该分析的主要终点是任何原因导致的死亡和心力衰竭住院的复合终点。在平均 5.4±1.2 年的随访后，145 名患者（31%）达到了联合终点。大多数超声心动图参数与结局相关，包括右心室功能参数。我们队列中的 RVFWLS 平均值为-21±8%，与联合终点显著相关，并且在多变量 Cox 回归模型中也是如此；当与其他在单变量分析中与结局显著相关的超声心动图参数一起测试时，RVFWLS 仍然与结局具有独立相关性（风险比 0.963，95%置信区间 0.948-0.978；P<0.001）。预测结局的 RVFWLS 最佳截断值为-22%（曲线下面积 0.677；P<0.001；敏感性 70%；特异性 65%）。
RVFWLS 可帮助临床医生识别左侧结构性心脏病患者，这些患者发生心力衰竭住院和任何原因导致的死亡的风险更高。
