Saad Aly, Abdelhady Mohammad, Attia Loai Ali AbdulHadi, Shereef Ahmed Shawky, Shehata Islam Elsayed
Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Cardiovascular Medicine, National Heart Institute, Giza, Egypt.
J Cardiovasc Echogr. 2025 Apr-Jun;35(2):121-128. doi: 10.4103/jcecho.jcecho_100_24. Epub 2025 Jul 30.
Right ventricle (RV) function is a recognized independent determinant of morbidity and mortality in heart failure (HF), encompassing various etiologies such as congenital heart disease, pulmonary hypertension, and coronary artery disease. The prognostic significance of RV dysfunction in different HF subtypes - HF with preserved ejection fraction (HFpEF), mid-range EF (HFmrEF), and reduced EF (HFrEF) - continues to gain attention. This study aimed to assess RV dysfunction, quantified by global longitudinal strain (RV GLS), as an early and sensitive predictor of outcomes in HF patients categorized by EF.
A prospective study of 100 HF patients categorized into HFpEF (left ventricular EF [LVEF] >50%, = 16), HFmrEF (LVEF 40%-50%, = 47), and HFrEF (LVEF < 40%, = 37). Echocardiographic assessments, including RV GLS, were performed using a standardized protocol on the Philips EPIC 7C system. RV GLS was analyzed as a sensitive marker for poor outcomes, defined by major adverse cardiac events (MACE) and worsening functional status.
RV GLS demonstrated significant variation among the groups. Patients in Group C (HFrEF, LVEF < 40%) exhibited markedly lower RV GLS compared to Group A (HFpEF, LVEF > 50%) (-13.5 ± 5.24 vs. -16.8 ± 4.21; = 0.006). In addition, a significant difference was noted between Group C and Group B (HFmrEF, LVEF 40-50%) (-13.5 ± 5.24 vs. -14.6 ± 4.15; = 0.047). The predictive value of RV GLS for poor outcomes in HF patients was supported by a sensitivity of 75% and specificity of 69.12%, with a cutoff threshold of - 14.7%.
RV GLS serves as a dependable marker for predicting poor outcomes in HF patients, with a defined cutoff value of -14.7%. This metric holds substantial clinical promise for effective risk stratification and timely intervention, demonstrating a sensitivity of 75% and a specificity of 69.12%.
右心室（RV）功能是心力衰竭（HF）发病率和死亡率公认的独立决定因素，涵盖多种病因，如先天性心脏病、肺动脉高压和冠状动脉疾病。右心室功能障碍在不同HF亚型（射血分数保留的HF（HFpEF）、中等射血分数（HFmrEF）和射血分数降低的HF（HFrEF））中的预后意义持续受到关注。本研究旨在评估通过整体纵向应变（RV GLS）量化的右心室功能障碍，作为按射血分数分类的HF患者预后的早期敏感预测指标。
对100例HF患者进行前瞻性研究，分为HFpEF（左心室射血分数[LVEF]>50%，n = 16）、HFmrEF（LVEF 40%-50%，n = 47）和HFrEF（LVEF<40%，n = 37）。使用飞利浦EPIC 7C系统上的标准化方案进行超声心动图评估，包括RV GLS。RV GLS被分析为不良预后的敏感标志物，不良预后由主要不良心脏事件（MACE）和功能状态恶化定义。
RV GLS在各组之间存在显著差异。C组（HFrEF，LVEF<40%）患者的RV GLS明显低于A组（HFpEF，LVEF>50%）（-13.5±5.24对-16.8±4.21；P = 0.006）。此外，C组与B组（HFmrEF，LVEF 40-50%）之间也存在显著差异（-13.5±5.24对-14.6±4.15；P = 0.047）。RV GLS对HF患者不良预后的预测价值得到支持，敏感性为75%，特异性为69.12%，截断阈值为-14.7%。
RV GLS可作为预测HF患者不良预后的可靠标志物，截断值为-14.7%。该指标在有效风险分层和及时干预方面具有重要临床前景，敏感性为75%，特异性为69.12%。
