Basal-Predominant Right-Ventricular Dysfunction in Pediatric Dilated Cardiomyopathy: An Integrated Biventricular Strain Analysis

Figures

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  Figure 1. Representative examples of RV STE analysis in the apical four-chamber view. (A) Patient with DCM showing severely reduced right-ventricular deformation (RV free-wall longitudinal strain [RVFWSL] −10.0%, RV four-chamber strain [RV4CSL] −8.5%). (B) Age-matched healthy control with preserved right-ventricular deformation (RVFWSL −24.0%, RV4CSL −22.1%). Colored curves represent segmental strain profiles for basal, mid-ventricular, and apical free-wall segments, with the average global strain shown in white.

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  Figure 2. Comparison of right-ventricular longitudinal strain parameters between pediatric patients with DCM and healthy controls. (Top) Global right-ventricular free-wall longitudinal strain (RVFWSL) and right-ventricular four-chamber strain (RV4CSL) were significantly reduced in the DCM group compared with controls (p < 0.05). (Bottom) Segmental analysis revealed that basal RV strain was significantly decreased in DCM (p < 0.05), whereas mid-ventricular (p = 0.06) and apical (p = 0.15) segments showed non-significant differences (ns). Data are expressed as mean ± SD or median [IQR], according to distribution. Group comparisons were performed using the independent-samples t-test or Mann–Whitney U test, as appropriate. Sample size: DCM, n = 29; Controls, n = 26.

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  Figure 3. Correlations between right-ventricular free-wall longitudinal strain and echocardiographic functional indices in pediatric dilated cardiomyopathy (DCM). RVFWSL showed significant negative correlations with RV systolic velocity (RV S′; r = –0.49, p < 0.05), RV early diastolic velocity (RV E′; r = –0.46, p < 0.05), and LV ejection fraction (LV EF; r = –0.63, p < 0.05). A strong positive correlation was observed between RVFWSL and LV global longitudinal strain (LVGLS; r = 0.79, p < 0.05). Correlation analyses were performed in the DCM group (n = 29).

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  Figure 4. Segmental longitudinal strain by ventricle (adjusted for age, body surface area, and heart rate). Estimated marginal means of longitudinal strain (±95% CI) are shown for left (LV, blue) and right (RV, red) ventricles across basal, mid-ventricular, and apical segments. More negative values indicate greater myocardial deformation. RV strain was significantly more negative than LV strain at the basal (p < 0.001) and mid-ventricular (p = 0.009) levels, whereas apical values did not differ significantly (p = 0.23). Both ventricles demonstrated a basal-to-apical decline in deformation magnitude. Analyses were performed in the DCM cohort (n = 29).

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  Figure 5. Receiver-operating characteristic (ROC) curve for the logistic regression model combining right-ventricular free-wall longitudinal strain (RVFWSL) and left-ventricular global longitudinal strain (LVGLS) in predicting severe functional limitation (NYHA/Ross class III–IV) among pediatric patients with dilated cardiomyopathy. The model demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.95 (95% CI 0.85–1.00, p < 0.001), indicating high accuracy for distinguishing between mild-to-moderate (NYHA/Ross I–II) and advanced functional class (NYHA/Ross III–IV) disease. Analyses were performed in the DCM cohort (n = 29).