Free-wall right ventricular longitudinal strain by echocardiography showed the strongest correlation with CMR-derived RVEF (r = -0.86, P<0.0001) and high diagnostic accuracy (AUC 0.92) for RVEF <45%.
Observational (n=63)
How do traditional and speckle-tracking echocardiographic parameters of right ventricular function correlate with cardiac magnetic resonance-derived right ventricular ejection fraction?
Free-wall right ventricular longitudinal strain by speckle-tracking echocardiography is a highly accurate parameter for assessing right ventricular systolic function compared to the CMR reference standard.
Effect estimate: r = -0.86 (free-wall RVLS)
p-value: p=<0.0001
AIMS: Right ventricle fractional area change (RVFAC), tissue Doppler and M-mode measurements of tricuspid systolic motion tricuspid Sm and tricuspid annular plane systolic excursion (TAPSE), and 3D echocardiography are the current non-invasive methods for the quantification of RV systolic function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of RV performance. Using cardiac magnetic resonance (CMR) as the reference standard, this study aimed at exploring the correlation between the traditional (fractional shortening, s'RV, TAPSE) and innovative (strain) echocardiographic parameters and RV ejection fraction (RVEF) measured by CMR. METHODS AND RESULTS: CMR and transthoracic echo-Doppler were performed in 63 patients referred for clinical assessment. Twenty-one presented the suspicion of myocarditis, 8 presented idiopathic dilated cardiomyopathy, 10 hypertrophic cardiomyopathy, 10 arrhythmogenic right ventricular dysplasia (ARVD), 5 infiltrative cardiomyopathy, and 9 other reasons. RVEF was measured by magnetic resonance imaging (MRI). RVFAC, tricuspid S', and TAPSE were calculated in all patients. RV longitudinal strain (RVLS) by STE was assessed by averaging RV free-wall segments (free-wall RVLS) and by averaging all segments (global RVLS). The ROC analysis was applied for the assessment of diagnostic accuracy. Good correlations were found for TAPSE, tricuspid S', and global RVLS with RVEF (r = 0.45, r = 0.52, and r = -0.71, respectively; P = 0.01 for all). Close correlations between free-wall RVLS and RVFAC with RVEF were found (r = -0.86 and r = 0.77, respectively; P < 0.0001 for both). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy area under curve (AUC) 0.92 and good sensitivity and specificity of 96 and 93%, respectively, to predict reduced RVEF <45%, using a cut-off value of less than -17.0%. CONCLUSION: In a heterogeneous group of patients referred to CMR evaluation, conventional (TAPSE, FAC, and tricuspid S') and novice (2D speckle-tracking-derived longitudinal strain) parameters of RV systolic function were compared and correlated with RVEF measured by MRI. All tested parameters were found to be independent predictors of reduced RVEF (<45%), but the strongest correlation was seen for the RV free-wall longitudinal strain.
Focardi et al. (Wed,) conducted a observational in Patients referred for clinical assessment (myocarditis, cardiomyopathies) (n=63). Echocardiographic parameters (RVFAC, tricuspid S', TAPSE, RVLS) vs. Cardiac magnetic resonance (CMR) was evaluated on Correlation between echocardiographic parameters and RVEF measured by CMR (r = -0.86 (free-wall RVLS), p=<0.0001). Free-wall right ventricular longitudinal strain by echocardiography showed the strongest correlation with CMR-derived RVEF (r = -0.86, P<0.0001) and high diagnostic accuracy (AUC 0.92) for RVEF <45%.