Key result
3DE-derived right ventricular free wall longitudinal strain had higher diagnostic accuracy (AUC 0.975) than 2DE-derived strain (AUC 0.930) for detecting right ventricular dysfunction.
Why the study?
Novel 3DE-derived strain analysis software specialized for RV monitoring has emerged, but its diagnostic performance in evaluating RV function compared to 2DE-derived longitudinal strain needed evaluation.
Does 3DE-derived longitudinal strain improve diagnostic accuracy for assessing right ventricular function compared to 2DE in patients with chronic left-sided heart failure?
Cross-Sectional (n=122)
Single-blind
No
Does 3DE-derived longitudinal strain improve diagnostic accuracy for assessing right ventricular function compared to 2DE in patients with chronic left-sided heart failure?
Absolute Event Rate: 0.975% vs 0.93%
p-value: p=<0.05
3DE-derived longitudinal strain analysis provides superior diagnostic accuracy compared to 2DE for assessing right ventricular systolic function in patients with chronic left-sided heart failure.
3DE RV strain may aid function assessment over 2DE; leaves open validation in larger outcome studies.
Background: A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain. Methods: Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV. Results: 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p <0.001), and it correlated well with cardiac magnetic resonance-derived RVEF ( r =0.74, p <0.001). On receiver operator characteristic analysis, a 3DE-derived RV-fwLS cutoff value of >-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p <0.05). Conclusion： Assessment of impaired RV systolic function by 3DE-derived longitudinal strain is better than 2DE in chronic left-sided heart failure patients with left ventricular EF <45%. 3DE-derived strain analysis specialized for RV should be considered as a complementary tool for assessing RV function.
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Gao et al. (2020) conducted a cross-sectional in Right ventricular dysfunction associated with chronic left-sided heart failure (n=122). Three-dimensional echocardiography (3DE)-derived longitudinal strain vs. Two-dimensional echocardiography (2DE)-derived longitudinal strain was evaluated on Area under the curve (AUC) for detecting impaired right ventricular systolic function (p=<0.05). 3DE-derived right ventricular free wall longitudinal strain had higher diagnostic accuracy (AUC 0.975) than 2DE-derived strain (AUC 0.930) for detecting right ventricular dysfunction.
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