Key result
Speckle-tracking echocardiography-derived right ventricle free wall longitudinal strain detected right ventricular dysfunction in 47% of lung transplant candidates, outperforming conventional echocardiography and ventriculography.
Why the study?
Lung transplant candidates have subclinical right ventricular dysfunction, which had not yet been assessed by speckle-tracking echocardiography-derived RV free-wall longitudinal strain.
Does STE-derived RVFWLS detect right ventricular dysfunction better than conventional echocardiographic indexes and ventriculography in lung transplant candidates?
Cohort (n=34)
No
Does STE-derived RVFWLS detect right ventricular dysfunction better than conventional echocardiographic indexes and ventriculography in lung transplant candidates?
Absolute Event Rate: 47% vs 15%
STE-derived RVFWLS detects a higher prevalence of subclinical right ventricular dysfunction in lung transplant candidates compared to standard 2D echocardiography and ventriculography.
RVFWLS may detect more subclinical RV dysfunction in lung transplant candidates than standard indexes; leaves open impact on risk stratification and requires prospective validation.
BACKGROUND: Lung transplant (LUTX) candidates have subclinical right ventricular (RV) dysfunction, which has not yet been assessed by speckle-tracking echocardiography (STE)-derived RV free-wall longitudinal strain (RVFWLS). To evaluate the prevalence of RV dysfunction by RVFWLS and its relationship with conventional RV echocardiographic indexes in LUTX candidates. METHODS: In a single-center prospective observational cohort study, from January 2021 to March 2023 consecutive LUTX candidates underwent cardiac catheterization, radionuclide ventriculography, standard and STE. The diagnostic accuracy of RV ejection fraction by ventriculography (RVEF), tricuspid annular plane excursion (TAPSE), fractional area change (FAC), tricuspid peak annulus systolic velocity (S') versus RVFWS were computed. RESULTS: Thirty-four patients (female, 41%) with a mean age of 48 [36-59] years old enlisted for pulmonary fibrosis (35%) and cystic fibrosis (30%) were included. At cardiac catheterization, only 7 (23%) had pulmonary hypertension. Around 15-25% presented right heart enlargement. Tricuspid regurgitation was present in 20 (60%) of the patients. Median RVFWLS was -20.1% [-22.5%--17%], being impaired (> -20%) in 16 (47%) of the patients. RVFWLS identified the highest percentage (47%) of RV dysfunction, compared to TAPSE (32%), S' (27%), FAC (26%), and ventriculography (15%), which had very low sensitivity for detecting RV dysfunction compared to RVFWLS. CONCLUSIONS: In patients enlisted for LUTX, RV dysfunction assessed by STE-derived RVFWLS is highly prevalent. STE can detect RV dysfunction better than standard two-dimensional echocardiography and ventriculography. Further studies are urgently needed to define the clinical implications and the prognostic value of RV dysfunction measured with RVFWLS.
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Scaravilli et al. (2024) conducted a cohort in Lung transplant candidates (n=34). Speckle-tracking echocardiography-derived right ventricle free wall longitudinal strain (RVFWLS) vs. Conventional echocardiography (TAPSE, FAC, S') and radionuclide ventriculography was evaluated on Detection of right ventricular dysfunction. Speckle-tracking echocardiography-derived right ventricle free wall longitudinal strain detected right ventricular dysfunction in 47% of lung transplant candidates, outperforming conventional echocardiography and ventriculography.
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