Key result
Right ventricular global longitudinal strain was associated with all-cause mortality in HFrEF patients independent of TAPSE (HR 1.07; 95% CI 1.02-1.13; p=0.010 per 1% decrease).
Why the study?
Right ventricular dysfunction is associated with poor outcomes in heart failure, but whether advanced RV echocardiographic measures better predict mortality than conventional measures was unclear.
Do advanced right ventricular echocardiographic measures (RV GLS and FWS) improve prediction of all-cause mortality compared to conventional measures (TAPSE) in patients with HFrEF?
Cohort (n=701)
Do advanced right ventricular echocardiographic measures (RV GLS and FWS) improve prediction of all-cause mortality compared to conventional measures (TAPSE) in patients with HFrEF?
Hazard Ratio: 1.07 (95% CI 1.02–1.13)
p-value: p=0.010
Advanced right ventricular echocardiographic measures (RV GLS and FWS) provide incremental prognostic value for all-cause mortality beyond conventional TAPSE in patients with HFrEF.
May enhance prognostic stratification in HFrEF beyond TAPSE; leaves open whether integration improves outcomes.
PURPOSE: Right ventricular (RV) dysfunction is associated with poor outcome in patients with heart failure. In order to better predict mortality in this patient group we wanted to compare the prognostic value of conventional and advanced RV echocardiographic measures. METHODS: Echocardiographic examinations were retrieved from 701 patients. End point was all-cause mortality and follow-up 100%. RV parameters were measured offline in accordance with current guidelines. Speckle tracking was derived using the algorithm originally designed for the left ventricle. RESULTS: During follow-up (median: 39 months) 118 patients (16.8%) died. RV global longitudinal strain (GLS) and RV free wall strain (FWS) remained associated with mortality after multivariable adjustment independent of Tricuspid annular plane systolic excursion (TAPSE) (RV GLS: HR 1.07, 95%CI 1.02-1.13, p = 0.010, per 1% decrease) (RV FWS: HR 1.05, 95%CI 1.01-1.09, p = 0.010, per 1% decrease). This seemed to be caused by significant associations in men. All RV estimates provided prognostic information incremental to established risk factors and significantly increased C-statistics. CONCLUSIONS: RV GLS and FWS were associated with mortality in HFrEF patients after multivariable adjustment independent of TAPSE. TAPSE, however, remained as the strongest prognosticator in women. More research is needed to identify whether speckle tracking could be superior to conventional RV measures in identifying HFrEF patients with poor outcome.
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Lundorff et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=701). Right ventricular global longitudinal strain (GLS) and free wall strain (FWS) was evaluated on All-cause mortality (HR 1.07, 95% CI 1.02-1.13, p=0.010). Right ventricular global longitudinal strain was associated with all-cause mortality in HFrEF patients independent of TAPSE (HR 1.07; 95% CI 1.02-1.13; p=0.010 per 1% decrease).
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