Key result
Lower RV systolic strain predicts 6-month major cardiovascular events better than CPET or BNP.
Why the study?
Does right ventricular longitudinal systolic strain predict major adverse cardiac events better than CPET or BNP in patients with NYHA class III-IV heart failure?
Cohort (n=19)
Does right ventricular longitudinal systolic strain predict major adverse cardiac events better than CPET or BNP in patients with NYHA class III-IV heart failure?
Right ventricular longitudinal systolic strain is a reliable and stronger prognosticator of major adverse cardiac events than CPET or BNP in patients with advanced heart failure.
Answers are grounded in this paper and cite their sources.
RV strain may aid short-term risk stratification in advanced HF; leaves open superiority over CPET/BNP in larger prospective cohorts.
OBJECTIVE: We sought to compare the additive value of right ventricular (RV) function assessed by longitudinal systolic strain (epsilon% - ROI: 9.2 at 10.8 mm) with cardiopulmonary exercise testing (CPET) or brain natriuretic peptide (BNP) in patients with heart failure (HF). METHOD: We studied 19-patients (age = 56 +/- 8 years) in New York Heart Association HF class III-IV, who underwent standard and tissue Doppler echocardiography, CPET and BNP measurements on the same day. RV function was assessed by systolic strain (epsilon, %, ROI: 9.2-10.8 mm) in the mid-segment. Clinical outcomes were examined at 6 months. RESULTS: epsilon (-19.9+/-6.8%) was correlated with BNP (R = 0.52, P = 0.02), slope VE/VCO(2) (R = -0.65, P = 0.003), peak VO(2) (R = 0.46, P = 0.04) and the maximal workload (Watts) developed during CPET (R = 0.54, P=0.02). During follow-up, 1-patient died, 1-underwent heart transplantation, and 4 were re-hospitalized for worsening HF. Patients with major adverse cardiac events (MACE) had a significantly higher mean BNP concentration (852.8 ng/mL +/- 1114.3 vs. 201.4+ /- 293.8, P = 0.03), higher VE/VCO(2) (41.3 +/- 3.6 vs. 35.0 +/- 4.8 P < 0.001) and lower epsilon (-13.9 +/- 4.9 vs. -22.2+ /- 5.8, P < 0.001) than patients who remained MACE-free. By multivariate analysis, ST was the only predictor of MACE. CONCLUSION: In HF-patients presenting, RV-function assessed by systolic epsilon was reliable, easily measurable and a stronger prognosticator than CPET or BNP.
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Donal et al. (2006) conducted a cohort in Heart failure (n=19). Right ventricular systolic strain vs. Cardiopulmonary exercise testing (CPET) or BNP was evaluated on Major adverse cardiac events (MACE) (p=< 0.001). Right ventricular systolic strain was a stronger predictor of major adverse cardiac events at 6 months than CPET or BNP, with lower strain in patients with major cardiovascular events.
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