What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=79). Intervention: Right ventricular systolic imaging parameters. Primary outcome: Composite primary endpoint defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure (AUC 0.922, p=<0.001).

July 20, 2020

What is the most useful imaging parameter to explore the prognostic value of the right ventricular function at the time of multimodality cardiovascular imaging?

Q: What are the key findings of this study?

Integral systolic S' wave tricuspid annular velocity (AUC 0.922) and RV free wall longitudinal strain (AUC 0.913) had the best prognostic performance for predicting adverse heart failure outcomes.

Key Result

Integral systolic S' wave tricuspid annular velocity (AUC 0.922) and RV free wall longitudinal strain (AUC 0.913) had the best prognostic performance for predicting adverse heart failure outcomes.

Study Design

Type

Cohort (n=79)

Structured PICO

Do echocardiographic parameters predict adverse outcomes better than CMR or ERV in patients undergoing right ventricular function assessment?

Population

79 patients undergoing comprehensive cardiovascular imaging for the assessment of right ventricular function, followed for a mean of 13 months.

Exposure

Echocardiographic assessment of right ventricular function (including integral systolic S' wave tricuspid annular velocity and RV free wall longitudinal strain)

Comparator

Cardiac magnetic resonance (CMR) imaging and tomographic equilibrium radionuclide ventriculography (ERV)

Outcome

Composite of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failurecomposite

Echocardiographic parameters, particularly integral systolic S' wave tricuspid annular velocity and RV free wall longitudinal strain, demonstrate superior prognostic performance for adverse heart failure outcomes compared to CMR and ERV.

Main Result

Effect estimate: AUC 0.922

p-value: p=<0.001

Abstract

BACKGROUND: Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome. METHODS: Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure. RESULTS: During a mean follow-up of 13 ± 9 months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P < .001), 0.913 (P < .001), 0.906 (P < .001), 0.849 (P = .002), 0.837 (P = .003), 0.799 (P = .009), 0.792 (P = .011), 0.753 (P = .026), 0.720 (P = .053), and 0.608 (P = .346) for integral systolic S' wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S' wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively. CONCLUSION: Echocardiographic parameters, and particularly integral systolic S' wave tricuspid annular velocity and RVFWLS, have the best prognostic performance.

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