Echocardiographic right ventricular strain analysis in chronic heart failure

doi:10.1016/j.euje.2006.07.011

European Journal of Echocardiography 2007 8(6):449-456; doi:10.1016/j.euje.2006.07.011

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Echocardiographic right ventricular strain analysis in chronic heart failure

Erwan Donal^a^,*, Manuel Roulaud^b, Pascale Raud-Raynier^c, Claire De Bisschop^b, Christophe Leclercq^a, Geneviève Derumeaux^d, Jean-Claude Daubert^a, Philippe Mabo^a and André Denjean^b

^aDepartment of Cardiology, University Hospital, CCP- CHU Pontchaillou, 35000 Rennes, France
^bLaboratory of human performance EA 3813, Poitiers, France
^cDepartment of Cardiology, University Hospital, Poitiers, France
^dINSERM E 0226, Faculty of Medicine, Lyon, France

Received 16 May 2006; received in revised form 16 July 2006; accepted after revision 26 July 2006.

^* This study was funded by a regional institutional grant. Corresponding author. Tel.: +33 2 9928 2507; fax: +33 2 9928 2529. erwan.donal{at}chu-rennes.fr

Abstract

Objective: We sought to compare the additive value of rightventricular (RV) function assessed by longitudinal systolicstrain ( $isin$ % – ROI: 9.2 at 10.8mm) with cardiopulmonary exercisetesting (CPET) or brain natriuretic peptide (BNP) in patientswith heart failure (HF).

Method: We studied 19-patients (age=56±8years) in NewYork Heart Association HF class III–IV, who underwentstandard and tissue Doppler echocardiography, CPET and BNP measurementson the same day. RV function was assessed by systolic strain( $isin$ , %, ROI: 9.2–10.8mm) in the mid-segment. Clinical outcomeswere examined at 6months.

Results: $isin$ (–19.9±6.8%) was correlated with BNP(R=0.52, P=0.02), slope VE/VCO₂ (R=–0.65, P=0.003), peakVO₂ (R=0.46, P=0.04) and the maximal workload (Watts) developedduring CPET (R=0.54, P=0.02). During follow-up, 1-patient died,1-underwent heart transplantation, and 4 were re-hospitalizedfor worsening HF. Patients with major adverse cardiac events(MACE) had a significantly higher mean BNP concentration (852.8ng/mL±1114.3vs. 201.4±293.8, P=0.03), higher VE/VCO₂ (41.3±3.6vs. 35.0±4.8 P<0.001) and lower $isin$ (–13.9±4.9vs. –22.2±5.8, P<0.001) than patients who remainedMACE-free. By multivariate analysis, ST was the only predictorof MACE.

Conclusion: In HF-patients presenting, RV-function assessedby systolic $isin$ was reliable, easily measurable and a strongerprognosticator than CPET or BNP.

Keywords: BNP brain natriuretic peptide; DTI Doppler tissue imaging; EF ejection fraction; HF heart failure; LV left ventricular; MACE major adverse clinical event; MPI myocardial performance index (Tei index); RV right ventricular; $isin$ strain; TAPSE maximal systolic excursion of the tricuspid annulus measured by M-mode echocardiography; TT Tissue tracking; VO_2max peak oxygen consumption during exercise; CPET cardiopulmonary exercise testing; ROI region of interest

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