Copyright © 2007, The European Society of Cardiology
Echocardiographic right ventricular strain analysis in chronic heart failure
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
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Abstract |
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Objective: We sought to compare the additive value of right ventricular (RV) function assessed by longitudinal systolic strain (
% – ROI: 9.2 at 10.8mm) with cardiopulmonary exercise testing (CPET) or brain natriuretic peptide (BNP) in patients with heart failure (HF).
Method: We studied 19-patients (age=56±8years) 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 (, %, ROI: 9.2–10.8mm) in the mid-segment. Clinical outcomes were examined at 6months.
Results: (–19.9±6.8%) was correlated with BNP (R=0.52, P=0.02), slope VE/VCO2 (R=–0.65, P=0.003), peak VO2 (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 (852.8ng/mL±1114.3 vs. 201.4±293.8, P=0.03), higher VE/VCO2 (41.3±3.6 vs. 35.0±4.8 P<0.001) and lower (–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 was reliable, easily measurable and a stronger prognosticator 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; strain; TAPSE maximal systolic excursion of the tricuspid annulus measured by M-mode echocardiography; TT Tissue tracking; VO2max peak oxygen consumption during exercise; CPET cardiopulmonary exercise testing; ROI region of interest