Prognostic value of RV isovolumic acceleration and tissue strain in moderate HFrEF

Right ventricular (RV) dysfunction in heart failure (HF) with reduced left ventricular ejection fraction (LVEF) is associated with a poorer prognosis. No studies to date have investigated the prognostic utility of RV isovolumic acceleration (IVA) measured at tissue Doppler imaging (TDI) in HF. RV strain instead has been already correlated to a poorer prognosis in these patients. We aimed to assess the predictive value of both parameters in this context.

Sixty patients enrolled, NYHA II-III. Everyone underwent echocardiographic examination including TDI and strain analysis. Adverse event was defined as cardiovascular death or rehospitalization.

Follow-up was 32 ± 13 months. Sixteen patients (26·7%) had an adverse event. IVA and RV strain were significantly lower in these patients. At logistic regression, they were both related to adverse event and their receiver operating characteristic (ROC) curve predictive (area under ROC 0·916 and 0·952, respectively). Kaplan-Meier survival curves were significantly worse for both parameters inferior to their respective means (P < 0·001 for both). Univariate and multivariate analyses confirmed their better utility than tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) or S' at TDI.

our study demonstrated a useful prognostic role of RV strain and IVA, which are parameters of subclinical RV impairment. Patients with low values may benefit from a more aggressive therapy and a closer follow-up.