Speckle-tracking echocardiographic evaluation of the right ventricle in patients with ischemic left ventricular dysfunction

Abstract

Background: The comprehensive assessment of right ventricular (RV) performance is of paramount importance because it is has been recognized as a strong prognostic factor in a variety of clinical settings. The aim herein was to evaluate the usefulness of RV longitudinal strain imaging by speckle-tracking echocardiography (STE) in daily clinical practice, especially in the context of RV systolic function and its changes after acute coronary syndrome (ACS).

Methods: This prospective study enrolled 63 patients with ischemic injury (left ventricular ejection fraction [LVEF] ≤ 45%). Additionally, a subgroup was created: patients with ACS treated with successful percutaneous coronary intervention. The clinical and echocardiographic parameters, including STE, were analyzed.

Results: Significant correlations for both RV free-wall (RVFWSL) and four-chamber (RV4CSL) longitudinal strain evaluated by STE with New York Heart Association class, LVEF, E/E' ratio, as well as conventional parameters of RV function were found. RVFWSL was able to detect subtle RV functional abnormalities, unreachable for traditional indices. RV recovery after ACS was not related to higher LVEF but better contractility of the interventricular septum (IVS) assessed by STE.

Conclusions: Right ventricular strain proved to be a useful two-dimensional echocardiographic method to detect impaired RV performance, which showed a significant relationship with clinical and other echocardiographic indices. The IVS played a vital role in RV recovery among ACS survivors.

Keywords: acute coronary syndrome; left ventricular fraction; longitudinal strain; right ventricle; speckle-tracking echocardiography.

Figure 1

Analysis of correlation between RV4CSL 1 and RV4CSL 2; RV4CSL 1 — right ventricular four-chamber longitudinal strain as the arithmetic mean of the segmental peak systolic strain values displayed by the software, RV4CSL 2 — right ventricular four-chamber longitudinal strain as the mean strain from the averaged strain curve of all segments.

Figure 2

Right ventricle (RV) dysfunction assessed by RVFWSL in patients with normal tricuspid annular plane systolic excursion (TAPSE) and S’; RVFWSL — right ventricular free-wall longitudinal strain, S’ — Doppler tissue imaging-derived tricuspid lateral annular systolic velocity.