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Observational Study
. 2024 Dec 20;19(12):e0314235.
doi: 10.1371/journal.pone.0314235. eCollection 2024.

Right ventricle free wall longitudinal strain screening of lung transplant candidates

Vittorio Scaravilli  1   2 , Silvia Scansani  1 , Paolo Meani  3   4 , Gloria Turconi  3 , Amedeo Guzzardella  3 , Marco Bosone  3 , Claudia Bonetti  3 , Marco Vicenzi  5   6 , Letizia Corinna Morlacchi  7 , Valeria Rossetti  7 , Lorenzo Rosso  3   5 , Francesco Blasi  3   7 , Mario Nosotti  3   5 , Giacomo Grasselli  1   2   3
Affiliations
Observational Study

Right ventricle free wall longitudinal strain screening of lung transplant candidates

Vittorio Scaravilli et al. PLoS One. .

Abstract

Background: Lung transplant (LUTX) candidates have subclinical right ventricular (RV) dysfunction, which has not yet been assessed by speckle-tracking echocardiography (STE)-derived RV free-wall longitudinal strain (RVFWLS). To evaluate the prevalence of RV dysfunction by RVFWLS and its relationship with conventional RV echocardiographic indexes in LUTX candidates.

Methods: In a single-center prospective observational cohort study, from January 2021 to March 2023 consecutive LUTX candidates underwent cardiac catheterization, radionuclide ventriculography, standard and STE. The diagnostic accuracy of RV ejection fraction by ventriculography (RVEF), tricuspid annular plane excursion (TAPSE), fractional area change (FAC), tricuspid peak annulus systolic velocity (S') versus RVFWS were computed.

Results: Thirty-four patients (female, 41%) with a mean age of 48 [36-59] years old enlisted for pulmonary fibrosis (35%) and cystic fibrosis (30%) were included. At cardiac catheterization, only 7 (23%) had pulmonary hypertension. Around 15-25% presented right heart enlargement. Tricuspid regurgitation was present in 20 (60%) of the patients. Median RVFWLS was -20.1% [-22.5%--17%], being impaired (> -20%) in 16 (47%) of the patients. RVFWLS identified the highest percentage (47%) of RV dysfunction, compared to TAPSE (32%), S' (27%), FAC (26%), and ventriculography (15%), which had very low sensitivity for detecting RV dysfunction compared to RVFWLS.

Conclusions: In patients enlisted for LUTX, RV dysfunction assessed by STE-derived RVFWLS is highly prevalent. STE can detect RV dysfunction better than standard two-dimensional echocardiography and ventriculography. Further studies are urgently needed to define the clinical implications and the prognostic value of RV dysfunction measured with RVFWLS.

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Conflict of interest statement

The Fondazione per la Ricerca sulla Fibrosi Cistica supported the study (# FFC 27/2019), and in particular the project was adopted by the Delegazione FFC di Napoli San Giuseppe Vesuviano and the Delegazione FFC di Como Dongo). The first author Dr. Vittorio Scaravilli received from the aforementioned grant support for publication and congress participation. Prof. Giacomo Grasselli received payment for lectures from Thermo-Fisher and Pfizer Pharmaceuticals and travel-accommodation-congress support from Biotest (all these relationships are unrelated with the present work). Moreover, this study was (partially) funded by Italian Ministry of Health – Current Research IRCCS. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patients recruitment flowchart.
LUTX: lung transplantation. RV: right ventricle.
Fig 2
Fig 2. The superior diagnostic capabilities of strain imaging in detecting right ventricular systolic dysfunction compared to standard two-dimensional echocardiography in a lung transplant candidate.
The apical RV-focused view is depicted in the left upper panel, which is central for both two-dimensional and speckle-tracking echocardiographic imaging evaluation. On the right upper panel, the right ventricle tissue Doppler imaging is shown, and the peak systolic velocity wave (S’) is measured. As in most of the lung transplant candidates in our cohort, S’ value is normal (13 cm/s). On the lower left panel, M-mode imagining on the tricuspid annular plane excursion (TAPSE) is shown. Similarly to S’, the TAPSE value is normal (18 mm). On the right lower panel, speckle-tracking echocardiography of the right ventricle was carried out, and the RV free wall longitudinal strain (RWFLS) was calculated with a significantly impaired value (-13.7%).
Fig 3
Fig 3. Linear correlations between right ventricle systolic strain and standard RV systolic echocardiographic analyses.
FAC, fractional area change; RV TVI S’, pulsed-wave tissue Doppler imaging tricuspid peak annulus systolic velocity; TAPSE, tricuspid annular plane excursion; RV, right ventricle.
Fig 4
Fig 4. Distribution of right ventricular systolic impairment according to different measures.
RVEF, right ventricle ejection fraction derived by multi-gated radionuclide ventriculography; FAC, fractional area change; RV TVI S’, pulsed-wave tissue Doppler imaging tricuspid peak annulus systolic velocity; TAPSE, tricuspid annular plane excursion, RVFWLS, right ventricle free wall longitudinal strain.
See this image and copyright information in PMC

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