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. 2025 Jul 8:12:1611772.
doi: 10.3389/fcvm.2025.1611772. eCollection 2025.

Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation

Călin-Dinu Hădăreanu  1   2 , Diana-Ruxandra Hădăreanu  3   4 , Despina-Manuela Toader  4 , Maria-Livia Iovănescu  3   4 , Cristina Florescu  3   5 , Victor-Cornel Raicea  2   3 , Ionuț Donoiu  3   4
Affiliations

Prognostic value of the ratio between right ventricular free wall longitudinal strain and systolic pulmonary artery pressure in patients with heart failure with reduced ejection fraction and ventricular secondary mitral regurgitation

Călin-Dinu Hădăreanu et al. Front Cardiovasc Med. .

Abstract

Background: In heart failure (HF) with reduced ejection fraction (HFrEF), ventricular secondary mitral regurgitation (V-sMR) leads to progressive impairment of right ventricular (RV) function and adversely affects outcomes. Non-invasive indices of RV-pulmonary artery (RVPA) coupling may offer enhanced prognostic value.

Methods: We retrospectively evaluated advanced echocardiographic surrogates of RVPA coupling in 104 HFrEF patients with V-sMR.

Results: Over a median follow-up of 526 days, 48 patients (46.2%) reached the composite endpoint of rehospitalization for HF decompensation or all-cause mortality. Patients who experienced events had significantly larger RV volumes, lower RV functional indices, and higher systolic pulmonary artery pressure (sPAP) compared with those without events. Among the RVPA coupling measures, the ratio of RV free-wall longitudinal strain (RVFWLS) to sPAP had the highest predictive accuracy (area under the curve 0.730), with an optimal cut-off of 0.46%/mmHg (71% sensitivity, 69% specificity). Kaplan-Meier analysis showed significantly lower event-free survival for patients with RVFWLS/sPAP < 0.46%/mmHg (log-rank p = 0.001). In multivariable Cox regression analysis, RVFWLS/sPAP (hazard ratio 0.110, 95% confidence interval 0.012-0.992; p = 0.049) emerged as an independent predictor of adverse outcomes.

Conclusion: The RVFWLS/sPAP ratio, with a cut-off value of 0.46%/mmHg, is a robust, independent prognostic marker in HFrEF patients with V-sMR.

Keywords: heart failure with reduced ejection fraction; prognosis; right ventricular strain to pulmonary artery pressure; right ventricular to pulmonary artery coupling; speckle-tracking echocardiography; three-dimensional echocardiography; ventricular secondary mitral regurgitation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart describing patients’ selection process.
Figure 2
Figure 2
Receiver operating characteristic curve for comparison of the prognostic value between echocardiographic right ventricular to pulmonary artery coupling indices. AUC, area under the curve; CI, confidence interval; RVEF, right ventricular ejection fraction; RVFAC, right ventricular fractional area change; RVFWLS, right ventricular free wall longitudinal strain; RVSV/ESV, right ventricular stroke volume to end-systolic volume; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annulus plane systolic excursion.
Figure 3
Figure 3
Kaplan–Meier event-free survival curves stratified by RVFWLS/sPAP < and ≥ 0.46%/mmHg. RVFWLS, right ventricular free wall longitudinal strain; sPAP, systolic pulmonary artery pressure.
See this image and copyright information in PMC

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