162 Right ventricular function: is longitudinal strain by speckle-tracking an option?

Abstract Introduction Estimation of right ventricular (RV) performance by echocardiography is challenging due to its anatomical and functional distinctiveness. RV longitudinal strain (RVLS) by speckle-tracking (STE) is an innovative tool and recent studies show that it can be used with prognostic significance, although it isn’t yet standardized. Purpose In this study, we aimed to evaluate global (G) and free wall (FW) RVLS-STE and its correlation with common RV evaluation methods. Methods We conducted a prospective observational study including 65 patients and 20 healthy controls. G and FW RVLS-STE were correlated to tricuspid annular plane systolic excursion (TAPSE), Doppler tissue tricuspid lateral annular systolic velocity (S`) and left ventricle ejection fraction (LVEF). Following current guidelines, a TAPSE higher than 17mm, a peak S` wave velocity higher than 9.5cm/s and a RVLS-STE inferior to -20% was considered normal. Results Mean age was 66.34 ± 15.45 years with 61.5% males in the patient group and 31.1 ± 7 years with 50% males in the control group. Echocardiographic findings in patient group included 44.6% with reduced LVEF (EF < 50%), 26.2% with moderate to severe valvular disease, 23% with an elevated systolic pulmonary pressure (> 35mmHg) and 36.9% without significant structural disease. The control group had no pathological signs on echocardiography. Peak S` wave and TAPSE showed a better correlation with FW RVLS-STE (r²=0.41, p < 0.001 and r²=0.46, p < 0.001) than G RVLS-STE (r²=0.27, p < 0.001 and r²=0.30, p < 0.001). A high absolute FW RVLS-STE (< -20%) was a good marker of a normal TAPSE and a normal peak S` wave velocity, with a negative predictive value of 87% and 98% respectively. Comparing to control group, patients with reduced LVEF showed a reduction in TAPSE (27.6 mm vs 18.53 mm, p < 0.001), S` (14.8 cm/s vs 10.84 cm/s, p < 0.001) and FW RVLS-STE (-28.7% vs -15.34%, p < 0.001). Patients with moderate to severe valvular disease also showed a reduction in TAPSE (27.6 mm vs 18.4 mm, p < 0.001), S` (14.8 cm/s vs 10.3 cm/s, p < 0.001) and FW RVLS-STE (-28.7% vs -16.04%, p < 0.001). And finally, patients with elevated systolic pulmonary pressure also showed a reduction in TAPSE (27.6 mm vs 17.94 mm, p < 0.001), S` (14.8 cm/s vs 10.47 cm/s, p < 0.001) and FW RVLS-STE (-28.7% vs -16.7%, p < 0.001). Conclusion FW RVLS-STE is better than G RVLS-STE as a RV evaluation method. RVLS-STE is correlated with TAPSE and peak S` wave velocity. It was the only parameter that showed reduction to abnormal values (> -20%) in pathological groups and seems to be an accurate marker of RV function particularly detecting early dysfunction