Right Ventricular Global Longitudinal Strain Is an Independent Predictor of Right Ventricular Function: A Multimodality Study of Cardiac Magnetic Resonance Imaging, Real Time Three-Dimensional Echocardiography and Speckle Tracking Echocardiography

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 32; no. 6; pp. 966 - 974
• Main Authors: Lu, Ken J., Chen, Janet X. C., Profitis, Konstantinos, Kearney, Leighton G., DeSilva, Dimuth, Smith, Gerard, Ord, Michelle, Harberts, Susan, Calafiore, Paul, Jones, Elizabeth, Srivastava, Piyush M.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2015
• Subjects: Computer Systems; Echocardiography, Three-Dimensional - methods; Elastic Modulus; Elasticity Imaging Techniques - methods; Female; Heart Ventricles - diagnostic imaging; Heart Ventricles - pathology; Heart Ventricles - physiopathology; Humans; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Multimodal Imaging - methods; real time three-dimensional echocardiography; Reproducibility of Results; right ventricular assessment; right ventricular strain; Sensitivity and Specificity; speckle tracking echocardiography; Stress, Mechanical; Stroke Volume; Tensile Strength; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - physiopathology; right ventricular assessment; real time three-dimensional echocardiography; right ventricular strain; speckle tracking echocardiography
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.12783

Objectives Accurate assessment of right ventricular (RV) systolic function is important, as it is an established predictor of mortality in cardiac and respiratory diseases. We aimed to compare speckle tracking–derived longitudinal deformation measurements with traditional two‐dimensional (2D) echocardiographic parameters, as well as real time three‐dimensional echocardiography (RT3DE) and cardiac magnetic resonance imaging (CMR)‐derived RV volumes and ejection fraction (EF). Method Subjects referred for CMR also underwent echocardiography. On both RT3DE and CMR, we measured RV volumes and EF. On 2D echocardiography, we analyzed RV fractional area change, RV internal diastolic diameter, tricuspid annular plane systolic excursion, tricuspid annular tissue Doppler–derived velocity, myocardial performance index, and RV global longitudinal strain (RV GLS). Results Sixty subjects were recruited (mean age = 45 ± 10 years; 60% male). RV GLS (R = −0.69, P < 0.001) and RT3DE RVEF (R = 0.56, P < 0.001) correlated well with CMR RVEF. RT3DE RV end‐diastolic (RVEDV) and end‐systolic (RVESV) volumes also correlated with CMR RV volumes: RVEDV, R = 0.74, P < 0.001 and RVESV, R = 0.84, P < 0.001. In addition, RV GLS best predicted the presence of RV dysfunction, defined as RVEF <48% on CMR (hazard ratio = 7.0 [1.5–31.7], P < 0.01). On receiver operator characteristic analysis, a RV GLS of −20% was the most sensitive and specific predictor of RV dysfunction (AUC 0.8 [0.57–1.0], P < 0.02). Conclusion RVEF and volumes estimated on RT3DE were closely correlated with CMR measurements. When compared to more traditional markers of RV systolic function and RT3DE, RVGLS produced the highest correlation with CMR RVEF and was a good predictor of RV dysfunction. RV GLS should be considered a complementary modality to RT3DE and CMR in the assessment of RV systolic function.