Comprehensive evaluation of right ventricular function in patients with chronic heart failure and pulmonary hypertension

Right ventricular (RV) dysfunction plays a significant role in the progression, complications, and outcomes of chronic heart failure (CHF). Timely diagnosis of RV dysfunction allows for therapeutic adjustments and helps prevent adverse disease outcomes.

Objective. To determine the diagnostic value and reproducibility of RV longitudinal strain parameters for detecting RV dysfunction in patients with CHF and pulmonary hypertension (PH) using two-dimensional speckle-tracking echocardiography.

Materials and Methods. A total of 41 patients with CHF due to coronary heart disease or dilated cardiomyopathy and signs of PH, by transthoracic echocardiography, were examined. The mean age was 69.2 ± 10.1 years; 12 (29%) were women, and 29 (71%) were men. Left ventricular ejection fraction (LVEF) remained normal in most CHF patients (65.9%). Echocardiographic assessment included standard RV function parameters, as well as longitudinal strain (RV global longitudinal systolic strain (RVGLS) and RV longitudinal systolic free wall strain (RVFWLS)). The control group comprised 31 individuals with no signs of cardiac dysfunction at rest (mean age: 57.9 ± 12.2 years). The reproducibility of RVGLS and RVFWLS measurement method was evaluated by analyzing inter- and intra-operator variability.

Results. A significant decrease in all RV systolic function parameters was observed in CHF and PH patients (p < 0.0001). RV function parameters were lower in patients with reduced left ventricular ejection fraction. ROC analysis demonstrated high sensitivity and specificity of RVGLS and RVFWLS in detecting RV dysfunction. The assessment of inter- and intra-operator variability, as well as the intraclass correlation coefficient, confirmed the good reproducibility of RV longitudinal strain measurement method.

Conclusions. A comprehensive evaluation of RV function using strain imaging techniques in patients with CHF and PH improves the detection of RV dysfunction.

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