Right Ventricular Longitudinal Strain and Right Ventricular Stroke Work Index in Patients With Severe Heart Failure: Left Ventricular Assist Device Suitability for Transplant Candidates

• Published in: Transplantation proceedings 2012-09, Vol.44 (7), p.2013-2015
• Main Authors: Cameli, M, Bernazzali, S, Lisi, M, Tsioulpas, C, Croccia, M.G, Lisi, G, Maccherini, M, Mondillo, S
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiac Catheterization; Echocardiography, Doppler, Color; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart Failure - physiopathology; Heart Transplantation; Heart-Assist Devices; Humans; Male; Medical sciences; Middle Aged; Neurology; Sensitivity and Specificity; Stroke Volume; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.06.018

Abstract Background Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed the analysis of RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed to explore the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) among patients referred for cardiac transplantation. Methods Right heart catheterization and transthoracic echo-Doppler were simultaneously performed in 47 patients referred for cardiac transplant assessment due to refractory heart failure (ejection fraction 25.1 ± 4.5%). Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging RV free-wall segments (free-wall RVLS). We also calculated. Tricuspid S' and tricuspid annular plane systolic excursion (TAPSE). Results No significant correlation was observed for TAPSE on tricuspid S' with RV stroke volume (r = 0.14 and r = 0.06, respectively). A close negative correlation between free-wall RVLS and RVSWI was found (r = −0.82; P < .0001). Furthermore, free-wall RVLS showed the highest diagnostic accuracy (area under the curve of 0.90) with good sensitivity and specificity of 95% and 91%, respectively, to predict depressed RVSWI using a cutoff value less than −11.8%. Conclusions Among patients referred for heart transplantation, TAPSE and tricuspid S' did not correlate with invasively obtained RVSWI. RV longitudinal deformation analysis by STE correlated with RVSWI, providing a better estimate of RV systolic performance.