Prognostic Value of Right Ventricular 3D Speckle-Tracking Strain and Ejection Fraction in Patients With HFpEF

Yuanli Meng; Shuangshuang Zhu; Yuji Xie; Yanting Zhang; Mingzhu Qian; Lang Gao; Meng Li; Yixia Lin; Wenqian Wu; Jing Wang; Yali Yang; Qing Lv; Li Zhang; Yuman Li; Mingxing Xie

doi:10.3389/fcvm.2021.694365

Prognostic Value of Right Ventricular 3D Speckle-Tracking Strain and Ejection Fraction in Patients With HFpEF

Front Cardiovasc Med. 2021 Jun 30:8:694365. doi: 10.3389/fcvm.2021.694365. eCollection 2021.

Authors

Yuanli Meng^{1

2

3

4}, Shuangshuang Zhu^{1

2

3}, Yuji Xie^{1

2

3}, Yanting Zhang^{1

2

3}, Mingzhu Qian^{1

2

3}, Lang Gao^{1

2

3}, Meng Li^{1

2

3}, Yixia Lin^{1

2

3}, Wenqian Wu^{1

2

3}, Jing Wang^{1

2

3}, Yali Yang^{1

2

3}, Qing Lv^{1

2

3}, Li Zhang^{1

2

3

5}, Yuman Li^{1

2

3}, Mingxing Xie^{1

2

3

5

6}

Affiliations

¹ Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
³ Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
⁴ Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
⁵ Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen, China.
⁶ Wuhan National Laboratory for Optoelectronics, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Background: Right ventricular longitudinal strain of free wall (RV FWLS) assessed by two-dimensional speckle-tracking echocardiography (2D-STE) is recognized as an independent predictor of poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). However, the prognostic implications of three-dimensional STE (3D-STE) parameters in patients with HFpEF have not been well-established. The purpose of our study was to determine whether 3D-STE parameters were the more powerful predictors of poor outcomes in HFpEF patients compared with 2D-STE indices. Methods: Eighty-one consecutive patients with HFpEF were studied by 2D-STE and 3D-STE. RV volumes, ejection fraction (EF) and 3D-RVFWLS were measured by 3D-STE. 2D-RVFWLS was determined by 2D-STE. Patients were followed for the primary end point of heart failure (HF)-related hospitalization and death for HF. Results: After a median follow-up period of 17 months, 39 (48%) patients reached the end point of cardiovascular events. Compared with HFpEF patients without end-point events, those with end-point events had lower RVEF and 3D-RVFWLS (P < 0.05). Separate multivariate Cox regression analyses revealed that 3D-RVFWLS (HR 5.73; 95% CI 2.77-11.85; P < 0.001), RVEF (HR 3.47; 95% CI 1.47-8.21; P = 0.005), and 2D-RVFWLS (HR 3.17; 95% CI 1.54-6.53; P = 0.002) were independent predictors of adverse outcomes. The models with 3D-RVFWLS (AIC = 246, C-index = 0.75) and RVEF (AIC = 247, C-index = 0.76) had similar predictive performance for future clinical events as with 2D-RVFWLS (AIC = 248, C-index = 0.74). Conclusions: 3D-STE parameters are powerful predictors of poor outcomes, providing a similar predictive value as 2D-STE indices in patients with HFpEF. These findings support the potential of RV 3D-STE to identify HFpEF patients at higher risk for adverse cardiac events.

Keywords: heart failure with preserved ejection fraction; prognosis; right ventricular; speckle tracking echocardiography; strain.