P779 Use of right ventricular strain analysis to detect right ventricle subtle dysfunction in patients with left ventricular ischemic cardiomyopathy
Authors: Darweesh R , Darweesh REHAM , El Aroussy WAFAA , El Aghaa ABDALL , Farrag AZZA , Youssry DINA , Ahmed KAMAL 
Published: January 2020

Back ground

Right ventricular (RV) systolic dysfunction is an independent prognostic marker of several cardiovascular diseases. Cardiac magnetic resonance imaging (CMR) is a gold standard for evaluation of RV ejection fraction and RV structure. However, the CMR is not available in all institution. So some researchers use strain echocardiography to evaluate RV systolic function

Purpose

Evaluation of different RV functions and prevalence of RV dysfunction in patients with ischemic cardiomyopathy (ICM) (EF &lt; 50%), using echocardiographic conventional methods and RV strain analysis

Methods

All our patients had ischemic cardiomyopathy (ICM) (EF&lt; 50), patients with previous inferior myocardial infarction were excluded. A standard comprehensive transthoracic echocardiographic assessment of the RV dimensions, conventional systolic parameters: TAPSE, fractional area change FAC, S" velocity, myocardial performance index (RV MPI- RV Tie index ) and diastolic parameters (E/A, E/E", DT). 2 Dimensional speckle tacking echocardiography (2D-STE) for right ventricular global strain analysis (RVGLS): RVGLS total and RVGLS free wall (RVGLS total is a measurement obtained from the average value of all six segments values and RVGLS free wall is the average value from three RV free wall segments) , RV and LV peak systolic strain rate (RV SRs, LV SRs) and early diastolic strain rate (RV SRe, LV SRe) were measured.

Results : we enrolled 50 patients (out of 1026 patients over one year ) 37 males (74%) , mean age 60.8 ± 7.4 years, according to RV strain analysis patients were divided into two groups, group I : patients who had normal RV function (RV free wall peak systolic strain PSS ≤-20%), and group II : had impaired RV function (RV free wall PSS &gt;-20%) .

there was no statistically significant difference between the two groups as regards LV dimensions, LV EF, LV GLS , LV SRs, RV dimensions nor other RV conventional parameters as TAPSE, FAC, S", or RV MPI. However mean RV GLS in group (I) was -17.52 ± 8.60 % vs -11.66 ± 3.25 % in group (II), (p = 0.003). Mean RV SRs in group (I) was -1.02 ± 0.27 /s vs -0.74 ± 0.38 /s in group (II), (p = 0.001)

There was a statistically significant correlation between RV MPI and RV GLS (r = 0.315, p = 0.026), RVSRs and RV GLS (r = 0.656, p &lt; 0.001) and between RV SRs and RVGLS free wall (r = 0.631, p &lt; 0.001). There was a statistically significant correlation between RV SRs and RVGLS free wall in group (I) (r = 0.693, p &lt; 0.001) and in group (II) (r = 0.819, p &lt; 0.001).

There was no agreement between TAPSE and RV GLS free wall (Kappa 0.063, p 0.2). MPI was the only conventional parameter that correlated with RV GLS free wall (p0.026).

Conclusion

RVGLS is a global, more sensitive parameter of RV systolic function compared to commonly used conventional parameters,it correlates better with RV systolic function and may have a more prognostic power for detection of subtle RV dysfunction.