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

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.694365

DOI=10.3389/fcvm.2021.694365

ISSN=2297-055X

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: 81 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 endpoint 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 were powerful predictors of poor outcomes, providing 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.