Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. Several RV imaging parameters have been proposed to detect patients at risk new-onset acute heart failure. The objective of our study was to compare the predictive value of main RV systolic parameters for outcome.

Seventy nine patients who underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance imaging (CMR) and tomographic equilibrium radio nuclide ventriculography (ERV) for the assessment of RV function were retrospectively included. The composite was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device or new-onset acute heart failure.

Mean NYHA class and left ventricular ejection fraction were 1.7±0.9 and 46±17%, respectively. During a mean follow-up of 13±9 months, 13 (20%) patients reached the composite primary end-point. The areas under the receiver operator characteristic curves for the prediction of MACE were 0.922 (P<0.0001), 0.913 (P<0.0001), 0.906 (P<0.0001), 0.849 (P=0.002), 0.837 (P=0.003), 0,799 (P=0.009), 0.792 (P=0.011), 0.753 (P=0.026), 0.720 (P=0.053) and 0.608 (0.346) for integral systolic S’ wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S’ wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively.

Among comprehensive cardiovascular imaging modalities allowing the assessment of RV function, echocardiographic parameters, and particularly integral systolic S’ wave tricuspid annular velocity and RVFWLS, have the best prognostic performance and the best rater reliabilities.