Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes - 03/07/24
, Noela Radu, MD c, d, Andrea Cascella, MD e, Denisa Muraru, MD, PhD c, e, Bálint Lakatos, MD, PhD a, Alexandra Fábián, MD, PhD a, Márton Tokodi, MD, PhD a, Michele Tomaselli, MD e, Mara Gavazzoni, MD e, Francesco Perelli, MD e, Béla Merkely, MD, PhD a, Luigi P. Badano, MD, PhD c, e, Elena Surkova, MD, PhD f, gAbstract |
Aims |
Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes.
Methods |
We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17 mm, FAC <35%, FWLS >−20%) considered.
Results |
Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P < .005).
Conclusion |
Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available.
Il testo completo di questo articolo è disponibile in PDF.Graphical abstract |
Outline and outcome measures of our study. FAC, Fractional area change; FWLS, free-wall longitudinal strain; RV, right ventricle; RVEF, right ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.
Central IllustrationOutline and outcome measures of our study. FAC, Fractional area change; FWLS, free-wall longitudinal strain; RV, right ventricle; RVEF, right ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Il testo completo di questo articolo è disponibile in PDF.
Highlights |
• | RV dysfunction cutoffs of 2D echo parameters are modestly associated with RVEF ˂45%. |
• | RVEF-based reclassification of RV dysfunction is associated with different outcomes. |
• | Impaired values of FWLS show the closest association with the RVEF cutoff. |
• | A multiparametric approach is the preferred option when 3D echo is not available. |
Keywords : 2D echocardiography, 3D echocardiography, Right ventricular ejection fraction, Tricuspid annular plane systolic excursion, Free-wall longitudinal strain, Fractional area change
Abbreviations : 2D, 3D, 3DE, ACS, AUC, DCM, EDAi, EDVi, EF, ESAi, ESVi, FAC, FWLS, HR, HTX, ICD, LV, ROC, RV, RVEF, RVSP, SVi, TAPSE
Mappa
| Drs. Tolvaj and Kovács contributed equally to this work. Drs. Badano and Surkova contributed equally to this work. |
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| Lawrence Rudski, MD, served as guest editor for this article. |
Vol 37 - N° 7
P. 677-686 - luglio 2024 Ritorno al numero
Articolo precedente
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