Evaluation of right heart function in heart failure patients using strain imaging and three-dimensional echocardiography

Introduction
Right heart function is an important predictor of morbidity and mortality in patients with cardiovascular diseases having left ventricular (LV) systolic dysfunction.
Aim
Assessment of right ventricular (RV) and right atrial (RA) functions in heart failure patients using strain imaging and three-dimensional echocardiography.
Patients and methods
This study included 60 patients (group I) having LV systolic dysfunction with LV ejection fraction less than or equal to 40% in addition to 20 healthy participants (group II) as a control group. LV measures included 2D and 3D-LV ejection fraction, LV-Tei index, and 2D and 3D-LV global longitudinal strain. RV measures included RV dimensions, RV fractional area change, RV-Tei index, 2D-RV global longitudinal strain, 3D-RV ejection fraction, 3D-average longitudinal strain for both interventricular septum, and RV free wall (3D-RVLS-sept and 3D-RVLS-FW, respectively). RA measures included RA dimensions, RA passive, active and total emptying volumes and fractions, peak RA longitudinal, and contractile strain. Parameters of LV, RV, and RA functions were compared between groups I and II.
Results
RV and RA dimensions and volumes, and LV-Tei and RV-Tei indexes were significantly higher in group I compared with group II. All other parameters of LV, RV, and RA function except RA-active emptying volumes were significantly lower in group I compared with group II. Cutoff values for parameters of RV and RA function showed good sensitivity and specificity to discriminate group I from group II. Cutoff points were 19.9% for 2D-RV global longitudinal strain, 46.4% for 3D-RV ejection fraction, 11.7% for 3D-RVLS-sept, 18.6% for 3D-RVLS-FW, 29.2% for peak RA longitudinal, and 17.1% for peak RA contractile strain. Sensitivity ranged from 78.3 to 96.7% and specificity ranged from 85 to 100% with a value of less than 0.001.
Conclusion
RV and RA functions are impaired in heart failure patients with LV systolic dysfunction. Both 3D and strain imaging are good echo modalities in the evaluation of right heart function.