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Prognostic value of right ventricular strain and peak oxygen consumption in heart failure with reduced ejection fraction

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Abstract

Our purpose is to evaluate the combined predictive value of cardiopulmonary exercise testing (CPET) and echocardiographic evidence of left ventricular (LV) and right ventricular (RV) strain in predicting mortality and heart transplant (HTx) in a series of outpatients with heart failure with reduced ejection fraction (HFrEF). A retrospective cohort study of 66 patients with HFrEF (median age, 57 years; 51% women) who underwent CPET and echocardiography (up to 90 days apart) to assess prognosis. The primary outcome was a composite of death and need for HTx. At a median follow-up of 27 [20–39] months, 19 patients (29%) experienced the primary outcome. In unadjusted analysis, most echocardiographic and CPET parameters were associated with the primary outcome, including percentage of predicted peak oxygen consumption (ppVO2), VE/VCO2 slope, LV ejection fraction, and LV and RV longitudinal strain. After adjusting for other clinical, echocardiographic and CPET variables, RV free wall longitudinal strain and ppVO2 remained significantly associated with the primary outcome. Kaplan–Meier survival curves for death and HTx, based on the best cutoff values, showed lower survival rates in patients with impairment in both ppVO2 and RV FW-LS than in those with one or neither parameter impaired (p < 0.001). RV dysfunction and low cardiorespiratory fitness were independent markers of death and need for HTx. Impairment of both ppVO2 and RV FW-LS had a strong additive impact on prognostic assessment in this cohort of patients with HFrEF.

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Acknowledgements

None.

Funding

This study was supported by the Research Incentive Fund (FIPE) of Hospital de Clínicas de Porto Alegre, Brazil. The sponsor had no participation in the design or conduct of the study, nor in the preparation or approval of the manuscript.

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Authors and Affiliations

  1. Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Willian Roberto Menegazzo, Angela Barreto Santiago Santos, Murilo Foppa, Fernando Luis Scolari, Fernando Colares Barros, Ricardo Stein & Anderson Donelli da Silveira

  2. Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

    Willian Roberto Menegazzo, Angela Barreto Santiago Santos, Murilo Foppa, Fernando Luis Scolari & Anderson Donelli da Silveira

  3. Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

    Ricardo Stein

  4. Research Group in Exercise Cardiology (Cardio-Ex), Porto Alegre, RS, Brazil

    Ricardo Stein & Anderson Donelli da Silveira

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  1. Willian Roberto Menegazzo
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  2. Angela Barreto Santiago Santos
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Contributions

WRM and ADS contributed to the conception or design of the work; acquisition, analysis, and interpretation of the work and drafted the manuscript. ABSS, MF, FLS, FCB and RS contributed to the conception or design of the work; acquisition, analysis, and interpretation of the work. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

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Correspondence to Willian Roberto Menegazzo.

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None declared.

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The study followed the tenets of the Declaration of Helsinki and was approved by the local Research Ethics Committee.

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Informed consent was waived due to the non-interventional design of the study and retrospective nature of data collection. All investigators signed a data use agreement to ensure the ethical and secure use of the data.

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Menegazzo, W.R., Santos, A.B.S., Foppa, M. et al. Prognostic value of right ventricular strain and peak oxygen consumption in heart failure with reduced ejection fraction. Int J Cardiovasc Imaging 39, 501–509 (2023). https://doi.org/10.1007/s10554-022-02747-0

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  • DOI: https://doi.org/10.1007/s10554-022-02747-0

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