Value of TAPSE normalized to right ventricular length as a substitute to speckle tracking-derived right ventricular free wall longitudinal strain assessment

Abstract

\n \n \n Type of funding sources: None.\n \n \n \n The diagnostic and prognostic value of right ventricular strain assessed by speckle-tracking imaging (STI-RV) has recently emerged in various clinical situations and this parameter has been incorporated into echocardiographic guidelines. However, it suffers from several limitations including the fundamental but often unmet requirement of good image quality and from the need for dedicated software with inter-vendor variability.\n \n \n \n We hypothesized that RV free wall (fw) longitudinal shortening, i.e. the ratio of tricuspid annular plane systolic excursion (TAPSE) to end-diastolic RV longitudinal length (RVDL) could be used as a surrogate of RVfw strain, without suffering from the abovementioned limitations. We therefore compared -(TAPSE/RVDL) to STI-RVfw strain in a series of non-selected patients undergoing echocardiography.\n \n \n \n 144 consecutive ≥18 y-o patients in sinus rhythm referred to our echocardiographic laboratory underwent transthoracic echocardiography using a Vivid E9 platform (GE Vingmed, Horten, Norway). STI-RVfw strain was obtained using a RV focused apical four chamber view and -(TAPSE/RVDL) was obtained from the apical four-chamber view. \xa0Images and loop were stored digitally and analyzed offline using EchoPac 2.02 software (GE Vingmed).\n \n \n \n Poor image quality precluded the assessment of STI-RVfw strain - but not of -(TAPSE/RVDL) - in 27 patients (18.8%) and of both parameters in 4 patients (2.8%); the study group consisted in the remaining 113 patients. Among all tested RV function indices, -(TAPSE/RVDL) best correlated\xa0with STI-RVfw strain (Panel A), without significant bias between the two methods (Panel B). The area under the ROC-curve for -(TAPSE/RVDL) to detect abnormal STI-RVfw strain (using a threshold of -20.2%) was 0.97 [IC 95% 0.94-1], and sensitivity, specificity, negative and positive predictive value were 83%, 96%, 96%, and 83%, respectively.\n \n \n \n In this unselected series of patients, the assessment of -(TAPSE/RVDL) performed reasonably well to predict abnormal STI-RVfw strain and was more often feasible than the latter. Its prognostic value should be prospectively tested.\n Abstract Figure 1\n