RV Longitudinal Deformation Correlates With Myocardial Fibrosis in Patients With End-Stage Heart Failure

JACC Cardiovasc Imaging. 2015 May;8(5):514-522. doi: 10.1016/j.jcmg.2014.12.026. Epub 2015 Apr 15.


Objectives: This study was performed to determine the accuracy of right ventricular (RV) longitudinal strain (LS) in predicting myocardial fibrosis in patients with severe heart failure (HF) undergoing heart transplantation.

Background: RVLS plays a key role in the evaluation of its systolic performance and clinical outcome in patients with refractory HF.

Methods: We studied 27 patients with severe systolic HF (ejection fraction ≤25% and New York Heart Association functional class III to IV, despite full medical therapy and cardiac resynchronization therapy) using echocardiography before heart transplantation. RV free wall LS, right atrial LS, sphericity index (SI), and tricuspid annular plane systolic excursion (TAPSE) were all measured. Upon removal of the heart, from the myocardial histologic analysis, the ratio of the fibrotic to the total sample area determined the extent of fibrosis (%).

Results: RV myocardial fibrosis correlated with RV free wall LS (r = 0.80; p < 0.0001), SI (r = 0.42; p = 0.01) and VO2 max (r = -0.41; p = 0.03), with a poor correlation with TAPSE (r = -0.34; p = 0.05) and right atrial LS (r = -0.37; p = 0.03). Stepwise multivariate analysis showed that RV free wall LS (β = 0.701, p < 0.0001) was independently associated with RV fibrosis (overall model R(2) = 0.64, p < 0.0001). RV free wall LS was the main determinant of myocardial fibrosis. In the subgroup of patients with severe RV fibrosis, RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (area under the curve = 0.87; 95% confidence interval: 0.80 to 0.94).

Conclusions: In late-stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate functional measure that correlates with the extent of RV myocardial fibrosis and functional capacity.

Keywords: heart failure; myocardial fibrosis; right ventricle.

MeSH terms

  • Area Under Curve
  • Biomechanical Phenomena
  • Biopsy
  • Echocardiography, Doppler, Pulsed
  • Female
  • Fibrosis
  • Heart Failure / diagnostic imaging
  • Heart Failure / pathology*
  • Heart Failure / physiopathology*
  • Heart Failure / surgery
  • Heart Transplantation
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Contraction*
  • Myocardium / pathology*
  • Predictive Value of Tests
  • ROC Curve
  • Risk Factors
  • Severity of Illness Index
  • Ventricular Dysfunction, Right / diagnostic imaging
  • Ventricular Dysfunction, Right / pathology*
  • Ventricular Dysfunction, Right / physiopathology*
  • Ventricular Dysfunction, Right / surgery
  • Ventricular Function, Left
  • Ventricular Function, Right*