Three-dimensional versus two-dimensional derived strain echocardiography for assessing right ventricular myocardial deformation in patients with chronic left ventricular heart failure: A proof-of-concept study

Abstract Background: A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain.Methods: Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV.Results: 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p<0.001), and it correlated well with cardiac magnetic resonance-derived RVEF (r=0.74, p-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p<0.05).Conclusion：Assessment of impaired RV systolic function by 3DE-derived longitudinal strain is better than 2DE in chronic left-sided heart failure patients with left ventricular EF <45%. 3DE-derived strain analysis specialized for RV should be considered as a complementary tool for assessing RV function.