Right ventricular free wall strain independently predicts short-term mortality in patients with acute dyspnoea
G Cesnaite, K Cerlinskaite-Bajore, D Verikas, A Jakstaite, A Kavoliuniene, D Zaliaduonyte, J CelutkieneAbstract
Background/Introduction
Right ventricular (RV) dysfunction is increasingly recognized as an important determinant of adverse outcomes in acute cardiopulmonary conditions. Conventional echocardiographic parameters may inadequately represent RV systolic function due to the complex RV geometry. Speckle-tracking echocardiography allows quantitative evaluation of RV free wall strain (RVFWS), providing more detailed insight into RV performance. Although its prognostic relevance has been demonstrated in selected cohorts with heart failure with reduced ejection fraction (HFrEF) and pulmonary hypertension, data on its predictive relevance in broader patient populations remain scarce.
Purpose
To assess the predictive value of RVFWS at admission for short-term mortality in acute dyspnoea patients, while also examining its interaction with conventional echocardiographic parameters and specific diagnoses.
Methods
This analysis included 452 adults admitted with acute dyspnoea (2015–2017) into two tertiary emergency departments who underwent two-dimensional echocardiography within first 48 hours. Echocardiographic data (including RVFWS, tricuspid annular plane systolic excursion [TAPSE], left ventricular ejection fraction [LVEF]) and laboratory markers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin-T [hs-TnT]) were collected. Dyspnoea etiology was adjudicated by three blinded cardiologists as acute heart failure (AHF) or non-AHF. Primary and secondary outcomes were 90- and 30-day all-cause mortality. Statistical analyses included Mann–Whitney U and Chi-square tests, Kaplan–Meier survival with log-rank test, conditional inference tree for RVFWS thresholds, and Cox regression adjusted for age, sex, LVEF, TAPSE, creatinine, and diagnosis.
Results
Among 452 adults admitted with acute dyspnoea, 64% were diagnosed with AHF. 90-day all-cause mortality was 12.8%. Non-survivors demonstrated pronounced RV dysfunction, including significantly lower RVFWS, TAPSE, and impaired RV-pulmonary artery (PA) coupling[JC1] , whereas LV systolic and diastolic parameters were less discriminatory. Conditional inference tree analysis defined RVFWS >-9.7% as a prognostic threshold, with significantly increased 90-day mortality risk in unadjusted (HR 4.5, [95% confidence interval (CI) 2-10.3], p<0.001) and multivariable Cox models (adjusted HR 5.2 [95% CI 2-14], p<0.001). Reduced RVFWS similarly predicted 30-day mortality in both unadjusted (HR 7.7 [95% CI 2.5-23.8], p < 0.001) and adjusted analysis (aHR 6.2 [95% CI 1.7-22.4], p = 0.005).
Conclusion
RVFWS independently predicts short-term mortality in patients admitted with acute dyspnoea. Its assessment could improve early risk stratification and identification of high-risk patients among a heterogeneous acute dyspnoea population.Mortality at 3 months