Right ventricular systolic function in severe tricuspid regurgitation: Prognostic relevance of longitudinal strain

Francesco Ancona, Francesco Melillo, Francesco Calvo, Nadia Attalla El Halabieh, Stefano Stella, Cristina Capogrosso, Giacomo Ingallina, Elvin Tafciu, Antonia Pascaretta, Marco Bruno Ancona, Michele De Bonis, Alessandro Castiglioni, Paolo Denti, Matteo Montorfano, Azeem Latib, Antonio Colombo, Ottavio Alfieri, Eustachio Agricola

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Aims: The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results: We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42-56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion: Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.

Original languageEnglish (US)
Pages (from-to)868-875
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number8
StatePublished - Aug 1 2021


  • right ventricular free wall longitudinal strain
  • right ventricular systolic function
  • strain analysis
  • tricuspid regurgitation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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