Association of Decreased Right Ventricular Strain with Worse Survival in Non–Acute Coronary Syndrome Angina

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Abstract

Background Regional strain by speckle-tracking echocardiography can be used to detect occult right ventricular (RV) myocardial dysfunction. However, in patients with coronary artery disease, the impact of RV strain is unknown. The aim of this study was to validate the prognostic value of RV strain in patients with non–acute coronary syndrome angina. Methods In total, 208 patients with coronary artery disease proved by coronary angiography were retrospectively identified (mean age, 63.81 ± 10.12 years; 161 men). In addition to clinical and traditional echocardiographic parameters, RV free wall longitudinal strain (RVLS_FW) was measured using speckle-tracking echocardiography from the apical four-chamber view. Cardiac mortality and major cardiovascular events were recorded. Results During follow-up (23.1 ± 6.6 months), 27 patients (12.98%) died of cardiovascular causes. These patients were found to have lower left ventricular ejection fractions and greater reductions in the amplitudes of left ventricular peak systolic global longitudinal strain and RVLS_FW. Using −18% as a cutoff point for RV strain, patients with strain ≤ −18% had superior outcomes (log-rank χ2 = 9.04 and 6.94 for cardiovascular mortality and arrhythmia, respectively, P = .003). In Cox multivariate regression analysis, RVLS_FW was an independent prognostic factor for both cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.03–1.72; P = .01) and hemodynamically unstable ventricular arrhythmia (hazard ratio, 1.72; 95% CI, 1.08–2.41; P = .01). Conclusions RVLS_FW is significantly related to cardiovascular outcomes and hemodynamically unstable ventricular arrhythmia in patients with non–acute coronary syndrome angina.

Original languageEnglish
Pages (from-to)350-358.e4
JournalJournal of the American Society of Echocardiography
Volume29
Issue number4
DOIs
Publication statusPublished - 2016 Apr 1

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Survival
Cardiac Arrhythmias
Echocardiography
Mortality
Coronary Artery Disease
Right Ventricular Dysfunction
Coronary Angiography
Stroke Volume
Multivariate Analysis
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{6a393ad471bb4ab1806aecc9371a42f8,
title = "Association of Decreased Right Ventricular Strain with Worse Survival in Non–Acute Coronary Syndrome Angina",
abstract = "Background Regional strain by speckle-tracking echocardiography can be used to detect occult right ventricular (RV) myocardial dysfunction. However, in patients with coronary artery disease, the impact of RV strain is unknown. The aim of this study was to validate the prognostic value of RV strain in patients with non–acute coronary syndrome angina. Methods In total, 208 patients with coronary artery disease proved by coronary angiography were retrospectively identified (mean age, 63.81 ± 10.12 years; 161 men). In addition to clinical and traditional echocardiographic parameters, RV free wall longitudinal strain (RVLS_FW) was measured using speckle-tracking echocardiography from the apical four-chamber view. Cardiac mortality and major cardiovascular events were recorded. Results During follow-up (23.1 ± 6.6 months), 27 patients (12.98{\%}) died of cardiovascular causes. These patients were found to have lower left ventricular ejection fractions and greater reductions in the amplitudes of left ventricular peak systolic global longitudinal strain and RVLS_FW. Using −18{\%} as a cutoff point for RV strain, patients with strain ≤ −18{\%} had superior outcomes (log-rank χ2 = 9.04 and 6.94 for cardiovascular mortality and arrhythmia, respectively, P = .003). In Cox multivariate regression analysis, RVLS_FW was an independent prognostic factor for both cardiovascular mortality (hazard ratio, 1.27; 95{\%} CI, 1.03–1.72; P = .01) and hemodynamically unstable ventricular arrhythmia (hazard ratio, 1.72; 95{\%} CI, 1.08–2.41; P = .01). Conclusions RVLS_FW is significantly related to cardiovascular outcomes and hemodynamically unstable ventricular arrhythmia in patients with non–acute coronary syndrome angina.",
author = "Chang, {Wei Ting} and Yen-Wen Liu and Ping-Yen Liu and Zi-Yi Chen and Cheng-Han Lee and Yi-Heng Li and Liang-Miin Tsai and Wei-Chuan Tsai",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.echo.2015.11.015",
language = "English",
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pages = "350--358.e4",
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TY - JOUR

T1 - Association of Decreased Right Ventricular Strain with Worse Survival in Non–Acute Coronary Syndrome Angina

AU - Chang, Wei Ting

AU - Liu, Yen-Wen

AU - Liu, Ping-Yen

AU - Chen, Zi-Yi

AU - Lee, Cheng-Han

AU - Li, Yi-Heng

AU - Tsai, Liang-Miin

AU - Tsai, Wei-Chuan

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Regional strain by speckle-tracking echocardiography can be used to detect occult right ventricular (RV) myocardial dysfunction. However, in patients with coronary artery disease, the impact of RV strain is unknown. The aim of this study was to validate the prognostic value of RV strain in patients with non–acute coronary syndrome angina. Methods In total, 208 patients with coronary artery disease proved by coronary angiography were retrospectively identified (mean age, 63.81 ± 10.12 years; 161 men). In addition to clinical and traditional echocardiographic parameters, RV free wall longitudinal strain (RVLS_FW) was measured using speckle-tracking echocardiography from the apical four-chamber view. Cardiac mortality and major cardiovascular events were recorded. Results During follow-up (23.1 ± 6.6 months), 27 patients (12.98%) died of cardiovascular causes. These patients were found to have lower left ventricular ejection fractions and greater reductions in the amplitudes of left ventricular peak systolic global longitudinal strain and RVLS_FW. Using −18% as a cutoff point for RV strain, patients with strain ≤ −18% had superior outcomes (log-rank χ2 = 9.04 and 6.94 for cardiovascular mortality and arrhythmia, respectively, P = .003). In Cox multivariate regression analysis, RVLS_FW was an independent prognostic factor for both cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.03–1.72; P = .01) and hemodynamically unstable ventricular arrhythmia (hazard ratio, 1.72; 95% CI, 1.08–2.41; P = .01). Conclusions RVLS_FW is significantly related to cardiovascular outcomes and hemodynamically unstable ventricular arrhythmia in patients with non–acute coronary syndrome angina.

AB - Background Regional strain by speckle-tracking echocardiography can be used to detect occult right ventricular (RV) myocardial dysfunction. However, in patients with coronary artery disease, the impact of RV strain is unknown. The aim of this study was to validate the prognostic value of RV strain in patients with non–acute coronary syndrome angina. Methods In total, 208 patients with coronary artery disease proved by coronary angiography were retrospectively identified (mean age, 63.81 ± 10.12 years; 161 men). In addition to clinical and traditional echocardiographic parameters, RV free wall longitudinal strain (RVLS_FW) was measured using speckle-tracking echocardiography from the apical four-chamber view. Cardiac mortality and major cardiovascular events were recorded. Results During follow-up (23.1 ± 6.6 months), 27 patients (12.98%) died of cardiovascular causes. These patients were found to have lower left ventricular ejection fractions and greater reductions in the amplitudes of left ventricular peak systolic global longitudinal strain and RVLS_FW. Using −18% as a cutoff point for RV strain, patients with strain ≤ −18% had superior outcomes (log-rank χ2 = 9.04 and 6.94 for cardiovascular mortality and arrhythmia, respectively, P = .003). In Cox multivariate regression analysis, RVLS_FW was an independent prognostic factor for both cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.03–1.72; P = .01) and hemodynamically unstable ventricular arrhythmia (hazard ratio, 1.72; 95% CI, 1.08–2.41; P = .01). Conclusions RVLS_FW is significantly related to cardiovascular outcomes and hemodynamically unstable ventricular arrhythmia in patients with non–acute coronary syndrome angina.

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U2 - 10.1016/j.echo.2015.11.015

DO - 10.1016/j.echo.2015.11.015

M3 - Article

C2 - 26743733

AN - SCOPUS:84960937102

VL - 29

SP - 350-358.e4

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 4

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