Prognostic value of right ventricular free wall longitudinal strain in a large cohort of outpatients with left-side heart disease

Mara Gavazzoni, Luigi P. Badano, Enrico Vizzardi, Riccardo Raddino, Davide Genovese, Maurizio Taramasso, Edoardo Sciatti, Chiara Palermo, Marco Metra, Denisa Muraru

Research output: Contribution to journalArticlepeer-review


Aims Right ventricular free wall longitudinal strain (RVFWLS) has been proposed as an accurate and sensitive measure of right ventricular function that could integrate other conventional parameters such as tricuspid annulus plane systolic excursion (TAPSE) and fractional area change (FAC%). The aim of the present study was to evaluate the relationship between RVFWLS and outcomes in stable asymptomatic outpatients with left-sided structural heart disease. Methods We enrolled 458 asymptomatic patients with left-side heart diseases and any ejection fraction who were referred and results for echocardiography to two Italian centres. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome of this analysis. After a mean follow-up of 5.4 ± 1.2 years, 145 patients (31%) reached the combined endpoint. Most of echocardiographic parameters were related to outcomes, including right ventricular functional parameters. Mean value of RVFWLS in our cohort was -21 ± 8% and it was significantly related to the combined endpoint and in multivariable Cox-regression model; when tested with other echocardiographic parameters that were significantly related to outcome at univariate analysis, RVFWLS maintained its independent association with outcome (hazard ratio 0.963, 95% confidence interval 0.948-0.978; P = 0.0001). The best cut-off value of RVFWLS to predict outcome was -22% (area under the curve 0.677; P < 0.001; sensitivity 70%; 65% specificity). Conclusion RVFWLS may help clinicians to identify patients with left-sided structural heart disease at higher risk for first heart failure hospitalization and death for any cause.

Original languageEnglish
Pages (from-to)1013-1021
Number of pages9
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number9
Publication statusPublished - Sep 1 2020


  • Death
  • Heart failure
  • Hospitalization
  • Outcome
  • Right ventricular free wall longitudinal strain
  • Right ventricular function
  • Speckle-tracking echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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