3-Dimensional Versus 2-Dimensional STE for Right Ventricular Myocardial Fibrosis in Patients With End-Stage Heart Failure

doi:10.1016/j.jcmg.2021.01.015

JACC: Cardiovascular Imaging

Volume 14, Issue 7, July 2021, Pages 1309-1320

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Abstract

Background

Longitudinal strain of the right ventricular (RV) free wall (RVFWLS) assessed by 2-dimensional (2D) speckle-tracking echocardiography (STE) has been recently demonstrated to correlate with the extent of RV myocardial fibrosis (MF). However, the value of 3-dimensional (3D) STE–derived strain parameters in predicting RV MF has not been investigated in patients with end-stage heart failure (HF).

Objectives

This study aimed to determine which RV strain parameter assessed by 2D-STE and 3D-STE was the most reliable parameter for predicting RV MF in patients with end-stage HF against histological confirmation of MF.

Methods

A total of 105 consecutive patients with end-stage HF undergoing heart transplantation were enrolled in our study. The conventional RV function parameters, 2D-RVFWLS, and 3D-RVFWLS were obtained in these patients. The degree of MF was quantified by Masson trichrome staining in RV myocardial samples. The study population was divided into 3 groups according to the degree of MF on histology.

Results

Patients with severe MF had lower 3D-RVFWLS, 2D-RVFWLS, and conventional parameters of RV function compared with those with mild and moderate MF. RV MF strongly correlated with 3D-RVFWLS (r = −0.72; p < 0.001), modestly with 2D-RVFWLS (r = −0.53; p < 0.001), and weakly with conventional RV function parameters (r = −0.21 to −0.49; p < 0.01). 3D-RVFWLS correlated best with the degree of MF (r = −0.72 vs. −0.21 to −0.53; p < 0.05) compared with 2D-RVFWLS and conventional RV function parameters. 3D-RVFWLS had the highest accuracy for detecting severe MF (area under the receiver-operating characteristic curve: 0.90 vs. 0.24–0.80; p < 0.05) compared with 2D-RVFWLS and conventional RV parameters. The model with 3D-RVFWLS (R² = 0.63; p < 0.001) was better in predicting the degree of RV MF than that with 2D-RVFWLS (R² = 0.54; p < 0.001).

Conclusions

3D-RVFWLS may be the most robust echocardiographic measure for predicting the extent of RV MF in patients with end-stage HF.

Central Illustration

Key Words

end-stage heart failure

myocardial fibrosis

right ventricular function

speckle tracking echocardiography

strain

Abbreviations and Acronyms

2-dimensional

3-dimensional

CMR

cardiac magnetic resonance

FAC

fractional area change

LVEF

left ventricular ejection fraction

myocardial fibrosis

RIMP

right-side index of myocardial performance

RVEF

right ventricular ejection fraction

RVFWLS

longitudinal strain of the right ventricular free wall

STE

speckle-tracking echocardiography

TAPSE

tricuspid annular plane systolic excursion

tricuspid regurgitation

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: The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

^∗: Drs. Tian, Zhang, and Xie contributed equally to this work.