Echocardiographic assessment of right ventricular (RV) function relies on multiple indirect parameters. We aimed of to evaluate both classical and newer parameters derived from 2D speckle imaging (2DSI) as compared to the gold standard RV ejection fraction (RVEF) measured by cardiac magnetic resonance (CMR).

All 193 stable pts (81 pts with pulmonary arterial hypertension, 97 pts with myocardial infarction, 15 miscellaneous) underwent echocardiography and CMR in a delay less than a week. We measured with 2DSI maximal systolic strain (ε %) in the basal, median and apical segments of each of the 3 RV walls [septal (sep), lateral (lat) from 4C view and inferior (inf) from RV2C view]. We calculated a global RVε as the mean of these nine values, a latε (mean of three segments of lat wall), an infε (mean of three segments of inf wall), a RV4Cε (mean of six segments of lat and sep walls) and an inflatε (mean of six segments of inf and lat walls). We also measured TAPSE, RV myocardial performance index (MPI), RV fractional area shortening (RVFAS) and maximal velocity of tricuspid annulus systolic wave (S max). We compared values of those parameters between pts with normal or decreased RVEF (< 45%, n = 65) and analyzed the Spearman correlation between RVEF and echo parameters.

Results .– Mean RVEF was 46.8 ± 13.2% [10–69]. All ε values (but the septal one) were higher in normal pts than in pts with decreased RVEF (latε: −24.9 ± 6.7 vs. −17.4 ± 8.2, P < 0.001; infε: −22.6 ± 6.3 vs. −15.6 ± 5.4, P < 0.001; septε: −15.8 ± 3.7 vs. −15.8 ± 5.1, ns; globalRVε: −21.1 ± 3.7 vs. −16.1 ± 5.3, P < 0.001; RV4Cε: −20.3 ± 3.9 vs. −16.6 ± 5.6 P < 0.001; inflatε: −23.7 ± 5.1 vs. −16.3 ± 6.5, P < 0.001). RVEF correlated significantly with TAPSE ( r = 0.46), MPI ( r = −0.64), Smax ( r = 0.44) and RVFAS ( r = 0.42) (all P < 0.001) and with all ε values but the septal one (latε: r = −0.54 P < 0.001; infε: r = −0.56 P < 0.001; septε: r = −0.03, ns; globalRVε: r = −0.57 P < 0.001; RV4Cε: r = 0.45 P < 0.001; inflatε: r = −0.63 P < 0.001). Stepwise logistic regression identified two independent predictors of RVEF: inflat ε (HR = −1.22[−1.50/−0.93]) and MPI (HR = −26.4[−34.8/−18.1]), both P < 0.001. Both inflat ε and RVTei were also the best predictors of decreased RVEF by ROC analysis (AUC 0.82 and 0.86 respectively).

So, a mean strain value taking into accounts both RV inf and lat walls but not the septal one seems the most interesting 2DSI derived parameter of RV function among patients with various levels of left and right ventricular dysfunction. Furthermore, inflat ε – a parameter related to contractility – together with RV MPI – a parameter related to timing of cardiac cycle phases – are the best predictors of RVEF.