Prognostic Value of Biventricular Strain in Risk Stratifying in Patients With Acute Heart Failure

BACKGROUND: Few studies have shown that right ventricular (RV) function is independently related to adverse events regardless of left ventricular (LV) function in heart failure. We evaluated the prognostic value of global longitudinal strain (GLS) of both ventricles in patients with acute heart failure. METHODS AND RESULTS: We measured biventricular strains in 1824 randomly selected patients (973 men, aged 70±14 years) from a strain registry. A total of 799 patients (43.8%) died during the median follow‐up duration of 31.7 months. In univariate analysis, LVGLS and RVGLS were significantly associated with all‐cause mortality. We classified them into 4 strain groups according to LVGLS (≥9%) and RVGLS (≥12%). On Cox proportional hazards analysis, group 4 (<9% LVGLS and <12% RVGLS) had the worst prognosis, with a hazard ratio (HR) of 1.755 (95% confidence interval [CI], 1.473–2.091; P<0.001) compared with that of group 1 (≥9% LVGLS and ≥12% RVGLS). After multivariate analysis, both LVGLS (per 1% decrease; HR: 1.057; 95% CI, 1.029–1.086; P<0.001) and RVGLS (per 1% decrease; HR: 1.022; 95% CI, 1.004–1.040; P=0.014) were also significant. The HR of RVGLS <12% was higher in patients without pulmonary hypertension (assessed by maximal tricuspid regurgitation ≤2.8 m/s) after the adjustment of LVGLS (HR: 1.40 [95% CI, 1.11–1.77] versus 1.07 [95% CI, 0.88–1.30] with pulmonary hypertension; interaction, P=0.043). CONCLUSIONS: In the patients with acute heart failure, RVGLS was significantly associated with all‐cause mortality regardless of LVGLS, and those with decreased biventricular GLS showed the worst prognosis. The predictive power of RVGLS was more prominent in the absence of pulmonary hypertension.