Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2026, 35(2):83-89

Right ventricular free wall longitudinal strain in heart failure with preserved and mild reduced ejection fraction. Application and prognostic implications

Daniel Grados-Saso1, Juan Manuel Salvador-Casabón1, Anyuli García-Gutiérrez2, Ana María Martínez-Royo1, Juan Ignacio Pérez-Calvo2, Isaac Lacambra-Blasco1
1 Department of Cardiology Hospital Clínico Universitario de Zaragoza, Aragón
2 Department of Internal Medicine Hospital Clínico Universitario de Zaragoza, Aragón, Spain

Aims: Right ventricle (RV) plays an important role in heart failure with preserved and mild reduced ejection fraction. Quantification of right ventricular functional parameters by echocardiography is challenging. In this context an advanced quantification parameter such as right ventricular strain (a measure of myocardial deformation) represents a tool that can provide useful information in the assessment of RV function, with potential prognostic implications.

Methods: In a cohort of 71 prospectively included patients admitted for an episode of heart failure with preserved and mild reduced ejection fraction (LVEF >40%) right ventricular function was evaluated through right ventricular free wall longitudinal strain. Relationship with variables such as hospital readmission and cardiovascular mortality was studied.

Results: Worse right ventricular free wall longitudinal strain was associated to higher probability of cardiovascular mortality at six months. In multivariate analysis RV free wall strain remained a predictor of cardiovascular mortality at 6 months.

Conclusion: In patients with heart failure, impairment of right ventricular free wall strain is related to worse clinical outcome (increased cardiovascular mortality) regardless of other right ventricular functional parameters. Therefore, representing a non-invasive prognostic indicator in these patients, and could be useful in stratifying the risk of adverse events.

Keywords: Heart failure; HFmrEF; HFpEF; Right ventricular free wall strain

Published: February 1, 2026  Show citation

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Grados-Saso D, Salvador-Casabón JM, García-Gutiérrez A, Martínez-Royo AM, Pérez-Calvo JI, Lacambra-Blasco I. Right ventricular free wall longitudinal strain in heart failure with preserved and mild reduced ejection fraction. Application and prognostic implications. Cardiology Letters. 2026;35(2):83-89.
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    References

    1. Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452-3462. Go to original source...
    2. Mohammed SF, Hussain I, AbouEzzeddine OF, Abou Ezzeddine OF, Takahama H, Kwon SH, et l. Right ventricular function in heart failure with preserved ejection fraction: a communitybased study. Circulation. 2014;130:2310-2320. Go to original source...
    3. Moreira H, Volpe GJ, Marin-Neto JA, Nwabuo CC, Ambale-Venkatesh B, Gali LG, et al. Right ventricular systolic dysfunction in Chagas disease defined by speckle-tracking echocardiography: a comparative study with cardiac magnetic resonance imaging. JASE. 2017;30:493-502. Go to original source...
    4. Kaul S, TeiC, Hopkins JM, ShahPM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984;107:526-531. Go to original source...
    5. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685-713. Go to original source...
    6. Barón A. Deformación de la pared libre del ventrículo derecho: evaluación no volumétrica de la función. Rev Colomb Cardiol. 2012;19:223-224. Go to original source...
    7. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults. J Am Soc Echocardiogr. 2015; 28:1-39. Go to original source...
    8. Teske AJ, De Boeck BW, Olimulder M, Prakken NH, Doevendans AF, Cramer MJ. Echocardiographic assessment of regional right ven­tricular function: a head-to-head comparison between 2-dimensional and tissue Doppler derived strain analysis. J Am Soc Echocardiogr. 2008;21:275-283. Go to original source...
    9. Morris DA, Gailani M, Vaz Pérez A, Blaschke F, Dietz R Haverkamp W, et al. Right ventricular myocardial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr. 2011;24:886-897. Go to original source...
    10. Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ, et al. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail. 2007;9:872-878. Go to original source...
    11. Obokata M, Reddy YNV, Melenovsky V, Pislaru S, Borlaug BA. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur Heart J. 2019;40:689-697. Go to original source...
    12. Meris A, Faletra F, Conca C, Klersy C, Regoli F, Klimusina J, et al. Timing and magnitude of regional right ventricular function: a speckle-tracking derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr. 2010;23:823-831. Go to original source...
    13. D'Andrea A, Caso P, Bossone E, Scarafile R, Riegler L, Di Salvo G, et al. Right ventricular myocardial involvement in either physiological or pathological left ventricular hypertrophy: an ultrasound speckle-tracking two-dimensional strain analysis. Eur J Echocardiogr. 2010;11:492-500. Go to original source...
    14. Cikes, M, Solomon S. An integrative approach for assessment of cardiac function in HF. Eur Heart J. 2016;37:1642-1650. Go to original source...
    15. Fukuda Y, Tanaka H, Sugiyama D, Ryo K, Onishi T, Fukuya H, et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr. 2011;24:1101-1108. Go to original source...
    16. Bogaard HJ, Natarajan R, Henderson SC, Long CS, Kraskauskas D, Smithson L, et al. Chronic pulmonary artery pressure elevation is insufficient to explain right heart failure. Circulation. 2009;120:1951-1960. Go to original source...
    17. Ng AC, Delgado V, Bertini M, van der Meer RW, Rijzewijk LJ, Shanks M, et al. Findings from left ventricular strain and strain rate imaging in asymptomatic patients with type 2 diabetes mellitus. Am J Cardiol. 2009;104:1398-1401. Go to original source...
    18. Stanton T, Marwick TH. Assessment of subendocardial structure and function. J Am Coll Cardiol Img. 2010;3:867-875. Go to original source...
    19. Broberg CS, Chugh SS, Conklin C, Sahn DJ, Jerosch-Herold M. Quantification of diffuse myocardial fibrosis and its association with myocardial dysfunction in congenital heart disease. Circ Cardiovasc Imaging. 2010;3:727-734. Go to original source...
    20. Kosmala W, Colonna P, Przewlocka-Kosmala M, Mazurek W. Right ventricular dysfunction in asymptomatic diabetic patients. Diabetes Care. 2004;27:2736-2738. Go to original source...
    21. Cicala S, Galderisi M, Caso P, Petrocelli A, D'Errico A, de Divitiis, O, et al. Right ventricular diastolic dysfunction in arterial systemic hypertension: analysis by pulsed tissue Doppler. Eur J Echocardiogr. 2002;3:135-142. Go to original source...
    22. Leather HA, Ama' R, Missant C, Rex S, Rademakers FE, Wouters PF. Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with open pericardium. Am J Physiol Heart Circ Physiol. 2006;290:23692375. Go to original source...
    23. Goroshi M, Chand D. Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus. Indian Heart J. 2016;68:83-87. Go to original source...
    24. Muraru D, Onciul S, Peluso D, Soriani N, Cucchini U, Aruta P, et al. Sex- and Method-Specific Reference Values for Right Ventricular Strain by 2-Dimensional Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging. 2016;9:e003866. Go to original source...

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