Association between right ventricle two- and three-dimensional echocardiography and exercise capacity in patients with reduced left ventricular ejection fraction.

INTRODUCTION: Echocardiography represents the most commonly performed noninvasive cardiac imaging test for patients with heart failure (HF). The aim of this study was to assess the relationship between exercise capacity parameters (peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production relationship (VE/VCO2)), two-dimensional speckle-tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) imaging of right ventricular (RV) function in HF patients with reduced ejection fraction (EF).

MATERIAL AND METHODS: This cross-sectional study included 54 patients with diagnosed ischemic LV systolic dysfunction (HF with reduced EF <40%) divided in subgroups based on the proposed values of the analyzed cardiopulmonary exercise testing (CPET) variables: VO2 peak ≤ 15 ml/kg/min, VO2 peak > 15 ml/kg/min, VE/VCO2 slope < 36 and VE/VCO2 slope ≥ 36. All patients underwent a physical examination, laboratory testing, conventional echocardiography, 2D-STE, 3DE, and CPET.

RESULTS: RV fractional area change (FAC), 2D RV global longitudinal strain (GLS), 3D RV EF were significantly decreased, and RV basal diameter (BD), systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), ratio between tricuspid flow and tissue Doppler derived e' of the lateral tricuspid annulus (TV E/e') were significantly increased in the subgroups of subjects with a worse VO2 peak and VE/VCO2 slope values. There was a significant positive correlation between the peak VO2 values and TAPSE, 2D RV GLS, 3D RV SV, and 3D RV EF as well as a significantly inverse correlation with VE/VCO2 slope.

CONCLUSIONS: The observed significant correlation between the examined parameters suggests that 2D RV GLS and 3D RV EF, SV are associated with exercise capacity in patients with reduced HF.