Right ventricular strain analysis in acute pulmonary embolism and its role for late complications

Acute pulmonary embolism (PE) can result in long-term complications, including post-PE impairment (PPEI) and chronic thromboembolic pulmonary hypertension (CTEPH). Right ventricular global longitudinal strain (RVGLS) is a sensitive measure of RV myocardial deformation that may detect subclinical dysfunction and predict adverse outcomes; however, its value in the follow-up of post-PE assessment has not been yet elucidated.

In this prospective sub-study of the FOCUS cohort, 175 consecutive PE survivors from the Mainz centre underwent echocardiographic follow-up at 3 and 12 months, including speckle-tracking assessment of RVGLS, RV free wall strain (RVFWLS), and strain-derived ventriculoarterial coupling indices. Conventional RV parameters, volumetric measures, and clinical outcomes were recorded. Overall, 175 patients were included, of whom 16 developed PPEI or CTEPH during follow-up. RV function improved over time in patients without PPEI/CTEPH, including increases in RVGLS (from −16 to −18%), RVFWLS, ejection fraction, and strain-based ventriculoarterial coupling, accompanied by reductions in RV volumes. In contrast, patients who developed PPEI/CTEPH (n = 16) displayed progressive deterioration of RV strain and strain-derived coupling despite relatively preserved TAPSE-based indices. At 3 months, RVGLS was significantly associated with the combined PPEI/CTEPH endpoint over 2 years (OR 1.10, 95% CI 1.01–1.21), whereas strain-derived ventriculoarterial coupling parameters demonstrated borderline associations [RVGLS/systolic pulmonary artery pressure (sPAP): OR 0.11, 95% CI 0.01–0.91; RVFWLS/sPAP: OR 0.16, 95% CI 0.02–1.17]. TAPSE/sPAP was not associated with the outcome.

RV strain and strain-derived ventriculoarterial coupling may provide sensitive early markers of maladaptive RV remodelling after acute PE and were associated with the development of PPEI/CTEPH, highlighting their potential value in post-PE follow-up strategies.