Right Ventricular Functional Improvement After Lung Transplantation and Adjunctive Pulmonary Rehabilitation: An Echocardiographic Analysis

<b>Background:</b> Right ventricular (RV) dysfunction is common in advanced lung disease due to chronic pressure overload and altered pulmonary vascular mechanics. Lung transplantation (LTx) reduces RV afterload, and pulmonary rehabilitation (PR) may further enhance functional recovery. However, the combined effects of LTx and structured PR on RV myocardial deformation-particularly using speckle-tracking echocardiography (STE)-remain insufficiently characterized. <b>Methods:</b> This single-arm pre-post study included 20 bilateral lung transplant recipients who completed an 8-week, twice-weekly supervised outpatient PR program. Echocardiographic evaluation-including 2D measurements, M-mode, tissue Doppler imaging (TDI), and STE-derived strain parameters-was performed immediately post-discharge (baseline) and after PR. RV global longitudinal strain (RVGLS) and RV free-wall longitudinal strain (RVFWS) served as primary functional outcomes. <b>Results:</b> Improvements were observed in RV myocardial deformation after PR. RVGLS improved from a median of 15.52% to 16.64% (<i>p</i> = 0.004), and RVFWS increased from 15.82% to 17.10% (<i>p</i> = 0.001). RV mid-cavity diameter decreased significantly (<i>p</i> = 0.042), reflecting favorably altered RV geometry. Conventional parameters-including TAPSE, S' velocity, RVEDA, and FAC-showed no statistically significant changes. These findings indicate that STE parameters are more sensitive than traditional indices for detecting early RV remodeling in the post-transplant period. <b>Conclusions:</b> Lung transplantation combined with a structured PR program was associated with early improvements in RV deformation indices measurable by STE, even when traditional echocardiographic indices remained within normal limits. STE may therefore serve as a sensitive tool for monitoring subclinical RV recovery after LTx and for assessing the additive benefits of PR.