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

Abstract Background Acute pulmonary embolism (PE) can result in long-term complications, including post-pulmonary embolism 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. Methods 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. Results 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/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. Conclusions 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 or CTEPH, highlighting their potential value in post-PE follow-up strategies.