Right ventricular strain assessment and type 1 cardiorenal syndrome in acute decompensated heart failure: a prospective cohort study

Abstract Background Right-sided cardiac abnormalities and venous congestion may contribute to the development of type 1 cardiorenal syndrome (CRS) in acute decompensated heart failure (ADHF). However, the association between myocardial deformation assessed early after admission and subsequent type 1 CRS remains insufficiently characterized. We investigated the associations of right ventricular (RV) free-wall and interventricular septal longitudinal strain with the development of type 1 CRS in patients hospitalized with ADHF. Methods This prospective, single-center observational cohort study included patients admitted to the coronary care unit with ADHF. Transthoracic echocardiography was performed within 24 h of admission, and renal function was monitored for 7 days. Type 1 CRS was defined as the development of acute kidney injury according to the serum creatinine component of the Kidney Disease: Improving Global Outcomes criteria. RV free-wall and interventricular septal longitudinal strain were evaluated separately using multivariable logistic regression models adjusted for age, baseline estimated glomerular filtration rate, and log₂-transformed N-terminal pro-B-type natriuretic peptide. Results Among 84 patients included in the final analysis, 40 developed type 1 CRS and 44 did not. Patients who developed CRS had larger RV basal diameter and RV areas, lower fractional area change, and less-negative RV free-wall and interventricular septal strain values. Greater absolute RV free-wall strain magnitude was independently associated with lower odds of CRS (odds ratio [OR] per 1-percentage-point increase, 0.555; 95% confidence interval [CI], 0.418–0.735; p < 0.001). Greater absolute interventricular septal strain magnitude was also independently associated with lower odds of CRS (OR, 0.491; 95% CI, 0.348–0.691; p < 0.001). Both associations remained significant in exploratory sensitivity analyses additionally including fractional area change or RV basal diameter. Conclusions Less-negative RV free-wall and interventricular septal longitudinal strain measured early after admission were independently associated with the development of type 1 CRS in patients with ADHF. These findings suggest that myocardial deformation assessment may provide complementary information for early cardiorenal risk characterization; however, validation in larger multicenter cohorts is required.