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Gustav Smith

Associate professor

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Right ventricular speckle tracking assessment for differentiation of pressure- versus volume-overloaded right ventricle


  • Anna Werther Evaldsson
  • Annika Ingvarsson
  • Johan Waktare
  • Gustav J Smith
  • Ulf Thilén
  • Martin Stagmo
  • Anders Roijer
  • Goran Rådegran
  • Carl Meurling

Summary, in English

BACKGROUND: Right ventricular (RV) dysfunction may be caused by either pressure or volume overload. RV function is conventionally assessed with echocardiography using tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), tricuspid lateral annular systolic velocity (S') and RV index of myocardial performance (RIMP). The purpose of this study was to evaluate whether RV global longitudinal strain (RVGLS) and RV-free wall strain (RV-free) could add additional information to differentiate these two causes of RV overload.

METHODS AND RESULTS: The study enrolled 89 patients with an echocardiographic trans-tricuspid gradient >30 mmHg. Forty-five patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (pressure overload) were compared with 44 patients with an atrial septum defect (volume overload). RV size was larger in the volume group (P<0·05). TAPSE and S' were lower in the pressure group (P<0·05, P<0·01). RVFAC was lower in the pressure group (P<0·001) as well as RVGLS (-12·1 ± 3·3% versus -20·2 ± 3·4%, P<0·001) and RV-free (-12·9 ± 3·3% versus -19·4 ± 3·4%, P<0·001).

CONCLUSION: In this study, RVGLS and RV-free could more accurately discriminate RV pressure from volume overload than conventional measures. The reason could be that TAPSE and S' are unable to differentiate active deformation from passive entrainment caused by the left ventricle. The pressure group had evidence of marked RV hypertrophy despite standard functional parameters (TAPSE and S) within normal range. This would enhance the value of strain to more sensitively detect abnormal function. A cut-off value of below -16% for RVGLS and RV-free predicts RV pressure overload with high accuracy.


  • Cardiology
  • Minimal invasive cardiac surgery in valvular heart disease
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health

Publishing year







Clinical Physiology and Functional Imaging





Document type

Journal article


John Wiley & Sons Inc.


  • Cardiac and Cardiovascular Systems


  • Journal Article



Research group

  • Minimal invasive cardiac surgery in valvular heart disease


  • ISSN: 1475-0961