Assessment of the Predictive Value of Right Ventricular Longitudinal Strain and Functional Trends in Right Ventricular Function of Patients after LVAD Implantation

Background Right heart failure (RHF) remains a major determinant of morbidity and mortality following left ventricular assist device (LVAD) implantation. Right ventricular free wall strain (RVFWS) and global longitudinal strain (RVGLS) have emerged as promising echocardiographic markers, yet their long-term prognostic utility and suitability to assess changes in RV function remain poorly defined. Methods In this single-center retrospective study, 57 of 95 consecutive HeartMate 3 LVAD recipients (mean age 57 ± 11 years; 79% male) with adequate echocardiographic quality were analyzed. Patients were stratified by RHF phenotype according to the 2020 MCS-ARC definition: no RHF (n = 28), early acute RHF (eaRHF, n = 18), and early postoperative RHF (epRHF, n = 11). RVFWS and RVGLS were measured preoperatively and at 2 weeks, 6 months, 12 months, and 36 months post-implantation using speckle-tracking echocardiography. Linear mixed-effects modelling and ROC analysis evaluated temporal changes and predictive value. Results Preoperative RVFWS predicted eaRHF with 51.7% sensitivity and 82.1% specificity (AUC = 0.671, p = 0.022). In patients without RHF, RVFWS declined from − 9.8 ± 4.6% preoperatively to − 6.3 ± 4.8% postoperative (Δ=−3.5, p = 0.01) and − 6.5 ± 4.9% at 6 months (Δ=−3.0, p = 0.04), stabilizing thereafter. RVGLS improved significantly from − 5.6 ± 3.7% early postoperatively to − 8.3 ± 4.1% at 12 months (Δ=+3.1, p = 0.02). In eaRHF patients, RVGLS improved from − 5.7 ± 4.1% to − 11.3 ± 5.1% (Δ=+5.1, p < 0.01) by 12 months, suggesting RV recovery after temporary support. No significant longitudinal change was observed in the epRHF group. One-year survival was 84.5%, 81.8%, and 50.0% in the no RHF, epRHF, and eaRHF groups, respectively. The differences did not reach statistical significance. Conclusions RVFWS offers modest predictive accuracy for early acute RHF, while RVGLS more sensitively reflects dynamic right ventricular remodelling and recovery after LVAD implantation. Distinct strain trajectories highlight differential pathophysiologic mechanisms across RHF phenotypes. This study highlights the possibility of using RVGLS and RVFWS to assess functional changes in RV function after LVAD implantation over time.