Right ventricular end-systolic remodeling (RVESR) index, right atrial area, and right ventricular global longitudinal strain (RVGLS) are strong markers of right ventricular dysfunction in patients with pretricuspid shunt and pulmonary arterial hypertension (PAH). This is according to a new study published in the journal Revista Española de Cardiología (English edition)

“The prognostic value of these parameters in this population remains to be studied,” according to the authors.

Right ventricular function is closely linked to outcomes in patients with congenital heart disease and PAH. Techniques such as RVESR and strain imaging can help quantify the function of the right ventricle. 

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In the present study, a team of researchers led by Sebastien Hascoët, MD, PhD, prospectively analyzed 30 patients with pretricuspid shunt and PAH, aged 36 to 50 years, and investigated the accuracy of multiple echocardiographic parameters of right ventricular function to right ventricular ejection fraction.

Read more about the prognosis of PAH

The results showed that a little less than half of the patients (43.3%) had a right ventricular ejection fraction of less than 45%. The RVGLS, right atrium area, RVESR index, the ratio of systolic-to-diastolic duration, and the change in right ventricular fractional area were correlated with right ventricular ejection fraction. 

The RVGLS, RVESR index, and right atrium area were parameters that could best predict a right ventricular ejection fraction of less than 45%. More specifically, an RVGLS of more than -16%, an RVESR index equal to or bigger than 1.7, and a right atrial area equal to or larger than 22 cm² predicted a right ventricular ejection fraction of less than 45%. The sensitivity of each parameter was 87.5%, 76.9%, and 92.3%, respectively while their specificity was 85.7%, 88.3%, and 82.4%, respectively.

“Our study demonstrates that RVES [index], right atrium area and RVGLS are strong markers of RV dysfunction in patients with pretricuspid shunt and PAH,” the researchers concluded.


Fournier E, Selegny M, Amsallem M, et al. Multiparametric evaluation of right ventricular function in pulmonary arterial hypertension associated with congenital heart disease. Rev Esp Cardiol (Engl Ed). 2022;5:S1885-5857(22)00209-2. doi:10.1016/j.rec.2022.07.010