IJCS | Volume 31, Nº6, November / December 2018

638 Table 3 - Echocardiographic parameters. Performance for the detection of RV dysfunction (RVEF 3DE < 44%) Parameter Se Sp PPV NPV Cut-off AUC CI RVFWS 86.5% 79.6% 72% 90% -18.65% 0.851 0.726 - 0.956 RFGS 83.8% 85.7% 92% 89% -20.1% 0.872 0.750 - 0.994 PSV 78.4% 64.3% 57% 83% 10.5 cm/s 0.756 0.593 - 0.919 TAPSE 84.2% 64.3% 60% 91% 15 mm 0.828 0.697 - 0.960 FAC 86.5% 92.9% 87% 90% 41% 0.932 0.867 - 0.998 RVFWS: right ventricular (RV) free wall longitudinal 2D strain; RVGS: RV global longitudinal 2D strain; PSV: peak systolic velocity of tricuspid annulus; TAPSE: tricuspid annular plane systolic excursion; FAC: RV fractional area change. Figure 5 - Comparison of mean values of echocardiographic parameters between the groups: right ventricular (RV) preserved systolic function (RVEF = 44%; n = 37) and RV systolic dysfunction (RVEF < 44%; n = 14). (a) PSV: peak systolic velocity of tricuspid annulus; TAPSE: tricuspid annular plane systolic excursion; FAC: fractional area change; (b) RVFWS: RV free wall longitudinal (two- dimensional) strain; RVGS: RV global longitudinal (two-dimensional) strain. Felix et al. RV function by 2D strain in left-sided valve disease Int J Cardiovasc Sci. 2018;31(6)630-642 Original Article values of conventional RV function parameters (TAPSE, PSV, FAC) and 2DS parameters (RVFWS, RVGS) were normal considering the overall study population, despite an elevation of the median values of PASP (40 mmHg (30-54)), secondary to the advanced stage of the disease in these patients. We excluded patients with severe TR, a condition that may affect the accuracy of RV functional assessment by alterations in RV preload. 25 We obtained acceptable 3DE images for RVEF analysis in 51 patients (96,2%), showing good feasibility of the technique, as previously shown by other authors (Kong et al., 26 - 97%, Niemann et al., 27 - 100%). The mean values of EDV, ESF and EF were normal in the overall population. Analyzing the patients according to their predominant valve lesions using multivariate analysis, we observed significant differences between the groups for RVGS, RVFWS, TAPSE, FAC, and RVEF 3D, showing a tendency towards lower absolute values of RVGS, RVFWS (less deformation) and lower levels of FAC and RVEF 3D in patients with mitral stenosis and combined lesions. These findings are probably related to higher levels of pulmonary capillary pressure and RV pressure overload in mitral stenosis and combined lesions than in regurgitant lesions and isolated aortic stenosis. Furthermore, all patients with combined lesions were rheumatic, pointing to the possibility of a concurrent