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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.In this single-center retrospective study, 57 of 95 consecutive HeartMate 3 LVAD recipients (mean age 57\u2009\u00b1\u200911 years; 79% male) with adequate echocardiographic quality were analyzed. Patients were stratified by RHF phenotype as no RHF (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200928) or RHF (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200929; comprising early acute and early postoperative RHF). RVFWS and RVGLS were measured preoperatively and at 2 weeks, 6 months, 12 months, and 36 months post-implantation using speckle-tracking echocardiography. Predictive value was assessed using logistic regression and ROC analysis; longitudinal change using linear mixed-effects models (LMM); and outcomes using Kaplan-Meier, Cox regression, restricted mean survival time (RMST), and competing-risks analyses.Preoperative RVFWS was lower in patients who developed RHF (-6.0% (IQR-9.5, -4.1) vs. -10.5% (IQR-12.6, -6.8);\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.037). Preoperative RVFWS predicted RHF with an AUC of 0.66 (95% CI 0.52\u20130.81), an optimal cut-off of -6.3%, 55% sensitivity and 79% specificity; no other echocardiographic parameter (RVGLS, TAPSE, RVEDD\/LVEDD, FAC) discriminated RHF, and no parameter was an independent predictor on multivariable analysis. On LMM, RVFWS declined early in the no-RHF group (\u0394\u2009+\u20093.3 at 2 weeks,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.005; \u0394\u2009+\u20093.0 at 6 months,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.022 vs. baseline) and then stabilized; this pattern was robust in complete-case and random-slope sensitivity analyses. RVGLS improved in the RHF group by 12 months (\u0394-3.3,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.010). No between-group difference was detected at any single time point. One- and two-year survival was 85% and 80% in the no-RHF group versus 61% and 57% in the RHF group; restricted mean survival time to 2 years was 169 days shorter in the RHF group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.018), reflecting significantly higher first-year mortality (HR 3.2;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.044) without a later difference. Transplant incidence was similar between groups and competing-risks analysis was concordant.Preoperative RVFWS provides modest discrimination between RHF and non-RHF after LVAD implantation. Serial strain captures dynamic RV changes - an early postoperative decline in RVFWS in patients without RHF and a later recovery of RVGLS in those with RHF - and RHF is associated with worse early survival. Serial RV strain may therefore complement, rather than replace, established risk assessment.\n                  <\/jats:p>","DOI":"10.1007\/s10554-026-03780-z","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:00:43Z","timestamp":1789660843000},"page":"2135-2145","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of the predictive value of right ventricular longitudinal strain and functional trends in right ventricular function of patients after LVAD implantation"],"prefix":"10.1007","volume":"42","author":[{"given":"Carl-Thadd\u00e4us","family":"Braun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Schramm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"Morshuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina PW","family":"Guenther","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Hulde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"K\u00f6rperich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian V.","family":"Rojas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Fritz","family":"Gummert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lech","family":"Paluszkiewcz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"3780_CR1","doi-asserted-by":"crossref","unstructured":"Mehra MR, Goldstein DJ, Cleveland JC, Cowger JA, Hall S, Salerno CT et al (2022) Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices. 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Due to the retrospective nature of the study, the need for collecting written consent was waived.","order":2,"name":"Ethics","label":"Ethics consent and approval to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}