RV free-wall longitudinal strain

RVFWS · RV-focused apical 4-chamber, speckle tracking of the free wall only (exclude septum)

Normal range & thresholds

Abnormal when magnitude <20% (men) or <21% (women) — ASE 2025 ^[3,76]. Report free-wall (3-segment) strain, not RV global (6-segment) strain.

Pathophysiology

Longitudinal shortening of the free wall generates most RV ejection. Strain measures deformation directly, so it is less affected by translation and tethering than TAPSE, and it falls earlier than FAC in pressure overload and cardiomyopathy ^[3].

Raised by

• Athletes; volume load with preserved function (mild)

Lowered by

• PH, acute PE, RV infarction, ARVC, amyloid, HF, cardiotoxicity; post-cardiac surgery less than TAPSE

Technique & pitfalls

• RV-focused view; ROI covering the free wall; exclude pericardium; frame rate 50–80 fps; vendor-consistent ^[163].

Pseudo-change & artefact

• Foreshortening, dropout of the free wall, vendor differences.

Treatment thresholds

• Defines RV dysfunction in PH risk stratification and transcatheter tricuspid candidacy ^[3,6,8].

Next step

• Integrate with TAPSE, S′, FAC and 3D RVEF.

Drugs

Improves with afterload reduction in PH responders.

Reversibility

Improves after PE reperfusion and in responders.