Right Ventricular Global Longitudinal Strain (RV-GLS) Calculator
- Right Ventricular Global Longitudinal Strain (RV-GLS): Explanation and Clinical Context
RV-GLS quantifies right ventricular systolic deformation along the longitudinal axis from an RV-focused apical four-chamber view using 2D speckle-tracking. Two reporting conventions exist: a 6-segment global value that includes free wall and septum (RV-GLS), and a 3-segment free-wall-only value (RVFWLS). Because septal motion is influenced by LV mechanics and ventricular interdependence, RVFWLS is often more sensitive to intrinsic RV systolic performance, while RV-GLS integrates biventricular coupling effects. Normal strain is more negative (greater shortening). The original NORRE dataset established sex- and method-specific lower-limit-of-normal (LLN) values: approximately −20% for RV-GLS and around −23% for RVFWLS (slightly more negative in women). Outcome studies across heart failure and cardiopulmonary cohorts consistently show that less negative RV strain conveys higher risk; pragmatic cut-points around −15% for RV-GLS and −18% for RVFWLS have been associated with increased mortality or adverse events. However, technical factors (frame rate, image quality, foreshortening), hemodynamic loading (pulmonary pressures, RV afterload), and vendor-specific tracking differences can shift measured values. Therefore, interpretation should triangulate strain with conventional RV indices (TAPSE, S', FAC, 3D RVEF), right-sided pressures, and the clinical syndrome rather than relying on a single metric.
Reference:
Muraru D, Onciul S, Peluso D, et al. Sex- and Method-Specific Reference Values for Right Ventricular Strain by 2-Dimensional Speckle-Tracking Echocardiography. Circ Cardiovasc Imaging. 2016;9(2):e003866.
Lupi L, et al. Prognostic value of right ventricular longitudinal strain in heart failure: optimal cut-offs for RVFWLS (~−18%) and RV-GLS (~−15%). Heart Fail Rev. 2023.
American Society of Echocardiography (ASE). Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension. JASE. 2025.
Additional contemporary reviews/meta-analyses corroborate method selection, acquisition, and prognostic use of RV strain in diverse populations.
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