Lung transplant (LUTX) candidates frequently have secondary right ventricular (RV) dysfunction, which standard assessment has poor sensitivity and high logistical footprint. In this single-center prospective observational cohort study on bilateral LUTX patients, the preoperative RV free-wall longitudinal strain (RVFWLS) was compared to conventional RV echocardiographic (tricuspid annular plane excursion ? TAPSE, fractional area change ? FAC, tricuspid peak annulus systolic velocity - S') and ventriculographic tests. Of the 44 enrolled patients, 10 had poor RV window. Compared to standards, LUTX candidates had statistically significant impaired RVFWLS (20.1% [-22.5% ? -17%], p<0.001): 47% having pathologic RVFWLS (> -20%), and 15% normal standard tests, but altered RVFWLS (Fig1).

RVFWLS identified the highest percentage of impaired RV function (47%) compared to conventional echocardiographic parameters (TAPSE, 32%; S', 27%; FAC, 26%) and ventriculography (15%) (Table1: Conventional RV tests vs. RVFWLS).

The RVFWLS provides sensitive, non-invasive, repeatable, and radiation-free RV assessment compared to standard tools in LUTX candidates.