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Background: Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices (LVADs), in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed a deeper analysis of RV longitudinal function. The aim of the study was to evaluate right ventricular function by speckle tracking echocardiography (STE) in patient with advanced heart failure before and after LVAD implant.Methods: Transthoracic echo-Doppler was performed in 9 patients referred for LVAD implant at baseline and with serial echocardiograms after LVAD implant (Jarvik 2000). In a subgroup of patients an additional intermediate echo evaluation, after intra-aortic balloon pump (IABP) implant, was performed. All echocardiographic images were analyzed off-line to calculate the free wall RV longitudinal strain (RVLS).Results: All patients, except two, which presented the lowest RVLS values at baseline, showed a progressive increase of RVLS after LVAD implant. Analyzing five patients undergone to IABP as an intermediate step, it was clear that only patients that presented an increase of RVLS after IABP implant, showed progressive increase of RVLS levels after LVAD implant. Three patients, that did not experienced an increase of RVLS after IABP implant, presented a RV failure after LVAD implant.Conclusions: This new parameter of RV myocardial deformation, RVLS, may have interesting clinical implications for LVAD patients; it can be applied for evaluation of RV function before LVAD implant, to potentially help in decision-making about the management of this kind of patients, and after LVAD implant, for the follow-up of patients.