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Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the "Right Way" to Explore the Forgotten Chamber.

Kossaify A - Clin Med Insights Cardiol (2015)

Bottom Line: The right ventricle (RV) has an essential function in cardiovascular physiology and pathology.Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions.However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber.

View Article: PubMed Central - PubMed

Affiliation: Echocardiography unit, cardiology division, University Hospital Notre Dame de Secours, Byblos, Lebanon.

ABSTRACT

Background: The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber.

Objective: We sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography.

Methods: A MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed.

Results: A RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S') <9.5 mm/s, a tricuspid annular plane systolic excursion <17 mm, and a fractional area change <35% are indices of right ventricular systolic dysfunction. A right ventricular ejection fraction of >45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography.

Conclusion: Accurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy.

No MeSH data available.


Related in: MedlinePlus

Main views used to explore the RV: A4C view (upper left quadrant), PLAX view (upper right quadrant), PSAX view (lower right quadrant), and the subcostal views (lower right quadrant).Abbreviations: RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium; RVOT, right ventricular outflow tract; Ao, Aorta; AV, Aortic valve; PA, pulmonary artery; MV, mitral valve; PV, pulmonary valve; TV, tricuspid valve.
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f1-cmc-9-2015-065: Main views used to explore the RV: A4C view (upper left quadrant), PLAX view (upper right quadrant), PSAX view (lower right quadrant), and the subcostal views (lower right quadrant).Abbreviations: RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium; RVOT, right ventricular outflow tract; Ao, Aorta; AV, Aortic valve; PA, pulmonary artery; MV, mitral valve; PV, pulmonary valve; TV, tricuspid valve.

Mentions: Various echocardiographic techniques, such as the time-motion mode (M-Mode), two-dimensional echo (2DE), pulsed wave Doppler (PWD), Doppler tissue imaging (DTI), STE, and 3DE, provide valuable qualitative and quantitative data regarding RVD and RVF. When used in conjunction with tricuspid flow and pulmonary artery hemodynamics, such data allow a better understanding of the structure, function, and pathophysiology of the right heart. Of note, the essential views used for RV assessment comprise the apical 4-chamber (A4C), parasternal long axis (PLAX), the PSAX, and the subcostal views (Fig. 1). The modified A4C view obtained with either lateral or medial transducer orientation allows a RV-focused visualization.


Echocardiographic Assessment of the Right Ventricle, from the Conventional Approach to Speckle Tracking and Three-Dimensional Imaging, and Insights into the "Right Way" to Explore the Forgotten Chamber.

Kossaify A - Clin Med Insights Cardiol (2015)

Main views used to explore the RV: A4C view (upper left quadrant), PLAX view (upper right quadrant), PSAX view (lower right quadrant), and the subcostal views (lower right quadrant).Abbreviations: RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium; RVOT, right ventricular outflow tract; Ao, Aorta; AV, Aortic valve; PA, pulmonary artery; MV, mitral valve; PV, pulmonary valve; TV, tricuspid valve.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4493918&req=5

f1-cmc-9-2015-065: Main views used to explore the RV: A4C view (upper left quadrant), PLAX view (upper right quadrant), PSAX view (lower right quadrant), and the subcostal views (lower right quadrant).Abbreviations: RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium; RVOT, right ventricular outflow tract; Ao, Aorta; AV, Aortic valve; PA, pulmonary artery; MV, mitral valve; PV, pulmonary valve; TV, tricuspid valve.
Mentions: Various echocardiographic techniques, such as the time-motion mode (M-Mode), two-dimensional echo (2DE), pulsed wave Doppler (PWD), Doppler tissue imaging (DTI), STE, and 3DE, provide valuable qualitative and quantitative data regarding RVD and RVF. When used in conjunction with tricuspid flow and pulmonary artery hemodynamics, such data allow a better understanding of the structure, function, and pathophysiology of the right heart. Of note, the essential views used for RV assessment comprise the apical 4-chamber (A4C), parasternal long axis (PLAX), the PSAX, and the subcostal views (Fig. 1). The modified A4C view obtained with either lateral or medial transducer orientation allows a RV-focused visualization.

Bottom Line: The right ventricle (RV) has an essential function in cardiovascular physiology and pathology.Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions.However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber.

View Article: PubMed Central - PubMed

Affiliation: Echocardiography unit, cardiology division, University Hospital Notre Dame de Secours, Byblos, Lebanon.

ABSTRACT

Background: The right ventricle (RV) has an essential function in cardiovascular physiology and pathology. Currently, it is gaining an increasing interest given its recognized role in many cardiovascular conditions. However, echocardiographic assessment of the RV in daily practice is frequently based on qualitative estimation, and it has been regarded as a neglected chamber.

Objective: We sought to review and discuss the appropriate approach and latest methods of assessment of the RV by echocardiography.

Methods: A MEDLINE/Pubmed search was performed, and 55 relevant articles were selected; articles addressing right ventricular assessment by echocardiography, along with the latest recommendations, have been reviewed and discussed.

Results: A RV diameter >42 mm at the base and >35 mm at the mid-cavitary level indicates right ventricular dilatation; a longitudinal myocardial velocity (S') <9.5 mm/s, a tricuspid annular plane systolic excursion <17 mm, and a fractional area change <35% are indices of right ventricular systolic dysfunction. A right ventricular ejection fraction of >45% and an absolute value of global longitudinal strain of >21% reflect normal systolic function. The significance of dp/dt, the right myocardial performance index and isovolumic myocardial acceleration, is also discussed along with the parameters of right ventricular diastolic function. The use of novel echocardiographic approaches, such as three-dimensional echo and speckle tracking imaging, allows practitioners to overcome the challenges encountered with conventional echocardiography.

Conclusion: Accurate assessment of the RV by echocardiography yields early detection of cardiac diseases, enhances risk stratification, and allows timely initiation of appropriate therapy.

No MeSH data available.


Related in: MedlinePlus