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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

Three-dimensional RV reconstruction. End-diastolic frame (upper left panel); end-systolic frame (upper right panel); mesh shell image showing end-diastolic frame (lower left panel). The volume time curve displayed in the lower right panel.
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f10-cmc-9-2015-065: Three-dimensional RV reconstruction. End-diastolic frame (upper left panel); end-systolic frame (upper right panel); mesh shell image showing end-diastolic frame (lower left panel). The volume time curve displayed in the lower right panel.

Mentions: Technically, 3DE of the RV requires a different transducer (frequency of 3–4 MHz with a volumetric frame rate of 16–24 frames/s) than the one used for conventional echocardiography, and the A4C view is the most frequently used approach. Semiautomated border detection needs to be manually adjusted, and after acquisition and display of end-diastolic and end-systolic frame, long axis, planes, and volumetric data of the RV may be analyzed offline. A variety of axial cuts (cropping planes) can be obtained at the apex, mid and base of the RV, whether in the sagittal or coronal planes. Volumetric calculation is achieved via the method of disks or via the mesh shell technique. Curves of regional and global RVF are produced and analyzed; RV end-diastolic volume, RV end-systolic volume, and RVEF are generated.32 Accepted normal values of RV end-diastolic volume as stated by recent guidelines30 are 129 ± 25 mL for men and 102 ± 33 mL for women (Fig. 10).


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)

Three-dimensional RV reconstruction. End-diastolic frame (upper left panel); end-systolic frame (upper right panel); mesh shell image showing end-diastolic frame (lower left panel). The volume time curve displayed in the lower right panel.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f10-cmc-9-2015-065: Three-dimensional RV reconstruction. End-diastolic frame (upper left panel); end-systolic frame (upper right panel); mesh shell image showing end-diastolic frame (lower left panel). The volume time curve displayed in the lower right panel.
Mentions: Technically, 3DE of the RV requires a different transducer (frequency of 3–4 MHz with a volumetric frame rate of 16–24 frames/s) than the one used for conventional echocardiography, and the A4C view is the most frequently used approach. Semiautomated border detection needs to be manually adjusted, and after acquisition and display of end-diastolic and end-systolic frame, long axis, planes, and volumetric data of the RV may be analyzed offline. A variety of axial cuts (cropping planes) can be obtained at the apex, mid and base of the RV, whether in the sagittal or coronal planes. Volumetric calculation is achieved via the method of disks or via the mesh shell technique. Curves of regional and global RVF are produced and analyzed; RV end-diastolic volume, RV end-systolic volume, and RVEF are generated.32 Accepted normal values of RV end-diastolic volume as stated by recent guidelines30 are 129 ± 25 mL for men and 102 ± 33 mL for women (Fig. 10).

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