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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

Right atrial linear dimensions.Abbreviations: d1, transverse diameter; d2, longitudinal diameter.
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f12-cmc-9-2015-065: Right atrial linear dimensions.Abbreviations: d1, transverse diameter; d2, longitudinal diameter.

Mentions: Quantification of RA size is usually performed using the A4C view. The minor diameter extends from the lateral border of the RA to the interatrial septum and the major diameter extends from the bottom of the RA to the tricuspid annulus. Upper reference limits are 4.4 and 5.3 cm, respectively (Fig. 12). The upper reference limit for RA area is 18 cm2 measured by 2DE at the end-systolic frame,4 and the reference values of indexed RA volume are 25 ± 7 mL/m2 in men and 21 ± 6 mL/m2 in women.9 Of note, RA size is correlated with clinical outcomes in PAH.41 RA pressure is estimated by measurement of the diameter of the inferior vena cava in the subcostal view, and normal diameter as measured at end expiration is between 1.5 and 2.1 cm.4 A diameter <2.1 cm that collapses more than 50% with a sniff suggests a normal RA pressure (range, 0–5 mmHg), a diameter >2.1 cm that collapses less than 50% with a sniff suggests high RA pressure (~15 mmHg), and in indeterminate cases where the diameter and collapsibility do not fit such patterns, an intermediate value of 8 mmHg is adopted.4,42


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)

Right atrial linear dimensions.Abbreviations: d1, transverse diameter; d2, longitudinal diameter.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f12-cmc-9-2015-065: Right atrial linear dimensions.Abbreviations: d1, transverse diameter; d2, longitudinal diameter.
Mentions: Quantification of RA size is usually performed using the A4C view. The minor diameter extends from the lateral border of the RA to the interatrial septum and the major diameter extends from the bottom of the RA to the tricuspid annulus. Upper reference limits are 4.4 and 5.3 cm, respectively (Fig. 12). The upper reference limit for RA area is 18 cm2 measured by 2DE at the end-systolic frame,4 and the reference values of indexed RA volume are 25 ± 7 mL/m2 in men and 21 ± 6 mL/m2 in women.9 Of note, RA size is correlated with clinical outcomes in PAH.41 RA pressure is estimated by measurement of the diameter of the inferior vena cava in the subcostal view, and normal diameter as measured at end expiration is between 1.5 and 2.1 cm.4 A diameter <2.1 cm that collapses more than 50% with a sniff suggests a normal RA pressure (range, 0–5 mmHg), a diameter >2.1 cm that collapses less than 50% with a sniff suggests high RA pressure (~15 mmHg), and in indeterminate cases where the diameter and collapsibility do not fit such patterns, an intermediate value of 8 mmHg is adopted.4,42

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