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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

Notching (arrow) of the pulmonary spectral flow (right panel).
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f13-cmc-9-2015-065: Notching (arrow) of the pulmonary spectral flow (right panel).

Mentions: Pulmonary artery hypertension is defined as a mean pulmonary artery pressure >25 mmHg.44 Of note, SPAP as measured using the tricuspid regurgitation peak velocity is only an estimate and cannot be considered an accurate measurement of SPAP.45 In view of this, it is important to consider other surrogates to estimate SPAP when judged necessary. The use of pulmonary flow acceleration time should be considered when the tricuspid flow is not reliable or cannot be measured, and a value <105 ms is suggestive of PAH. Other echocardiographic parameters or surrogates may suggest PAH, and they are better used in the context of an integrated approach to estimate SPAP. These parameters include indexed RA volume >34 mL/m2 in men and >27 mL/m2 in women, RV FAC <32%, LV eccentricity index (end-systole or end-diastole) >1, RV IVRT <75 ms, and TAPSE <16.10 Of note, the pulmonary Doppler flow envelope may give insights into the origin of PAH; a mid or late systolic notching is typically encountered in PAH associated with pulmonary vascular disease (pre-capillary PAH) (Fig. 13).46


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)

Notching (arrow) of the pulmonary spectral flow (right panel).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f13-cmc-9-2015-065: Notching (arrow) of the pulmonary spectral flow (right panel).
Mentions: Pulmonary artery hypertension is defined as a mean pulmonary artery pressure >25 mmHg.44 Of note, SPAP as measured using the tricuspid regurgitation peak velocity is only an estimate and cannot be considered an accurate measurement of SPAP.45 In view of this, it is important to consider other surrogates to estimate SPAP when judged necessary. The use of pulmonary flow acceleration time should be considered when the tricuspid flow is not reliable or cannot be measured, and a value <105 ms is suggestive of PAH. Other echocardiographic parameters or surrogates may suggest PAH, and they are better used in the context of an integrated approach to estimate SPAP. These parameters include indexed RA volume >34 mL/m2 in men and >27 mL/m2 in women, RV FAC <32%, LV eccentricity index (end-systole or end-diastole) >1, RV IVRT <75 ms, and TAPSE <16.10 Of note, the pulmonary Doppler flow envelope may give insights into the origin of PAH; a mid or late systolic notching is typically encountered in PAH associated with pulmonary vascular disease (pre-capillary PAH) (Fig. 13).46

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