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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

(Left panel) Normal crescent shape of the RV. (Right panel) Dilated RV with D-shape of the LV and flattening of the septum.
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f2-cmc-9-2015-065: (Left panel) Normal crescent shape of the RV. (Right panel) Dilated RV with D-shape of the LV and flattening of the septum.

Mentions: An experienced sonographer must be capable of making an adequate qualitative assessment of RVF when the sonographic signal is adequate, staging a potential dysfunction as mild, moderate, or severe. Qualitative signs of RV dysfunction mainly address the RVFW and septal motion. Examination of the septal motion in the PSAX view at the level of the papillary muscles may help to distinguish volume from pressure overload. RV volume overload produces RV dilatation with septal flattening (D-shaped pattern) at end-diastole, whereas pressure overload produces maximal septal flattening at end-systole (Fig. 2).10 Different views are used to assess accurately the various segments of the RV: the PLAX to assess the anterior wall of the RVOT; the basal PSAX to assess the inferior wall of the RV and the anterior wall of the RVOT; the PSAX at the papillary muscles level to assess the inferior, lateral, and anterior wall of the RV; A4C to assess the lateral wall; the subcostal long axis to assess the inferior wall; and the parasternal RV inflow view to assess the anterior and inferior walls (Fig. 3).11,12


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)

(Left panel) Normal crescent shape of the RV. (Right panel) Dilated RV with D-shape of the LV and flattening of the septum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f2-cmc-9-2015-065: (Left panel) Normal crescent shape of the RV. (Right panel) Dilated RV with D-shape of the LV and flattening of the septum.
Mentions: An experienced sonographer must be capable of making an adequate qualitative assessment of RVF when the sonographic signal is adequate, staging a potential dysfunction as mild, moderate, or severe. Qualitative signs of RV dysfunction mainly address the RVFW and septal motion. Examination of the septal motion in the PSAX view at the level of the papillary muscles may help to distinguish volume from pressure overload. RV volume overload produces RV dilatation with septal flattening (D-shaped pattern) at end-diastole, whereas pressure overload produces maximal septal flattening at end-systole (Fig. 2).10 Different views are used to assess accurately the various segments of the RV: the PLAX to assess the anterior wall of the RVOT; the basal PSAX to assess the inferior wall of the RV and the anterior wall of the RVOT; the PSAX at the papillary muscles level to assess the inferior, lateral, and anterior wall of the RV; A4C to assess the lateral wall; the subcostal long axis to assess the inferior wall; and the parasternal RV inflow view to assess the anterior and inferior walls (Fig. 3).11,12

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