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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

Tricuspid annular plane systolic excursion (TAPSE) measured at the lateral tricuspid annulus in M-Mode.
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f6-cmc-9-2015-065: Tricuspid annular plane systolic excursion (TAPSE) measured at the lateral tricuspid annulus in M-Mode.

Mentions: TAPSE is defined as the total excursion of the tricuspid annulus from tele-diastole to end-systole, and it is measured typically at the lateral annulus using M-mode (Fig. 6). TAPSE is a reliable, sensitive, and reproducible index for the initial diagnosis and for the follow-up of RV function. Moreover, it presents an excellent correlation with the RV ejection fraction (RVEF) as calculated with radionuclide ventriculography or magnetic resonance.16 The normal value of TAPSE is >16 mm.4,17 Of note, TAPSE is relatively load- and angle-dependent, and is subject to cardiac translation; however, it is the least user-dependent parameter for assessment of RV function.17,18 Guazzi et al reported that the ratio TAPSE/systolic pulmonary artery pressure (SPAP) improves the prognostic risk stratification in heart failure patients when compared to TAPSE alone and a ratio <0.36 mm/mmHg predicts higher mortality in such patients.17


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)

Tricuspid annular plane systolic excursion (TAPSE) measured at the lateral tricuspid annulus in M-Mode.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f6-cmc-9-2015-065: Tricuspid annular plane systolic excursion (TAPSE) measured at the lateral tricuspid annulus in M-Mode.
Mentions: TAPSE is defined as the total excursion of the tricuspid annulus from tele-diastole to end-systole, and it is measured typically at the lateral annulus using M-mode (Fig. 6). TAPSE is a reliable, sensitive, and reproducible index for the initial diagnosis and for the follow-up of RV function. Moreover, it presents an excellent correlation with the RV ejection fraction (RVEF) as calculated with radionuclide ventriculography or magnetic resonance.16 The normal value of TAPSE is >16 mm.4,17 Of note, TAPSE is relatively load- and angle-dependent, and is subject to cardiac translation; however, it is the least user-dependent parameter for assessment of RV function.17,18 Guazzi et al reported that the ratio TAPSE/systolic pulmonary artery pressure (SPAP) improves the prognostic risk stratification in heart failure patients when compared to TAPSE alone and a ratio <0.36 mm/mmHg predicts higher mortality in such patients.17

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