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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

Myocardial systolic excursion velocity (S’) displayed with DTI using the A4C view at the lateral tricuspid annulus. E’, early diastolic filling; A’, late diastolic filling. The first systolic wave represents the myocardial isovolumic contraction (arrow).
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f7-cmc-9-2015-065: Myocardial systolic excursion velocity (S’) displayed with DTI using the A4C view at the lateral tricuspid annulus. E’, early diastolic filling; A’, late diastolic filling. The first systolic wave represents the myocardial isovolumic contraction (arrow).

Mentions: DTI is useful for the assessment of both systolic and diastolic RV function. S’ is obtained using the A4C view, and measurement is typically performed at the lateral tricuspid annulus or at the basal segmental level of the RVFW, using either pulsed or color DTI. Pulsed DTI is more robust than color DTI and it has a higher temporal resolution in this respect.19 S’ is one of the most reliable and reproducible methods to assess RV systolic function, and it correlates positively with RVEF as calculated by cardiac magnetic resonance.20 The lower reference limit with pulsed DTI is set at 9.5 cm/s.4 Of note, S’ is load-dependent and requires correction when heart rate is <70 bpm or >100 bpm; correction is achieved by multiplying S’ by 75 and dividing it by the heart rate (Fig. 7).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)

Myocardial systolic excursion velocity (S’) displayed with DTI using the A4C view at the lateral tricuspid annulus. E’, early diastolic filling; A’, late diastolic filling. The first systolic wave represents the myocardial isovolumic contraction (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f7-cmc-9-2015-065: Myocardial systolic excursion velocity (S’) displayed with DTI using the A4C view at the lateral tricuspid annulus. E’, early diastolic filling; A’, late diastolic filling. The first systolic wave represents the myocardial isovolumic contraction (arrow).
Mentions: DTI is useful for the assessment of both systolic and diastolic RV function. S’ is obtained using the A4C view, and measurement is typically performed at the lateral tricuspid annulus or at the basal segmental level of the RVFW, using either pulsed or color DTI. Pulsed DTI is more robust than color DTI and it has a higher temporal resolution in this respect.19 S’ is one of the most reliable and reproducible methods to assess RV systolic function, and it correlates positively with RVEF as calculated by cardiac magnetic resonance.20 The lower reference limit with pulsed DTI is set at 9.5 cm/s.4 Of note, S’ is load-dependent and requires correction when heart rate is <70 bpm or >100 bpm; correction is achieved by multiplying S’ by 75 and dividing it by the heart rate (Fig. 7).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