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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

Fractional area change (FAC; left panel) and fractional linear shortening (FS; right panel).Abbreviations: RVTDA, RV tele-diastolic area; RVTSA, RV tele-systolic area; RVOTD, RVOT diameter in diastole; RVOTS, RVOT diameter in systole.
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f8-cmc-9-2015-065: Fractional area change (FAC; left panel) and fractional linear shortening (FS; right panel).Abbreviations: RVTDA, RV tele-diastolic area; RVTSA, RV tele-systolic area; RVOTD, RVOT diameter in diastole; RVOTS, RVOT diameter in systole.

Mentions: Fractional linear shortening is obtained by measuring the RVOT diameter at end-diastole and end-systole using the PSAX view. Reference limits are not set in the latest guidelines; however, “normal” values are reported with a wide range of standard variation (43% ± 18%).4,21 The main limitation in obtaining fractional linear shortening is the poor definition of the RV anterior wall. Also, there are no established landmarks for orienting the image axis at the level of the RVOT. FAC, calculated with the A4C view, is a more reliable parameter; it is defined as the difference between end-diastolic and end-systolic area divided by the end-diastolic area and multiplied by 100 (Fig. 8). Of note, FAC has been shown to correlate with RVEF as measured by magnetic resonance imaging, and the lower reference value is 35%.4,22


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)

Fractional area change (FAC; left panel) and fractional linear shortening (FS; right panel).Abbreviations: RVTDA, RV tele-diastolic area; RVTSA, RV tele-systolic area; RVOTD, RVOT diameter in diastole; RVOTS, RVOT diameter in systole.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f8-cmc-9-2015-065: Fractional area change (FAC; left panel) and fractional linear shortening (FS; right panel).Abbreviations: RVTDA, RV tele-diastolic area; RVTSA, RV tele-systolic area; RVOTD, RVOT diameter in diastole; RVOTS, RVOT diameter in systole.
Mentions: Fractional linear shortening is obtained by measuring the RVOT diameter at end-diastole and end-systole using the PSAX view. Reference limits are not set in the latest guidelines; however, “normal” values are reported with a wide range of standard variation (43% ± 18%).4,21 The main limitation in obtaining fractional linear shortening is the poor definition of the RV anterior wall. Also, there are no established landmarks for orienting the image axis at the level of the RVOT. FAC, calculated with the A4C view, is a more reliable parameter; it is defined as the difference between end-diastolic and end-systolic area divided by the end-diastolic area and multiplied by 100 (Fig. 8). Of note, FAC has been shown to correlate with RVEF as measured by magnetic resonance imaging, and the lower reference value is 35%.4,22

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