Dominance of free wall radial motion in global right ventricular function of heart transplant recipients

Abstract

Assessment of right ventricular (RV) function using conventional echocardiography might be inadequate as the radial motion of the RV free wall is often neglected. Our aim was to quantify the longitudinal and the radial components of RV function using three-dimensional (3D) echocardiography in heart transplant (HTX) recipients. Fifty-one HTX patients in stable cardiovascular condition without history of relevant rejection episode or chronic allograft vasculopathy and 30 healthy volunteers were enrolled. RV end-diastolic (EDV) volume and total ejection fraction (TEF) were measured by 3D echocardiography. Furthermore, we quantified longitudinal (LEF) and radial ejection fraction (REF) by decomposing the motion of the RV using the ReVISION method. RV EDV did not differ between groups (HTX vs control; 96 ± 27 vs 97 ± 2 mL). In HTX patients, TEF was lower, however, tricuspid annular plane systolic excursion (TAPSE) decreased to a greater extent (TEF: 47 ± 7 vs 54 ± 4% [-13%], TAPSE: 11 ± 5 vs 21 ± 4 mm [-48%], P < .0001). In HTX patients, REF/TEF ratio was significantly higher compared to LEF/TEF (REF/TEF vs LEF/TEF: 0.58 ± 0.10 vs 0.27 ± 0.08, P < .0001), while in controls the REF/TEF and LEF/TEF ratio was similar (0.45 ± 0.07 vs 0.47 ± 0.07). Current results confirm the superiority of radial motion in determining RV function in HTX patients. Parameters incorporating the radial motion are recommended to assess RV function in HTX recipients.

Left and right ventricular function detection and myocardial deformation analysis in heart transplant patients with long‐time follow‐ups

“…This surgery pattern resulted in a significantly lower TAPSE value related to the global and segmental RV function decreased with myocardial longitudinal strain mechanics detection. In addition, we found similar results in the studies by Moñivas et al 8 and Lakatos et al 16–19 This evaluation detected impaired RV and stable LV functions from our studies, and monitored recovered or improved strain values during the 1‐, 5‐year than that in 1‐, 3‐month follow‐ups. Even though still reduced strain than controls we assessed, it was different than what Moñivas et al 8 revealed.…”

Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?

“…Thus, conventional M-mode and 2D indices may be inadequate for the post-operative assessment of RV function. 20 Our results clearly demonstrated that the radial motion could effectively compensate for the post-operative decline of longitudinal motion to maintain RVEF. Interestingly, we have found that 6 months after the successful operation, the native contraction pattern is restored in MVR patients as RV longitudinal and radial contributions (LEFi, REFi) are comparable with healthy controls'.…”

Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

“…Under physiological conditions, the longitudinal shortening was suggested to account for the majority of RV pump function [ 5 ]; however, the majority of recent studies suggest a similar importance of longitudinal and radial motions (Fig. 2 ) [ 6 , 7 ]. Larger studies are needed to characterize potential age-related and gender-related alterations.…”