Echocardiographic assessment of right ventricular function: current clinical practice

Abstract

Echocardiographic evaluation of right ventricular (RV) function is a challenge due to the complex anatomy of the RV. Several transthoracic echocardiographic methods have been suggested for the quantification of RV function. However, many of the parameters are time consuming and need dedicated hardware and software. We suspected that the majority of the established markers are not used on a wide basis. In a multinational online survey, we evaluated the use of current clinical standards for the quantification of RV function in clinical practice. Through the network of an Ultrasound Online Teaching Platform, echocardiographers were invited to participate in an open online survey. The participants were asked about the parameters (eyeballing, TAPSE, S', fractional area change, RIMP, 3D-EF, dp/dt, longitudinal strain) they used in clinical practice. A total of 1150 participants from 109 countries completed the survey. Only eyeballing (72%), TAPSE (69%), and S' (31%) were commonly used in clinical routine. These methods were applied significantly less common in low-income economies when compared to high-income economies. Twenty-three percent of all participants stated to rely on eyeballing only, when evaluating RV function in clinical routine. New technologies, such as global longitudinal strain (3%) and 3D echocardiography (1%) were rarely applied independent of region and economic strength. Eyeballing and TAPSE are the most widely used methods in echocardiography for the assessment of RV function. Although advanced parameters such as longitudinal strain and 3D echocardiography were shown to be highly accurate, they are rarely used in clinical routine.

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“…Additionally, due to the retrospective design of our study, many patients lacked laboratory testing of coagulation and inflammatory markers during their workup, limiting our evaluation of values such as for fibrinogen, ferritin, and ESR; echocardiography; and understanding for ordering CTPA. Also, echocardiography is subject to observer variation (36). Another limitation is that we cannot ascertain whether right heart strain was acute or preceded the current clinical presentation.…”

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“…Rapid detection of acute RV dysfunction can significantly affect patient management and is an independent predictor of mortality in pulmonary embolism, ARDS and acute myocardial infarction [37][38][39]. Eyeballing and tricuspid annular plane systolic excursion (TAPSE) measurements are the most commonly used echocardiographic methods for the assessment of RV function [40]. Echocardiographic criteria of RV dysfunction include: RV dilatation (diastolic diameter ≥30 mm in the parasternal short-axis view) or an elevated right/left ventricular end-diastolic diameter ratio (cut-off of 0.9 or 1.0), an abnormal motion of the interventricular septum, an elevated tricuspid valve regurgitation velocity (cut-off 2.7 or 2.8 m/s) and hypokinesis of the RV free wall [41].…”

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“…32 Assessment of RV systolic function relied on TAPSE and TDI, two longitudinal measures that have that have had mixed predictive outcome value for patients and may not be reflective of overall systolic performance. 5,23,37,38 The study used guidelines 5 to assess RVDD. However, these data were based on relationships among Doppler parameters and measured right atrial (RA) and RV pressures, [39][40][41] which then were correlated with outcome, reported as exercise capacity, atrial arrhythmias, heart failure, and mortality.…”

“…32 Future investigations should be more comprehensive, including conventional and tissue Doppler, speckle tracking, and two-dimensional and three-dimensional measures of chamber size and function allowing determination of pressurevolume relations. 3,4,5,37,38 This more comprehensive assessment should be applied to various populations and pathologies that result in RV dysfunction, with the expectation that Doppler profiles and patterns may differ from one case type to another.…”