Echocardiographic assessment of the right ventricle in the current era: Application in clinical practice

Abstract

The right ventricle has unique structural and functional characteristics. It is now well recognized that the so-called forgotten ventricle is a key player in cardiovascular physiology. Furthermore, there is accumulating evidence that demonstrates right ventricular dysfunction as an important marker of morbidity and mortality in several commonly encountered clinical situations such as heart failure, pulmonary hypertension, pulmonary embolism, right ventricular myocardial infarction, and adult congenital heart disease. In contrast to the left ventricle, echocardiographic assessment of right ventricular function is more challenging as volume estimations are not possible without the use of three-dimensional (3D) echocardiography. Guidelines on chamber quantification provide a standardized approach to assessment of the right ventricle. The technique and limitations of each of the parameters for RV size and function need to be fully understood. In this era of multimodality imaging, echocardiography continues to remain a useful tool for the initial assessment and follow-up of patients with right heart pathology. Several novel approaches such as 3D and strain imaging of the right ventricle have expanded the usefulness of this indispensable modality.

Nocturnal Hypoxemia Impacts Right Ventricle Diastolic Function in Obstructive Sleep Apnea: A Retrospective Observational Study

“…ETT was carried out with a commercial ultrasound system (Vivid 7 and Vivid E9, GE Healthcare, Horton, Norway) and a 2.5 MHz probe. All measurements (M-Mode, 2D, color-Doppler and tissue Doppler imaging) were performed and interpreted according to the recommendations of the European Association of Echocardiography/American Society of Echocardiography [23][24][25]28]. The analysis was carried out by two cardiologists.…”

“…Hence, in this study we focused our attention on a specific marker of RV diastolic (RVD) function: the early trans-tricuspid diastolic inflow curve (or E-wave) deceleration time (EDT), measured by pulsed wave (PW) Doppler. EDT is considered to be one of the most useful indicators of RVD alterations [22][23][24][25]. Our primary aim was to evaluate how many patients admitted to our out-patient sleep service for nCRP, with nocturnal apnea and free from significant comorbidities, i.e., pure OSA patients, showed alterations of RVD function, as evaluated by EDT.…”

Echocardiographic Assessment of the Right Ventricle–State of the Art

“…Assessment of the RV should be included in all routine transthoracic echocardiograms, and should be performed from multiple windows, including the parasternal long-axis, parasternal right ventricular inflow and outflow views, apical four-chamber, apical view with a right ventricular focus and subcostal views. Given the geometric complexity of the right ventricular, each view provides additional information to help assess right ventricular function [10].…”

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

“…In addition to fetal CHD [6][7][8][9], conditions such as fetal growth restriction [10], the use of assisted reproductive techniques [11], twin-to-twin transfusion in monochorionic twin pregnancies [12][13][14], and right-sided congenital diaphragmatic hernia [15] can induce RV morphometric and functional changes, which can persist into childhood [16] leading to cardiovascular dysfunction in adulthood. Therefore, the prenatal assessment of RV performance may be useful not only for fetal monitoring but also for postnatal follow-up [17][18][19][20].…”

“…RV FAC is a 2D echocardiographic parameter that can be measured in the 4-chamber view by manually tracing the contour of the RV. RV FAC is considered a global systolic parameter [17] as it provides information on the percentage of change in RV area from end-diastole to endsystole, which results from the combination of longitudinal and radial (transverse) shortening [22]. RV FAC has some advantages compared to other RV echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE) by m-Mode [22] and tricuspid annular peak systolic velocity (S') by tissue Doppler imaging [24].…”