Echocardiographic Assessment of the Right Heart in Adults: A Practical Guideline from the British Society of Echocardiography

Abstract

The structure and function of the right side of the heart is influenced by a wide range of physiological and pathological conditions. Quantification of right heart parameters is important in a variety of clinical scenarios including diagnosis, prognostication, and monitoring response to therapy. Although echocardiography remains the first-line imaging investigation for right heart assessment, published guidance is relatively sparse in comparison to that for the left ventricle. This guideline document from the British Society of Echocardiography describes the principles and practical aspects of right heart assessment by echocardiography, including quantification of chamber dimensions and function, as well as assessment of valvular function. While cut-off values for normality are included, a disease-oriented approach is advocated due to the considerable heterogeneity of structural and functional changes seen across the spectrum of diseases affecting the right heart. The complex anatomy of the right ventricle requires special considerations and echocardiographic techniques, which are set out in this document. The clinical relevance of right ventricular diastolic function is introduced, with practical guidance for its assessment. Finally, the relatively novel techniques of three-dimensional right ventricular echocardiography and right ventricular speckle tracking imaging are described. Despite these techniques holding considerable promise, issues relating to reproducibility and inter-vendor variation have limited their clinical utility to date.

A practical guideline for performing a comprehensive transthoracic echocardiogram in adults: the British Society of Echocardiography minimum dataset

“…The image may be tilted to provide optimal Doppler alignment with the TR jet. PWD of RV inflow velocities may be performed for the assessment of RV diastolic function 32 Full Doppler assessment of the PV (CFD, CWD, PWD) can also be performed in this view. Assess for pulmonary regurgitation (PR) and any abnormal flow 35 PSAX LV: MV level (2D/CFD)…”

Study protocol for COVID-RV: a multicentre prospective observational cohort study of right ventricular dysfunction in ventilated patients with COVID-19

“…For both, the images will be optimised, have ECG monitoring present throughout and the frame rate should be maximised; both will be recorded for four beats. 31 These data will be anonymised and transferred electronically to the research team for further analysis.…”

Different Pathophysiology and Outcomes of Heart Failure With Preserved Ejection Fraction Stratified by K-Means Clustering

“…The identified subgroups of HFpEF in this study had more hemodynamic concepts than those in previous reports because LV and RV function, especially RV distensibility were taught in machine learning. Echocardiography is excellent for the assessment of cardiac function, but in comparison with LV diastolic function, there is a lack of guidance for the assessment and quantification of RV diastolic function (15). The examination of tricuspid inflow was recommended for the assessment of RV diastolic function (26); however, the echocardiographic assessment of RV function is often difficult due to the complex RV anatomy and these measures do not typically form part of a standard clinical echocardiographic study (15,46).…”

“…Indeed, using several machine-learning algorithms, previous studies clarified the phenotypes and therapeutic strategies for HFpEF; however, the features of heart failure with mid-range ejection fraction may influence the features of unknown phenotypes and RV diastolic function was not taught in previous studies (9)(10)(11)(12)(13). Although RV function plays an important role in the pathophysiology of HFpEF (14), there is a lack of guidance for the assessment and quantification of RV diastolic function (15). The physiological properties of the right ventricle are lower contractility and higher compliance than the left ventricle (16).…”