Echocardiographic evaluation of the right ventricle: Clinical implications

Abstract

Interest in evaluation of the right ventricle (RV) has increased recently. With the growth of new echocardiographic techniques and technology, there has been a corresponding increase in the ability to evaluate the RV, both qualitatively and quantitatively. Older echocardiographic techniques, such as right ventricular fractional area of change, tricuspid annular plane systolic excursion, and tissue S 0 , and newer echocardiographic techniques including 3-dimensional evaluation and global longitudinal strain, can improve our evaluation of RV function. These techniques provide both diagnostic and prognostic data on a large variety of clinical diseases including pulmonary hypertension and congestive heart failure. With the continuing and exponential advances in technology, echocardiography is well poised to become the primary modality to evaluate the RV. | ANATOMY OF THE RVThe RV is composed of 3 different segments: the inlet area, the trabecular portion, and the outflow area. The inlet extends from the papillary muscles to the tricuspid annulus. The trabecular portion extends from the papillary muscles to the right ventricular (RV) apex.The outflow portion is a smooth area leading to the pulmonic valve. 1Because the RV does not follow a traditional symmetrical shape, the RV volume does not lend itself to estimation. Wall-motion abnormalities are also more difficult to evaluate, as there are 3 different subsections. Wall motion is also difficult to evaluate due to a combination of radial, longitudinal, and circumferential shortening; these independent movements are not clearly visible on an echocardiogram. 2Normal values for the RV were significantly limited due to the lack of standardization across echocardiographic protocols. cMRI, which measures the RV in planes that are not visualized on echocardiography, was able to provide a series of normal valves. As a result, we know that although RV mass and volumes are larger among males vs females, there is no significant difference in systolic function. | FUNCTION OF THE RVThe LV is often described as a pump whose function is based on its inherent contractility. In contrast, the RV is profoundly affected by loading conditions. The RV function is dependent on preload and afterload.2 It provides the same stroke volume as the LV with

Pulmonary hypertension secondary to pulmonary fibrosis: clinical data, histopathology and molecular insights

“…Therefore, detection of PH in PF patients by TTE can be confirmed by RHC although it may not change the clinical management given there is no approved PH-targeted therapy currently available for this patient population. TTE is also widely used to visualize right ventricular morphology and detect right ventricular dysfunction [65]. Commonly used RV indices to assess for PH by TTE include RV/LV basal diameter ratio to assess for RV dilatation, and tricuspid annular plane systolic excursion (TAPSE), fractional area change, and RV pulsed tissue doppler S wave velocity to evaluate for RV dysfunction [62].…”

Right Ventricular Outflow Tract Fractional Shortening (RVOT FS) As Echocardiography Parameter for Assessment Right Ventricular Function in Systolic Heart Failure

“…5 RVOT contribute 20% of RV contraction and 15% stroke volume of RV. 7,8,11,13 In our study, we correlate the other RV function parameter such as RVOT FS, TAPSE and S' with RV FAC. We found that TAPSE had high positive correlation than other (r=0.788) (P<0.001).…”

An association between right ventricular dysfunction and sudden cardiac death

“…RV dysfunction is emerging as a novel marker for risk stratification in SCD. Although RVFAC is a standard measure for echocardiographic assessment of RV function, 20 it is not clear at this time which measure of RV function would be the most suitable for risk stratification. Previous work has identified RV dysfunction as a potential predictor of SCD risk, although it has not been shown for quantitative measures in clinically acquired echocardiograms.…”