Echocardiographic linear fractional shortening for quantification of right ventricular systolic function—A cardiac magnetic resonance validation study

Abstract

Background Echocardiography (Echo)-based linear fractional shortening (FS) is widely used to assess left ventricular dysfunction (LVdys), but has not been systematically tested for right ventricular dysfunction (RVdys). Methods The population comprised LVdys patients with and without RVdys (EF<50%) on cardiac MRI (CMR): Echo included standard RV indices (fractional area change [FAC], TAPSE, S’ and FS in parasternal long axis (RV outflow tract [RVOT]) and apical 4-chamber views (width [RVWD], length [RVLG]). Results 168 patients underwent echo and CMR (3±3 days); FAC (46±9 vs. 28±11), TAPSE (1.9±0.4 vs. 1.5±0.3) and S’ (11.4±2.3 vs. 10.0±2.6, all p≤ 0.001) were lower among RVdys patients, as were FS indices (RVOT 32±8 vs 17±10 | RVWD 40±11 vs 22±12 | RVLG 16±5 vs 9±4%; all p<0.001). FS indices yielded similar magnitude of correlation with CMR RVEF (r=0.73–0.56) as did FAC (r=0.70), which was slightly higher than TAPSE (r=0.47) and S’ (r=0.31; all p<0.001). FS indices decreased stepwise vs. CMR RVEF tertiles, as did FAC (all p<0.001). In multivariate analysis, FS in RVOT (regression coefficient 0.51 [CI 0.37–0.65]), RVWD (0.30 [0.19–0.41]), and RVLG (0.45 [0.20–0.71]; all p≤ 0.001) were independently associated with CMR RVEF. FS indices yielded good overall diagnostic performance (AUC: RVOT 0.89 [CI 0.82–0.97] | RVWD 0.87 [0.78–0.96] | RVLG 0.80 [0.70–0.90]; all p<0.001) for CMR-defined RVdy (RVEF<50%). Conclusions RV linear FS provides RV functional indices that parallel CMR RVEF. Parasternal long-axis RVOT width, 4-chamber RV width and length are independently associated with RVEF, supporting use of multiple FS indices for RV functional assessment.

Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two‐ and three‐dimensional echocardiography

“…However, our approach is consistent with that applied in prior multicenter studies of MClp, for which post‐procedural MR severity has been similarly assessed . More broadly, all analyses performed in this study are consistent with methods applied and validated by our group and others in prior large epidemiologic and outcomes research . Second, whereas our sample size ( n = 67) was similar to several other studies that have tested imaging predictors of MClp response ( n = 50–77), larger multicenter prospective studies are warranted to confirm our findings and test LV remodeling as a predictor of post‐MClp clinical outcomes.…”

Echocardiographic Findings in Canine Model of Chagas Disease Immunized with DNA Trypanosoma cruzi Genes

“…There are some studies that report systematic tests for right ventricular dysfunction by FS evaluation. Right ventricular function is an important predictor of mortality and quality of life in patients with LV failure, myocardial infarction, congenital heart disease, and pulmonary hypertension [43,44]; according to this, we suggest that non-vaccinated dogs developed an ability reduction of the myocardial fibers to distend, which together with the diastolic dimensions suggests little contractility. It is documented that a high afterload hindering muscle contraction could show a decreased FS as an important feature by echocardiography [43], such as that we can observe in those non-vaccinated/infected dogs, suggesting an impairing in general cardiac function.…”

Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation

“…Cine-CMR was used to assess RV and LV geometry/function: End-diastolic and end-systolic chamber volumes were measured in contiguous short axis images, with results used to calculate EF. Cine-CMR quantified RVEF was employed as the reference standard for RV DYS , which was defined using an established binary cutoff (RVEF< 50%) [ 11 , 29 – 31 ]. CMR analyses were performed by an experienced reader (JWW), for whom high reproducibility for both LV and RV indices has been documented [ 12 , 32 , 33 ].…”

“…Conventional echo methods assess the RV in a single 2D orientation, which can provide limited insight into global RV performance. Recent data by our group and others have shown multiplanar echo quantification–including linear fractional shortening in apical and parasternal long axis (PLAX) views–to yield improved echo assessment of CMR evidenced RV DYS [ 11 – 13 ]. New echo methods enable assessment of myocardial deformation (strain); utility of multiplanar strain imaging for assessment of volumetric RV DYS and NIF-associated RV remodeling by CMR is unknown.…”