Limitations of Standard Echocardiographic Methods for Quantification of Right Ventricular Size and Function in Children and Young Adults

Srinivasan, Chandramouleeswaran; Sachdeva, Ritu; Morrow, W. Robert; Greenberg, S. Bruce; Vyas, Himesh V.

doi:10.7863/jum.2011.30.4.487

Cited by 49 publications

(34 citation statements)

References 27 publications

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“…It also correlates well with RVEF determined by CMR or angiography. 16,[20][21][22][23]39,40 The low intra-and interobserver variability for TAPSE in the current study is consistent with those previous findings. TAPSE has the potential to discriminate well between patients with ARVC/D and healthy probands.…”

Section: Predictive Role Of Echocardiographic Variablessupporting

confidence: 82%

“…9,14,15 Echocardiographic assessment of RV dimension and function is challenging because of the complex RV geometry, and both FAC and TAPSE do not always correlate well with the more accurate 3-dimensional volumes and EF obtained by CMR. [16][17][18][19][20] This is particularly true for FAC, which depends on an optimal image quality. FAC also does not fully reflect the regional function of the RV outflow tract and subtricuspid area that are often involved in ARVC/D.…”

Section: Predictive Role Of Echocardiographic Variablesmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15] Data about the predictive role of RV fractional area change (FAC) in ARVC/D as measured by 2-dimensional transthoracic echocardiography (2D TTE) are scarce and controversial. 9,[14][15][16][17][18][19][20] Tricuspid annulus plane systolic excursion (TAPSE) can easily be determined by M-mode TTE. It is a robust parameter for …”

mentioning

confidence: 99%

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Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Saguner

Vecchiati

Baldinger

et al. 2014

Circ: Cardiovascular Imaging

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A rrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited disease characterized by a progressive fibrofatty replacement mainly involving the RV myocardium. It is associated with ventricular arrhythmias, heart failure, and sudden cardiac death (SCD). 1-6Clinical Perspective on p 239 RV dilation, reduced RV systolic function, and diffuse RV involvement have previously been studied as predictors of an adverse outcome in patients with ARVC/D but have yielded conflicting results possibly because of divergent imaging modalities, varying parameters measured, and heterogeneous patient cohorts. [7][8][9][10][11][12][13][14][15] Data about the predictive role of RV fractional area change (FAC) in ARVC/D as measured by 2-dimensional transthoracic echocardiography (2D TTE) are scarce and controversial. 9,[14][15][16][17][18][19][20] Tricuspid annulus plane systolic excursion (TAPSE) can easily be determined by M-mode TTE. It is a robust parameter for

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Section: Predictive Role Of Echocardiographic Variablessupporting

confidence: 82%

Section: Predictive Role Of Echocardiographic Variablesmentioning

confidence: 99%

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Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Saguner

Vecchiati

Baldinger

et al. 2014

Circ: Cardiovascular Imaging

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“…In separate studies, Lai et al and Srinivasan et al each demonstrated a weak correlation between RV FAC by echocardiography and MRI-derived RV volumes in children with a wide range of congenital heart defects. 21,39 In contrast, several recent studies have successfully utilized RV FAC by echocardiography to monitor RV function in both neonates and children with congenital heart disease, pulmonary hypertension, and sickle cell anemia. 34,35,40-43 Alghamadi et al demonstrated that the RV systolic and diastolic areas measured by echocardiography correlated well with systolic and diastolic volumes by MRI in pediatric patients with repaired Tetralogy of Fallot (TOF).…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Levy

Dioneda

Holland

et al. 2015

Journal of the American Society of Echocardiography

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Background Right Ventricle fractional area of change (RV FAC) is a quantitative two- dimensional echocardiographic measurement of RV function. RV FAC expresses the percentage change in the RV chamber area between end-diastole (RVEDA) to end-systole (RVESA). The objectives of this study were to determine the maturational (age- and weight- related) changes of RV FAC and RV areas and to establish reference values in healthy preterm and term neonates. Methods A prospective longitudinal study was conducted in 115 preterm infants (23-28 weeks gestational age at birth, 500-1500 gram). RV FAC was measured at 24 hours of age, 72 hours of age, 32 weeks and 36 weeks postmenstrual age (PMA). The maturational patterns of RVEDA, RVESA, and RV FAC were compared to 60 healthy full term infants in a cross sectional study (> 37 weeks, 3.5 +/− 1 kg), who received echocardiograms at birth (n=25) and one month of age (n=35). RVEDA and RVESA were traced in the RV focused apical 4-chamber view, and FAC was calculated using the formula: 100 * [(RVEDA – RVESA)/RVEDA)]. Premature infants that developed chronic lung disease or had a clinically and hemodynamically significant PDA were excluded (n=55) from the reference values. Intra- and inter- observer reproducibility analysis was performed. Results RV FAC ranged from 26% at birth to 35% by 36 weeks PMA in preterm infants (n=60) and increased almost two times faster in the first month of age as compared to healthy term infants (n=60). Similarly, RVEDA and RVESA increased throughout maturation in both term and preterm infants. RV FAC and RV areas correlated with weight (r=0.81, p<0.001), but were independent of gestational age at birth (r=0.3, p=0.45). RVEDA and RVESA correlated with PMA in weeks (r=0.81, p<0.001). RV FAC trended lower in preterm infants with bronchopulmonary dysplasia (p=0.04), but did not correlate to size of PDA (p=0.56). There was no difference in RV FAC based on gender or need for mechanical ventilation. Conclusions This study establishes reference values of RV areas (RVEDA and RVESA) and RV fractional area of change (RV FAC) in healthy term and preterm infants and tracks their maturational changes during postnatal development. These measures increase from birth to 36 weeks PMA, and this is reflective of the postnatal cardiac growth as a contributor to the maturation of cardiac function These measures are also linearly associated with increasing weight throughout maturation. This study suggests that two-dimensional RV FAC can be used as a complementary modality to assess global RV systolic function in neonates and facilitates its incorporation into clinical pediatric and neonatal guidelines.

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“…The 2D measurements correlated, but the agreement between the measurements weakened with progressive RV dilatation. [333435]…”

Section: Introductionmentioning

confidence: 99%

Pulmonary regurgitation after tetralogy of fallot repair: A diagnostic and therapeutic challenge

Senthilnathan

Dragulescu

Mertens

2013

J Cardiovasc Echography

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Background:Pulmonary regurgitation is the key hemodynamically significant lesion in repaired tetralogy of Fallot contributing to progressive right ventricular (RV) dilatation and biventricular dysfunction. The timing for pulmonary valve replacement remains a controversial topic, and the decision to intervene depends on assessment of RV size and RV function.Objectives:This review aims to discuss the echocardiographic techniques that can be used to assess patients with pulmonary regurgitation after the repair of tetralogy of Fallot defect. While cardiac magnetic resonance (CMR) imaging is the clinical reference method, there is an important role of echocardiography in identifying patients with significant pulmonary regurgitation and assessing the RV size and function. The different echocardiographic techniques that can be used in this context are discussed. Newer techniques for assessing RV size and function include three-dimensional (3D) echocardiography, tissue Doppler and strain imaging. 3D RV volumetric reconstruction based on two-dimensional imaging is a promising new technique that could potentially replace CMR for RV volumetric assessment.Conclusions:Developments in echocardiographic techniques provide new insights into the impact of pulmonary regurgitation on RV structure and function. Echocardiography and CMR are complementary modalities and further research is required to define the optimal use of both techniques for this indication.

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Limitations of Standard Echocardiographic Methods for Quantification of Right Ventricular Size and Function in Children and Young Adults

Abstract: In contrast to the LV, 2D echocardiographic indices of RV size and function, with the exception of TAM, do not correlate with MRI data.

Cited by 49 publications

References 27 publications

Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Right Ventricular Function in Preterm and Term Neonates: Reference Values for Right Ventricle Areas and Fractional Area of Change

Pulmonary regurgitation after tetralogy of fallot repair: A diagnostic and therapeutic challenge

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