Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function

Abstract

Introduction The right ventricle (RV) strain measured by speckle tracking (RVS) is an echocardiographic parameter used to assess RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Doppler tissue imaging‐derived peak systolic velocity (Sʹ) in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). Methods We enrolled consecutive patients who underwent cardiac MRI between Jan 2012 and Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, Sʹ, and FAC% were tested for accuracy to identify impaired RV EF (EF < 45% & <30%) using receiver operator curves. Results The study cohort included 500 patients with mean age 55 years ± 18 and peak tricuspid regurgitation velocity 2.7 ± 1.4 m/s. The area under ROC for RVS was 0.69 (95% CI 0.63–0.75) and 0.78 (95% CI 0.70–0.88) to predict RVEF < 45% & RVEF < 30%, respectively. The RV FAC% had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. Conclusion Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.

Lateral annular systolic excursion ratio: A novel measurement of right ventricular systolic function by two-dimensional echocardiography

“…The diagnostic performance of FAC, TAPSE and S' in this cohort was similar to the diagnostic performance reported by Pavlicek et al with AUCs of 0.728, 0.716 and 0.779 for each parameter respectively (16). Agasthi of FAC, TAPSE and S' with AUCs of 0.6658, 0.5819 and 0.5909 respectively, though a different dichotomous cutoff for abnormal RVEF was used (28). The stepwise logistic regression model that FAC and TAPSE do not add additional diagnostic value over LASER and S' which further suggests that LASER as a simple measure may be a robust parameter for discriminating abnormal RV function.…”

“…Lastly, the chosen dichotomous cutoff value for abnormal RVEF was <50% in this study as it was similar to two other large cohorts used to assess parameters of RV structure and function (15,16). Other studies have used an RVEF <45% to dichotomize normal from abnormal (27)(28)(29). The optimal cutoff value for defining abnormal RVEF is not known with some authors advocating for age, sex and BMI adjusted cutoffs (17).…”

“…These measures are simple to obtain, reproducible and familiar to imagers due to decades of clinical use (20,(23)(24)(25)(26). Despite these advantages, these onedimensional parameters are highly angle dependent, may neglect radial contractile function, do not account for cardiac translational motion and correlate weakly with CMR derived right ventricular ejection fraction (RVEF) (15,16,20,27,28).…”

“…Two-dimensional fractional area change (FAC) offers a more comprehensive assessment of right ventricular systolic function by incorporating both longitudinal and radial contractile elements leading to improved diagnostic accuracy and correlation with CMR derived RVEF (27)(28)(29). However, FAC may suffer from foreshortening and interference from trabeculations.…”

Application and Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio in Patients with Ischemic and Non-Ischemic Cardiomyopathy

“…By providing high spatial resolution and 3D volumetric data, CMR allows accurate quantification of cardiac function and dimensions. This is especially important in RV assessment because of its distinctive geometry [ 20 , 21 ]. Furthermore, CMR measurements in healthy subjects as well as in patients with various cardiovascular disorders show high reproducibility [ 5 , 6 , 11 , 22 ].…”