Echocardiographic Assessment of the Right Ventricle–State of the Art

Jones, N.; Burns, Andrew; Prior, David

doi:10.1016/j.hlc.2019.04.016

Cited by 52 publications

(43 citation statements)

References 38 publications

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“…Endocardial right ventricular borders were traced in end-systole and end-diastole to obtain the corresponding RV areas. Subsequently, RVFAC was calculated [24]: TASV was captured in 4CH views at the intersection of the RV free wall and the anterior leaflet of the tricuspid valve using tissue Doppler ( Fig. 2a) [25].…”

Section: Systolic Ventricular Functionmentioning

confidence: 99%

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Billig

Zayat

Ebeling

et al. 2020

Int J Cardiovasc Imaging

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This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281–2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72–88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.

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Section: Systolic Ventricular Functionmentioning

confidence: 99%

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Billig

Zayat

Ebeling

et al. 2020

Int J Cardiovasc Imaging

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“…A paradigm shift is occurring in the assessment of the RV from a simple, qualitative visual assessment on echocardiography to a more sophisticated routine quantification of parameters of RV structure and function, despite technical difficulties related to its complex, roughly triangular shape that wraps around the left ventricle [12,13]. As one of many examples of clinical utility, dimensions of the right ventricular outflow tract (RVOT) may be used as part of the revised diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy [14].…”

mentioning

confidence: 99%

“…TAPSE measures right ventricular longitudinal shortening and is a surrogate of systolic function [13]. With further technical development in 3D and strain imaging, more assessment may become routine [12,13].…”

mentioning

confidence: 99%

Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology

Gregory

Stanton

Thomas

et al. 2019

Heart, Lung and Circulation

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Echocardiography has been around for more than half a century [1]. Recent decades have seen significant technological advances, with increasing clinical applications of this non-invasive imaging tool, beyond the basic assessment of left ventricular function, with further evolution evident on the horizon. There has also been a burgeoning increase in use: According to the 2017 Australian Medicare Medical Benefits Schedule (MBS) Taskforce, about 900,000 echocardiographic procedures (excluding stress echo) are reimbursed annually, at a cost of over $180 million each year [2]. In addition, the use of echo is growing at a rate of about 8.8% each year [3]. Stress echocardiography accounts for over $56 million in billing annually in Australia and has grown each year at a rate of 12% for the past 5 years [4]. In recognition of this expanding use, this fully commissioned Special Issue of Heart, Lung and Circulation presents an overview of contemporary practice in echocardiography.

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“…Visual estimation of the LVEF is feasible and comparable to other quantitative methods and has several benefits, including time conservation and less dependence on image quality, both of which are crucial for critically ill patients [4,5,17]. The RV has complex structural geometry and quantitative RV assessment is more difficult, causing physicians to rely on visual estimates rather than quantitative assessments [18]. RV enlargement and paradoxical septal motion are the most commonly recommended parameters for detecting acute RV dysfunction [6,19].…”

Section: Discussionmentioning

confidence: 99%

“…Since the images and interpretations were uploaded as part of the test, we assume that they reflect the participants' real abilities regarding FCU. The physicians showed relatively poor performance in terms of obtaining PSAX images, though this view is crucial in the assessment of regional wall motion abnormalities and paradoxical septal motion [18]. Some guidelines even recommend that the LVEF be measured from this view [25].…”

Section: Discussionmentioning

confidence: 99%

Physicians’ abilities to obtain and interpret focused cardiac ultrasound images from critically ill patients after a 2-day training course

Zhang

Lian

et al. 2020

BMC Cardiovasc Disord

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Background: This study aimed to determine whether a focused 2-day cardiac ultrasound training course could enable physicians to obtain and interpret focused cardiac ultrasound (FCU) images from critically ill patients. Methods: We retrospectively reviewed the FCU images submitted by the physicians who attended a 2-day FCU training courses. Three experienced trainers reviewed the images separately. They determined whether the images were assessable and scored the images on an 8-point scale. They also decided whether the physicians provided correct responses for visual estimations of the left ventricular ejection fraction (LVEF) and right ventricle (RV) dilatation and septal motion. Results: Among the 327 physicians, 291 obtained images that were considered assessable (89%). The scores for parasternal short-axis view were lower than those obtained for other transthoracic echocardiographic views, p < 0.001. More physicians provided incorrect appraisals of LVEF than of RV dilatation and septal motion (19.9% vs. 3.1%, p < 0.001). The percentages of incorrect answers by LVEF category were as follows: 34.8% on images of LVEF < 30, 24.7% on images of LVEF 30-54, and 16.4% on images of LVEF ≥55%, p < 0.001. A logistic regression analysis showed that patients with abnormal LVEF were associated with physicians' incorrect assessment of LVEF, with an odds ratio of 1.923 (95% confidence interval (CI):1.071-3.456, p = 0.029). Conclusions: A large proportion of physicians could obtain and interpret FCU images from critically ill patients after a 2-day training course. However, they still scored low on the parasternal short-axis view and were more likely to make an incorrect assessment of LVEF in patients with abnormal left ventricular systolic function.

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Echocardiographic Assessment of the Right Ventricle–State of the Art

Cited by 52 publications

References 38 publications

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work

Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology

Physicians’ abilities to obtain and interpret focused cardiac ultrasound images from critically ill patients after a 2-day training course

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