Echocardiographic evaluation of right ventricular systolic function: The traditional and innovative approach

Abstract

Estimation of right ventricular (RV) performance still remains technically challenging due to its anatomical and functional distinctiveness. The current guidelines for the echocardiographic quantification of RV function recommend using multiple indices to describe the RV in a thorough and comprehensive manner, such as RV index of myocardial performance, tricuspid annular plane systolic excursion, fractional area change, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'-wave), three-dimensional RV ejection fraction (3D RVEF), RV longitudinal strain (RVLS)/strain rate by speckle-tracking echocardiography (STE). Among these, the last one mentioned here is an innovative and a particularly promising tool that yields more precise information about complex regional and global RV mechanics. STE was initially designed to evaluate left ventricular function, but recently it has been intro-duced to assess RV performance, which is difficult due to its unique structure and physiology. Many studies have shown that both free wall and 6-segment RVLS present a stronger correlation with the RVEF assessed by cardiac magnetic resonance than conventional parameters and seem to be more sensitive in detecting myocardial dysfunction at an earlier, subclinical stage. (Cardiol J 2017; 24, 5: 563-572)

Quantitative evaluation of fetal right and left ventricular fractional area change using speckle‐tracking technology

“…Of interest, the SD for the FAC of the left ventricle became progressively smaller between 20 and 40 weeks of gestation, while it changed minimally for the right ventricle over the same time period. This may reflect more efficient function of the left ventricle as a result of the interaction and maturation of its longitudinal, circumferential and oblique muscle fibers.…”

“…In adult and pediatric patients, the right ventricle is triangular in shape in the coronal plane and crescent‐shaped in the transverse plane, thus not allowing the examiner to use Simpson's rule to compute the ejection fraction. A surrogate for evaluating right ventricular systolic function is measurement of the FAC from the four‐chamber view; it has been shown to identify cardiac dysfunction in neonates, pediatric and adult patients, and is correlated with right ventricular ejection fraction measured with magnetic resonance imaging.…”

Meta-analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

“…However, there is no accurate index to assess RV function. RV Tei index, tricuspid annular plane systolic excursion (TAPSE) and RV area change fraction (RVFAC) are currently the most commonly used methods for evaluating RV contractile function [31][32][33][34]. This meta-analysis found that PADN did not signi cantly change the Tei index of PH, which might be due to too little data Moreover, TAPSE and RVFAC are incomplete, so metaanalysis cannot be performed.…”

The diagnostic value of three-dimensional echocardiography and speckle tracking echocardiography in patients after myocardial infarction with right ventricle involvement (clinical case)

“…The two-dimensional echocardiography has some important limitations in the assessment of RV [8]. This cardiac chamber has a unique crescent shape and no geometrical assumption can be made.…”