Right ventricular mechanical pattern in health and disease: beyond longitudinal shortening

Abstract

Right ventricular (RV) function has proven to be a prognostic factor in heart failure with reduced and preserved ejection fraction and in pulmonary hypertension. RV function is also a cornerstone in the management of novel clinical issues, such as mechanical circulatory support devices or grown-up congenital heart disease patients. Despite the notable amount of circumferentially oriented myofibers in the subepicardial layer of the RV myocardium, the non-longitudinal motion directions are often neglected in the everyday assessment of RV function by echocardiography. However, the complex RV contraction pattern incorporates different motion components along three anatomically relevant axes: longitudinal shortening with traction of the tricuspid annulus towards the apex, radial motion of free wall often referred as the “bellows effect”, and anteroposterior shortening of the chamber by stretching the free wall over the septum. Advanced echocardiographic techniques, such as speckle-tracking and 3D echocardiography allow an in-depth characterization of RV mechanical pattern, providing better understanding of RV systolic and diastolic function. In our current review, we summarize the existing knowledge regarding RV mechanical adaptation to pressure- and/or volume-overloaded states and also other physiologic or pathologic conditions.

Importance of Nonlongitudinal Motion Components in Right Ventricular Function: Three-Dimensional Echocardiographic Study in Healthy Volunteers

“…Conventional parameters of RV function, such as TAPSE and FAC, have demonstrated their correlation with RVEF and also their diagnostic and prognostic value in various cardiovascular conditions. [16][17][18] On the other hand, TAPSE refers only to the longitudinal motion of the chamber, and several sources of measurement error must be taken into consideration. FAC also refers to the radial motion of the RV free wall; nevertheless, similarly to TAPSE, it represents the function of the right ventricle in only a single 2D cut plane.…”

Right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of post‐operative dysfunction?

“…However, just as it has been described concerning the LV, the elemental components of myocardial mechanics could be more sensitive and predictive because the native RV contraction pattern could be disrupted even before the RVEF starts to decline. 22 In our current study, patients with severe primary MR but with preserved biventricular function were recruited. Despite this fact, a reduction in radial and an increase in longitudinal wall motion could be observed pointing to a functional shift induced by the severe valvular disease and the subsequent post-capillary pulmonary hypertension.…”

Galectin-3 is related to right ventricular dysfunction in heart failure patients with reduced ejection fraction and may affect exercise capacity

“…In HFrEF, the development of RV HF is observed due to pressure overload resulting from an increase in pulmonary hypertension, which leads to a gradual increase in RV afterload and volume overload, mainly due to tricuspid regurgitation. Right ventricular dilation and a decline in longitudinal function are the main steps in RV failure development 21 . All the elements of the abovementioned pathology were observed in our study group with higher Gal-3 concentrations.…”