Right Ventricular Mechanics Using a Novel Comprehensive Three-View Echocardiographic Strain Analysis in a Normal Population

Abstract

Background While quantitative RV strain analysis may be useful in congenital and acquired heart disease populations with RV failure, a comprehensive, standardized approach is lacking. An 18 segment RV strain analysis obtained from 3 standardized RV apical echo images was used to determine the feasibility, normal values and reproducibility of the method in normal adults. Methods Forty healthy, prospectively-enrolled volunteers with no cardiac history and normal QRS duration received an echo optimized for strain analysis including 3 RV apical views. 2D speckle tracking longitudinal strain analysis was performed on EchoPAC software. Eleven retrospectively-identified subjects with RV disease were included as a pilot population. All had been imaged using the same protocol including the 3 RV apical views. Results All control subjects had normal anatomic morphology and function by echo. Feasibility of the RV strain analysis was good (adequate tracking in 696/720 (97%) of segments). RV global peak systolic strain was −23 ± 2%. Peak strain was highest in the RV free wall and lowest in the septum. Dyssynchrony indices demonstrated no dyssynchrony using LV criteria. Reproducibility of most strain measures was acceptable. This methodology identified important disease not seen in the 4-chamber apical view alone in the pilot population of 11 patients with RV disease. Strain pattern and values were different from the control population indicating differences do exist from normal. Conclusions The 18 segment RV strain analysis is feasible with strain measures falling into discrete ranges in this normal population. Those with RV disease illustrate the potential utility of this approach. These data indicate that this model can be utilized for more detailed studies evaluating abnormal RV populations where its full potential can be assessed.

Assessment of right ventricular functional recovery after acute myocardial infarction by 2D speckle-tracking echocardiography

“…Certain recent studies have highlighted the opportunity to measure RV strain in an 18-segments RV strain analysis similar to the widespread LV bull's eye [26]. These authors demonstrated the utility of regional and RVLS calculated from multiple views to comprehensively assess RV function.…”

Adult echocardiographic nomograms: overview, critical review and creation of a software for automatic, fast and easy calculation of normal values

“…Pregnant or lactating women, athletes, and subjects addicted to alcohol were also excluded by a few authors (15,16,60), and some studies also evaluated smoking (15,21,38,82), anaemia and fever (15,16) as exclusion criteria. However, in some studies (15,19,38,43,52,54,63,82), inclusion criteria were well defined, in other sufficiently explained (20,21,24,30,50,52,61,67,70,74,76), while in few works the criteria were more generic (23,24,26,58,59,69,73).…”

“…In the last years, normative data on new indices of STE data have become available for the LV (60,61,63,66,67), the RV (72,73), the LA (68)(69)(70)74,77,79), and the RA (70)(71)(72)(73)(74)(75)(76)(77)(78). Some of the most recent publications evaluated 3D STE parameters (61,72,95), while data on twist and untwist are still limited (60).…”

“…Tacking quality was accomplished by using automated method (i.e., the automated QT score) (67,77) or more often subjectively (60,66,73,94). As summarised in Table S1 different vendors have been used to acquire measurements, despite GE was mostly employed with few exception (68,79) and usually vendor specific software has been employed for data analysis with a few exceptions (66,70,95).…”

Right ventricular strain analysis from three‐dimensional echocardiography by using temporally diffeomorphic motion estimation

“…Speckle tracking image (STI) has been an alternative technique to analysis the RV strains. 6,[29][30][31][32][33][34] It depends on the assumption that the speckle pattern in the consecutive frames is preserved. 35,36 Most of the above studies use 2D echocardiography because of its high temporal resolution.…”