Right ventricular speckle tracking assessment for differentiation of pressure‐ versus volume‐overloaded right ventricle

Evaldsson, Anna Werther; Ingvarsson, Annika; Waktare, Johan; Smith, Gudmund J. W.; Thilén, Ulf; Stagmo, Martin; Roijer, Anders; Rådegran, Göran; Meurling, Carl

doi:10.1111/cpf.12477

Cited by 19 publications

(14 citation statements)

References 49 publications

(88 reference statements)

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“…However, it is important to realize that RVFWS is not completely load independent. 13,19 The relationship between the preload and tension development underscores the importance of taking the RVEDV (as a marker of preload) into consideration for comprehensive assessment of RV contractility. Therefore, to investigate the association between significant STR and the intrinsic RV myocardial performance adjusted for preload, the present study performed a propensity score-matched analysis including RV Values are mean § SD, median (interquartile range), or n (%).…”

Section: Discussionmentioning

confidence: 99%

“…However, the presence of persistent RV dysfunction was associated with increased 1year cardiovascular mortality (adjusted hazard ratio = 2.16, 95% confidence interval: 1.16 to 4.02). 21 However, since these conventional parameters are more influenced by volume overload compared with RVFWS by STE, 19 the assessment of RVFWS may potentially have incremental prognostic value in patients with significant STR.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Hirasawa

Rosendael

Dietz

et al. 2020

The American Journal of Cardiology

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Assessment of right ventricular (RV) systolic function in patients with significant secondary tricuspid regurgitation (STR) remains challenging. In patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI), STR and RV enlargement have been associated with poor outcomes. In these patients, speckle tracking echocardiography (STE) may detect RV systolic dysfunction better than 3-dimensional (3D) RV ejection fraction (EF). The purpose of this study was to investigate the prevalence of RV dysfunction when assessed with STE in patients with significant STR (≥3+) compared with patients without significant STR (<3+) matched for 3D RV dimensions and RVEF on dynamic computed tomography (CT). Patients with dynamic CT data before TAVI were evaluated retrospectively. To assess the performance of RV-free wall strain (RVFWS) for identifying patients with impaired RV systolic function, patients were subsequently matched 1:1 based on age, gender, indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RVEF, and left ventricular ejection fraction (LVEF). In a total 267 patients (80 § 8 years, 48% male), significant STR (≥3+) was observed in 67 patients. Patients with STR≥3+ had larger RVEDVi, larger RVESVi, lower LVEF, and more impaired RVFWS compared with patients with STR<3+ (n = 200). After propensity score matching, patients with STR≥3+ (n = 53) had significantly more impaired RVFWS compared with patients with STR<3+ (n = 53): À18.2 § 5.0% versus À21.1 § 3.7%, p = 0.001. In conclusion, patients with significant STR have more pronounced RV systolic dysfunction as assessed with STE than the patients without significant STR despite having similar 3D RV dimensions and RVEF on dynamic CT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Hirasawa

Rosendael

Dietz

et al. 2020

The American Journal of Cardiology

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“…Newer echocardiographic methods have been developed for more accurate assessment of RV function. More recently, myocardial deformation measures of longitudinal strain based on speckle tracking echocardiography (STE) have shown promising results when measured from an apical fourchamber view (Fukuda et al, 2011;Werther Evaldsson et al, 2018) with lower strain values when compared to controls (Borges et al, 2006;Pirat et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic right ventricular strain from multiple apical views is superior for assessment of right ventricular systolic function

Evaldsson

Ingvarsson

Smith

et al. 2018

Clin Physio Funct Imaging

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Summary Background Right ventricular (RV) systolic function is an important determinant of outcome in patients with pulmonary hypertension (PH). Conventional echocardiographic measures of RV are mainly based on longitudinal contractility. Recently, measurement of RV global longitudinal strain derived from multiple windows (RVGLS) has emerged as an option but has not been well evaluated. The aim of the present study was to evaluate which echocardiographic RV function parameter correlates best with RV ejection fraction derived from cardiac magnetic resonance imaging (RVEFCMR). Methods and results Fifty‐five patients evaluated for PH underwent RV assessment with echocardiography and CMR. Conventional echocardiographic parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (S′), RV fractional area change (RVFAC) and RV index of myocardial performance (RIMP). RVGLS was measured from three separate apical views using a 17‐segment model and strain from the lateral free wall was calculated separately (RVfree). The study included 55 patients, whereas assessment of RVGLS could be obtained in 29 patients. The Pearson correlation coefficient with RVEFCMR was strong for RVGLS (r = 0·814, P<0·001) and RVfree (r = 0·778, P<0·001), modest for RVFAC (r = 0·681, P<0·001), TAPSE (r = 0·592, P<0·001) and RIMP (r=−0·521, P<0·01), and weak for S′ (r = 0·385, P<0·01). Conclusion The echocardiographic RV measures, RVGLS and RVfree correlated well with RVEFCMR, whereas correlation with TAPSE, RIMP and S′ was unsatisfactory. Our findings suggest that RVGLS and RVfree are the preferred echocardiographic methods for clinical practice. RVfree is easiest to perform but RVGLS could provide incremental value in selected patients.

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“…Calculation of FWS echo was made as an average of the three peak systolic strains values along the RV free wall. Low intraand inter-observer variability within our research group has previously been validated and published [10].…”

Section: Echocardiographymentioning

confidence: 75%

“…Conventionally, RV function by echocardiography is estimated by tricuspid annular plane systolic excursion (TAPSE), S'-wave velocity (S' echo ), RV fractional area change (FAC echo ) and myocardial strain derived from the RV lateral free wall (FWS echo ) [3]. FWS echo has shown promising results in assessment of RV longitudinal systolic function [8][9][10][11] and has consequently been included in guidelines [3]. In clinical practice, FAC echo is more commonly used as a surrogate to RVEF [3].…”

Section: Introductionmentioning

confidence: 99%

Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance

Evaldsson

Lindholm

Jumatate

et al. 2020

BMC Cardiovasc Disord

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Background: Right ventricular (RV) function is a major determinant of outcome in patients with pulmonary hypertension. Cardiac magnetic resonance (CMR) is gold standard to assess RV ejection fraction (RVEF CMR), however this is a crude measure. New CMR measures of RV function beyond RVEF CMR have emerged, such as RV lateral atrioventricular plane displacement (AVPD lat), maximum emptying velocity (S' CMR), RV fractional area change (FAC CMR) and feature tracking of the RV free wall (FWS CMR). However, it is not fully elucidated if these CMR measures are in parity with the equivalent echocardiography-derived measurements: tricuspid annular plane systolic excursion (TAPSE), S'-wave velocity (S' echo), RV fractional area change (FAC echo) and RV free wall strain (FWS echo). The aim of this study was to compare regional RV function parameters derived from CMR to their echocardiographic equivalents in patients with pulmonary hypertension and to RVEF CMR. Methods: Fifty-five patients (37 women, 62 ± 15 years) evaluated for pulmonary hypertension underwent CMR and echocardiography. AVPD lat , S' CMR , FAC CMR and FWS CMR from cine 4-chamber views were compared to corresponding echocardiographic measures and to RVEF CMR delineated in cine short-axis stack. Results: A strong correlation was demonstrated for FAC whereas the remaining measurements showed moderate correlation. The absolute bias for S' was 2.4 ± 3.0 cm/s (relative bias 24.1 ± 28.3%), TAPSE/AVPD lat 5.5 ± 4.6 mm (33.2 ± 25.2%), FWS 4.4 ± 5.8% (20.2 ± 37.5%) and for FAC 5.1 ± 8.4% (18.5 ± 32.5%). In correlation to RVEF CMR, FAC CMR and FWS echo correlated strongly, FAC echo , AVPD lat , FWS CMR and TAPSE moderately, whereas S' had only a weak correlation.

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Right ventricular speckle tracking assessment for differentiation of pressure‐ versus volume‐overloaded right ventricle

Cited by 19 publications

References 49 publications

Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Echocardiographic right ventricular strain from multiple apical views is superior for assessment of right ventricular systolic function

Right ventricular function parameters in pulmonary hypertension: echocardiography vs. cardiac magnetic resonance

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