To access this material please log in or register

Register Authorize

Current Echocardiographic Techniques for Evaluation of the Right Ventricle

Pickure Z.1,2, Kalinin A.1,2, Lejnieks A.2, Alekhin M. N.3,4
1 - Riga East Clinical University Hospital, Clinical centre Gailezers, Riga, Latvia
2 - Riga Stradiņš University, Riga, Latvia
3 - Central Clinical Hospital with Policlinic of the Presidential Administration of the Russian Federation, Moscow, Russia
4 - Central State Medical Academy, President Management Department RF, Moscow, Russia

Keywords: right ventricle; myocardial deformation; three-dimensional echocardiography; right ventricular ejection fraction

DOI: 10.18087/cardio.2017.9.10019

The review is dedicated to the new echocardiographic techniques in the assessment of right ventricular (RV) function, such as two-dimensional speckle tracking and determining the RV volume by a three-dimensional model. Subclinical changes in RV function are of great importance for the diagnosis and assessment of prognosis of multiple cardiovascular as well as non-cardiac pathologies. Two-dimensional speckle tracking allows to assess longitudinal strain of the RV myocardium and to detect pathological changes before their clinical manifestations. Three-dimensional echocardiography enables calculation of the RV ejection fraction, what was not possible before with the use of ultrasound. Currently, both methods are promising for a comprehensive assessment of RV function.
  1. Haddad F., Hunt S.A., Rosenthal D.N., Murphy D.J. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 2008;117:1436–1448. DOI: 10.1161/CIRCULATIONAHA.107.653576.
  2. Ho S.Y., Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart 2006;92 Suppl 1:i2–13. DOI: 10.1136/hrt.2005.077875.
  3. Kukulski T., Hubbert L., Arnold M. et al. Normal regional right ventricular function and its change with age: a Doppler myocardial imaging study. J Am Soc Echocardiogr 2000;13:194–204. DOI: dx.doi.org/10.1067/mje.2000.103106.
  4. Leather H.A., Ama’ R., Missant C. et al. Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with open pericardium. Am J Physiol Heart Circ Physiol 2006;290:H2369–H2375. DOI: 10.1152/ajp-heart.01211.2004.
  5. Jurcut R., Giusca S., La Gerche A. et al. The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Echocardiogr 2010;11:81–96. DOI: 10.1093/ejechocard/jep234.
  6. Dandel M., Lehmkuhl H., Knosalla C. et al. Strain and strain rate imaging by echocardiography – basic concepts and clinical applicability. Current Cardiol Rev 2009;5(2):133–148. DOI: 10.2174/157340309788166642.
  7. Otto C.M. The practice of clinical echocardiography. 4th ed. Philadelphia: Saunders 2012;177–196.
  8. Lang R.M., Badano L.P., Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1–39. DOI: 10.1093/ehjci/jev014.
  9. Rudski L.G., Lai W.W., Afilalo J. et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685–713. DOI: 10.1016/j.echo.2010.05.010.
  10. Bockeria O. L., Averina I. I. New opportunities for evaluation of right ventricle and atriums functions. The Bulletin of A.N. Bakoulev SCCS of RAMS 2014;5(15). Russian (Бокерия О. Л., Аверина И. И. Новые возможности в оценке функции правого желудочка и предсердий. Бюллетень НЦССХ им. А.Н. Бакулева РАМН 2014;5(15)).
  11. Lu K.J., Chen J.X., Profitis K. et al. Right ventricular global longitudinal strain is an independent predictor of right ventricular function: a multimodality study of cardiac magnetic resonance imaging, real time three-dimensional echocardiography and speckle tracking echocardiography. Echocardiography 2015;32(6):966–974. DOI: 10.1111/echo.12783.
  12. Teske A.J., Cox M.G., Te Riele A.S. et al. Early detection of regional functional abnormalities in asymptomatic ARVD/C gene carriers. J Am Soc Echocardiogr 2012;25(9):997–1006. DOI: 10.1016/j.echo.2012.05.008.
  13. Vigneault D.M., te Riele A.S., James C.A. et al. Right ventricular strain by MR quantitatively identifies regional dysfunction in patients with arrhythmogenic right ventricular cardiomyopathy. J Magn Reson Imagin 2016;43(5):1132–1139. DOI: 10.1002/jmri.25068.
  14. Pérez de Isla L., Millán M., Lennie V. et al. Area strain: normal values for a new parameter in healthy people. Rev Esp Cardiol 2011;64(12):1194–1197. DOI: 10.1016/j.recesp.2011.03.021.
  15. Atsumi A., Seo Y., Ishizu T., Nakamura A. Right ventricular deformation analysis using a three-dimensional speckle-tracking echocardiographic system specialized for the right ventricle. J Am Soc Echocardiogr 2016;29(5):402–411.e2. DOI: 10.1016/j.echo.2015.12.014.
  16. Prakasa K.R., Wang J., Tandri H. et al. Utility of tissue Doppler and strain echocardiography in arrhythmogenic right ventricular dysplasia/cardiomyopathy. Am J Cardiol 2007;100(3):507–512. DOI: 10.1016/j.amjcard.2007.03.053.
  17. Shvets D. A., Povetkin S. V. Right ventricle functional state in patients with coronary artery disease. Ultrasound and Functional Diagnostics 2016;3:62–71. Russian (Швец Д. А., Поветкин С. В. Функциональное состояние правого желудочка у больных ишемической болезнью сердца. Ультразвуковая и функциональная диагностика 2016;3:62–71).
  18. Antoni M.L., Scherptong R .W., Atary J.Z. et al. Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging 2010;3:264–271. DOI: 10.1161/CIRCIMAGING.109.914366.
  19. Lemarié J., Huttin O., Girerd N. et al. Usefulness of speckle-tracking imaging for right ventricular assessment after acute myocardial infarction: a magnetic resonance imaging/echocardiographic comparison within the relation between aldosterone and cardiac remodeling after myocardial infarction study. J Am Soc Echocardiogr 2015;28(7):818–827.e4. DOI: 10.1016/j.echo.2015.02.019.
  20. Dambrauskaite V., Delcroix M., Claus P. et al. Regional right ventricular dysfunction in chronic pulmonary hypertension. J Am Soc Echocardiogr 2007 Oct;20(10):1172–1180. DOI: 10.1016/j.echo.2007.02.005.
  21. Fukuda Y., Tanaka H., Sugiyama D. et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 2011;24(10):1101–1108. DOI: 10.1016/j.echo.2011.06.005.
  22. Motoji Y., Tanaka H., Fukuda Y. et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 2013;77(3):756–763. DOI: 10.1253/circj.CJ-12-1083.
  23. Vitarelli A., Mangieri E., Terzano C. et al. Three-dimensional echocardiography and 2D–3D speckle-tracking imaging in chronic pulmonary hypertension: diagnostic accuracy in detecting hemodynamic signs of right ventricular failure. J Am Heart Assoc 2015;4(3):e001584. DOI: 10.1161/JAHA.114.001584.
  24. Hardegree E.L., Sachdev A., Villarraga H.R . et al. Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol 2013;111:143–148. DOI: 10.1016/j.amjcard.2012.08.061.
  25. Platz E., Hassanein A.H., Shah A. et al. Regional right ventricular strain pattern in patients with acute pulmonary embolism. Echocardiography. 2012;29(4):464–470. DOI: 10.1111/j.1540-8175.2011.01617.x.
  26. Bart B.Ya., Dergunova E.N., Vartanyan E.A., Kulbachinskaya O.M. Early echocardiographic markers of structural and functional right ventricular remodelling in patients with chronic obstructive pulmonary disease. Russ J Cardiol 2012;3(95):33–37. Russian (Барт Б. Я., Дергунова Е. Н., Вартанян Е. А., Кульбачинская О. М. Ранние эхокардиографичские признаки структурно-функционального ремоделирования правого желудочка у больных хронической обструктивной болезнью легких. Российский кардиологический журнал 2012;3(95):33–37).
  27. Guendouz S., Rappeneau S., Nahum J. et al. Prognostic significance and normal values of 2D strain to assess right ventricular systolic function in chronic heart failure. Circ J 2012;76:127–136. DOI: 10.1253/circj.CJ-11-0778.
  28. Cameli M., Lisi M., Righini F.M. et al. Right ventricular longitudinal strain correlates well with right ventricular stroke work index in patients with advanced heart failure referred for heart transplantation. J Card Fail 2012;18(3):208–215. DOI: 10.1016/j.card-fail.2011.12.002.
  29. Grant A.D., Smedira N.G., Starling R.C., Marwick T.H. Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation. J Am Coll Cardiol 2012;60:521–528. DOI: 10.1016/j.jacc.2012.02.073.
  30. Moñivas Palomero V., Mingo Santos S., Goirigolzarri Artaza J. et al. Two-dimensional speckle tracking echocardiography in heart transplant patients: two-year follow-up of right and left ventricular function. Echocardiography 2016;33(5):703–713. DOI: 10.1111/echo.13169.
  31. Mingo-Santos S., Moñivas-Palomero V., Garcia-Lunar I. et al. Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. J Am Soc Echocardiogr 2015;28(10):1149–1156. DOI: 10.1016/j.echo.2015.06.005.
  32. Menting M.E., van den Bosch A.E., McGhie J.S. et al. Assessment of ventricular function in adults with repaired tetralogy of Fallot using myocardial deformation imaging. Eur Heart J Cardiovasc Imagin. 2015;16(12):1347–1357. DOI: 10.1093/ehjci/jev090.
  33. Haugaa K.H., Bergestuen D.S., Sahakyan L.G. et al. Evaluation of right ventricular dysfunction by myocardial strain echocardiography in patients with intestinal carcinoid disease. J Am Soc Echocardiogr 2011;24(6):644–650. DOI: 10.1016/j.echo.2011.02.009.
  34. Moaref A., Abtahi F., Aghasadeghi K., Shekarforoush S. Right ventricular strain and strain rate in patients with systemic sclerosis without pulmonary hypertension. Arch Cardiovasc Imaging 2014;2(3):e20735. DOI: 10.5812/acvi.20735.
  35. Cappelli F., Porciani M.C., Bergesio F. et al. Right ventricular function in AL amyloidosis: characteristics and prognostic implication. Eur Heart J Cardiovasc Imaging 2012;13:416–422. DOI: 10.1093/ejechocard/jer289.
  36. Urbano-Moral J.A., Gangadharamurthy D., Comenzo R.L. et al. Three-dimensional speckle tracking echocardiography in light chain cardiac amyloidosis: examination of left and right ventricular myocardial mechanics parameters. Rev Esp Cardiol 2015;68(8):657–664. DOI: 10.1016/j.rec.2015.01.009.
  37. Patel M.B., Mor-Avi V., Murtagh G. et al. Right heart involvement in patients with sarcoidosis. Echocardiography 2016;33(5):734–741. DOI: 10.1111/echo.13163.
  38. Tadic M., Celic V., Cuspidi C. et al. Right heart mechanics inuntreated normotensive patients with prediabetes and type 2 diabetes mellitus: a two- and three-dimensional echocardiographic study. J Am Soc Echocardiogr 2015;28(3):317–327. DOI: 10.1016/j.echo.2014.11.017.
  39. Tadic M., Celic V., Cuspidi C. et al. How does subclinical hyperthyroidism affect right heart function and mechanics? J Ultrasound Med 2016;35(2):287–295. DOI: 10.7863/ultra.15.03054.
  40. Meng S., Guo L., Li G. Early changes in right ventricular longitudinal function in chronic asymptomatic alcoholics revealed by two-dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2016;14:16. DOI: 10.1186/s12947-016-0058-3.
  41. Alizade E., Avci A., Tabakcı M.M. et al. Comparison of right ventricle systolic function between long-term anabolic-androgenic steroid user and nonuser bodybuilder athletes: a study of two-dimensional speckle tracking echocardiography. Echocardiography 2016;33(8):1178–1185. DOI: 10.1111/echo.13243.
  42. Calleja A., Poulin F., Khorolsky C. et al. Right ventricular dysfunction in patients experiencing cardiotoxicity during breast cancer therapy. J Oncol. 2015;2015:609194. DOI: 10.1155/2015/609194.
  43. Bayar N., Küçükseymen S., Göktaş S., Arslan Ş. Right ventricle failure associated wıth trastuzumab. Ther Adv Drug Saf 2015;6(3):98–102. DOI: 10.1177/2042098615582162.
  44. Haddad F., Doyle R., Murphy D.J., Hunt S.A. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 2008;117:1717–1731. DOI: 10.1161/CIRCULATIONAHA.107.653584.
  45. Meyer P., Filippatos G.S., Ahmed M.I. et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation 2010;121:252–258. DOI: 10.1161/CIRCULATIONAHA.109.887570.
  46. Knauth A.L., Gauvreau K., Powell A.J. et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart 2008;94:211–216. DOI: 10.1136/hrt.2006.104745.
  47. Kjaergaard J., Petersen C.L., Kjaer A. et al. Evaluation of right ventricular volume and function by 2D and 3D echocardiography compared to MRI. Eur J Echocardiogr 2006;7:430–438; DOI: 10.1016/j.euje.2005.10.009.
  48. Jenkins C., Chan J., Bricknell K. et al. Reproducibility of right ventricular volumes and ejection fraction using real-time three-dimensional echocardiography: comparison with cardiac MRI. Chest 2007;131(6):1844–1851. DOI: 10.1378/chest.06-2143.
  49. van der Zwaan H.B., Geleijnse M.L., McGhie J.S. et al. Right ventricular quantification in clinical practice: two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr 2011;12(9):656–664. DOI: 10.1093/ejechocard/jer107.
  50. Skidan V.I., Borowski A., Park M.M. et al. Assessment of right ventricular function from realtime three-dimensional echocardiography in patients with acute heart failure. Far East Med J 2011;3:6–10. Russian (Скидан В. И., Боровски А., Парк М.М. и др. Применение трехмерной эхокардиографии в режиме реального времени в оценке сократительной способности правого желудочка у больных с острой декомпенсированной сердечной недостаточностью. Дальневосточный медицинский журнал 2011;3:6–10).
  51. Maffessanti F., Muraru D., Esposito R. et al. Age-, body size-, and sex-specific reference values for right ventricular volumes and ejection fraction by three-dimensional echocardiography: a multicenter echocardiographic study in 507 healthy volunteers Circ Cardiovasc Imaging 2013;6(5):700–710. DOI: 10.1161/CIRCIMAGING.113.000706.
  52. D’Oronzio U., Senn O., Biaggi P. et al. Right heart assessment by echocardiography: gender and body size matters. J Am Soc Echocardiogr 2012;25(12):1251–1258. DOI: 10.1016/j.echo.2012.08.013.
  53. Knight D.S., Schwaiger J.P., Krupickova S. et al. Accuracy and test-retest reproducibility of two-dimensional knowledge-based volumetric reconstruction of the right ventricle in pulmonary hypertension. J Am Soc Echocardiogr 2015;28(8):989–998. DOI: 10.1016/j.echo.2015.02.020.
  54. Trzebiatowska-Krzynska A., Driessen M., Sieswerda G.T. et al. Knowledge-based 3D reconstruction of the right ventricle: comparison with cardiac magnetic resonance in adults with congenital heart disease. Echo Res Pract 2015;2(4):109–116. DOI: 10.1530/ERP-15-0029.
  55. Laser K.T., Horst J.P., Barth P. et al. Knowledge-based reconstruction of right ventricular volumes using real-time three-dimensional echocardiographic as well as cardiac magnetic resonance images: comparison with a cardiac magnetic resonance standard. J Am Soc Echocardiogr 2014;27(10):1087–1097. DOI: 10.1016/j.echo.2014.05.008.
  56. Hung J., Lang R., Flachskampf F. et al. 3D echocardiography: a review of the current status and future directions. J Am Soc Echocardiogr 2007;20(3):213–233. DOI: 10.1016/j.echo.2007.01.010.
  57. Lang R.M., Badano L.P., Tsang W. et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr 2012 Jan;25(1):3–46. DOI: 10.1016/j.echo.2011.11.010.
  58. Buck T., Franke A., Monaghan M.J. Three-dimensional echocardiography. 2nd ed. Berlin Heidelberg: Springer 2014;107–114.
Pickure Z., Kalinin A., Lejnieks A., Alekhin M. N. Current Echocardiographic Techniques for Evaluation of the Right Ventricle. Kardiologiia. 2017;57(9):54–64.

To access this material please log in or register

Register Authorize
Ru En