Skip to main content
Log in

Non-invasive quantification of right ventricular systolic function by echocardiography: a new semi-automated approach

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Right ventricular (RV) function determines long-term outcome in many cardiopulmonary diseases. However, the assessment of RV function is time-consuming and surrogate parameters derived from two-dimensional (2D) or Doppler echocardiography show poor consistency.

Methods

Forty consecutive patients were examined within 30 min after magnetic resonance imaging (MRI) with comprehensive echocardiography, including strain imaging and real-time three-dimensional echocardiography. A new parameter, the RV automated systolic index (RV-ASI), was obtained from the apical four-chamber view using semi-automated border detection.

Results

RV-ASI could be assessed by 2D echocardiography in 38 of 40 patients. RV ejection fraction assessed by MRI was 48 ± 9 %, while RV-ASI was 52 ± 11 % (r = 0.74, SEE = 6 %, p < 0.0001). Intra- and inter-observer variabilities were 7.5 and 8.9 %, respectively. An RV-ASI cut-off value of 52 % in this cohort was able to differentiate between normal and impaired RV function (AUC 0.92, sensitivity 87 %, specificity 93 %).

Conclusions

In this study, the RV-ASI showed to be an easy, rapid to assess and reliable tool for quantification of right ventricular function. Furthermore, this index can complement the assessment of right ventricular mechanics by 2D strain imaging for efficient and comprehensive non-invasive evaluation of right ventricular function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Grünig E, Janssen B, Mereles D, Barth U, Borst MM, Vogt IR, Fischer C, Olschewski H, Kuecherer HF, Kübler W (2000) Abnormal pulmonary artery pressure response in asymptomatic carriers of primary pulmonary hypertension gene. Circulation 102:1145–1150

    Article  PubMed  Google Scholar 

  2. Grünig E, Weissmann S, Ehlken N, Fijalkowska A, Fischer C, Fourme T, Galié N, Ghofrani A, Harrison RE, Huez S, Humbert M, Janssen B, Kober J, Koehler R, Machado RD, Mereles D, Naeije R, Olschewski H, Provencher S, Reichenberger F, Retailleau K, Rocchi G, Simonneau G, Torbicki A, Trembath R, Seeger W (2009) Stress Doppler echocardiography in relatives of patients with idiopathic and familial pulmonary arterial hypertension: results of a multicenter European analysis of pulmonary artery pressure response to exercise and hypoxia. Circulation 119:1747–1757

    Article  PubMed  Google Scholar 

  3. Mereles D, Grünig E (2006) A stepwise and practical approach to Optimizing echocardiography in pulmonary hypertension. Adv Pulmonary Hypertens 5:30–33. http://www.phaonlineuniv.org/Journal/Vol5No3Autumn06/OptimizingEchocardiography. Accessed 23 March 2012

    Google Scholar 

  4. Haddad F, Doyle R, Murphy DJ, Hunt SA (2008) Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 117:1717–1731

    Article  PubMed  Google Scholar 

  5. Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, Dupuis J, Long CS, Rubin LJ, Smart FW, Suzuki YJ, Gladwin M, Denholm EM, Gail DB (2006) Right ventricular function and failure: report of a national heart, lung, and blood institute working group on cellular and molecular mechanisms of right heart failure. Circulation 114:1883–1891

    Article  PubMed  Google Scholar 

  6. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the european association of echocardiography, a registered branch of the european society of cardiology, and the canadian society of echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  PubMed  Google Scholar 

  7. Borges AC, Knebel F, Eddicks S, Panda A, Schattke S, Witt C, Baumann G (2006) Right ventricular function assessed by two-dimensional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy. Am J Cardiol 98:530–534

    Article  PubMed  CAS  Google Scholar 

  8. Tamborini G, Brusoni D, Torres Molina JE, Galli CA, Maltagliati A, Muratori M, Susini F, Colombo C, Maffessanti F, Pepi M (2008) Feasibility of a new generation three-dimensional echocardiography for right ventricular volumetric and functional measurements. Am J Cardiol 102:499–505

    Article  PubMed  Google Scholar 

  9. Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S (2011) Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest 139:988–993

    Article  PubMed  Google Scholar 

  10. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  11. Rajagopalan N, Simon MA, Mathier MA, Lopez-Candales A (2008) Identifying right ventricular dysfunction with tissue Doppler imaging in pulmonary hypertension. Int J Cardiol 128:359–363

    Article  PubMed  Google Scholar 

  12. Sato T, Tsujino I, Ohira H, Oyama-Manabe N, Yamada A, Ito YM, Goto C, Watanabe T, Sakaue S, Nishimura M (2012) Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension. J Am Soc Echocardiogr 25:280–286

    Article  PubMed  Google Scholar 

  13. Leong DP, Grover S, Molaee P, Chakrabarty A, Shirazi M, Cheng YH, Penhall A, Perry R, Greville H, Joseph MX, Selvanayagam JB (2012) Nonvolumetric echocardiographic indices of right ventricular systolic function: validation with cardiovascular magnetic resonance and relationship with functional capacity. Echocardiography 29:455–463

    Article  PubMed  Google Scholar 

  14. Filusch A, Mereles D, Gruenig E, Buss S, Katus HA, Meyer FJ (2010) Strain and strain rate echocardiography for evaluation of right ventricular dysfunction in patients with idiopathic pulmonary arterial hypertension. Clin Res Cardiol 99:491–498

    Article  PubMed  Google Scholar 

  15. Giusca S, Dambrauskaite V, Scheurwegs C, D’hooge J, Claus P, Herbots L, Magro M, Rademakers F, Meyns B, Delcroix M, Voigt JU (2010) Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring. Heart 96:281–288

    Article  PubMed  CAS  Google Scholar 

  16. Puwanant S, Park M, Popović ZB, Tang WH, Farha S, George D, Sharp J, Puntawangkoon J, Loyd JE, Erzurum SC, Thomas JD (2010) Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 121:259–266

    Article  PubMed  Google Scholar 

  17. Raymond RJ, Hinderliter AL, Willis PW, Ralph D, Caldwell EJ, Williams W, Ettinger NA, Hill NS, Summer WR, de Boisblanc B, Schwartz T, Koch G, Clayton LM, Jöbsis MM, Crow JW, Long W (2002) Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 39:1214–1219

    Article  PubMed  Google Scholar 

  18. Leibundgut G, Rohner A, Grize L, Bernheim A, Kessel-Schaefer A, Bremerich J, Zellweger M, Buser P, Handke M (2010) Dynamic assessment of right ventricular volumes and function by real-time three-dimensional echocardiography: a comparison study with magnetic resonance imaging in 100 adult patients. J Am Soc Echocardiogr 23:116–126

    Article  PubMed  Google Scholar 

  19. van der Zwaan HB, Geleijnse ML, McGhie JS, Boersma E, Helbing WA, Meijboom FJ, Roos-Hesselink JW (2011) Right ventricular quantification in clinical practice: two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr 12:656–664

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sebastian Greiner.

Additional information

Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT01230294.

Electronic supplementary material

Below is the link to the electronic supplementary material.

392_2012_528_MOESM1_ESM.avi

Movie 1. Assessment of the right ventricular automated systolic index (RV-ASI) by semi-automated endocardial border detection tool. Two-points are set at the basal segments and one at the apex of the right ventricle. The software conducts automatically the endocardial border detection and calculates the index. Supplementary material 1 (AVI 19594 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Greiner, S., André, F., Heimisch, M. et al. Non-invasive quantification of right ventricular systolic function by echocardiography: a new semi-automated approach. Clin Res Cardiol 102, 229–235 (2013). https://doi.org/10.1007/s00392-012-0528-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-012-0528-z

Keywords

Navigation