Evaluation of Right Ventricular Function
- 509 Downloads
Right ventricular (RV) function is a powerful prognostic factor in congestive heart failure and pulmonary hypertension, but assessing RV function is a challenge because of the right ventricle’s complex geometry, its extreme sensitivity to loading conditions, and a limited understanding of underlying mechanisms of right heart failure. At present, a single widely accepted and generally applicable index of RV function is not available. Current approaches to assessment of RV function include physical examination, catheterization, conventional contrast and radionuclide angiography, nuclear perfusion scintigraphy, cardiac CT, MRI, echocardiography, and positron emission tomography. This review will discuss assessment of RV function in the context of RV physiology.
KeywordsRight ventricle Right heart failure Congestive heart failure Pulmonary hypertension Echocardiography Strain Radionuclide angiography Magnetic resonance imaging Pulmonary artery catheterization Deformation Cor pulmonale Hemodynamics
No potential conflict of interest relevant to this article was reported.
Papers of particular interest, published recently, have been highlighted as: •Of importance •• Of major importance
- 7.•• Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008;117(13):1717–31. This is a very good overview of right heart pathophysiology, and the limited treatment options currently available.PubMedCrossRefGoogle Scholar
- 13.Davidson CJ, Bonow RO. Cardiac catheterization. In: Braunwald E, Zipes DP, Libby P, editors. Heart disease, vol. 1. Philadelphia: W. B. Saunders Company; 2001. p. 372.Google Scholar
- 17.Orlov MV, Ansari MM, Akrivakis ST, Jadidi A, Nijhof N, Natan SR, et al. First experience with rotational angiography of the right ventricle to guide ventricular tachycardia ablation. Heart Rhythm. 2011;8(2):207–11.Google Scholar
- 20.Gao Y, Du X, Liang L, Cao L, Yang Q, Li K. Evaluation of right ventricular function by 64-row CT in patients with chronic obstructive pulmonary disease and cor pulmonale. Eur J Radiol. 2010. doi: 10.1016/j.ejrad.2010.11.004.
- 21.•• Horton KD, Meece RW, Hill JC. Assessment of the right ventricle by echocardiography: a primer for cardiac sonographers. J Am Soc Echocardiogr. 2009;22(7):776–92. This is a comprehensive handbook on RV echocardiography for cardiac sonographers, with detailed recommendations on imaging windows, standard views, measurement standards, methods of hemodynamic assessment, and technical tips. Although intended for sonographers, it also provides numerous examples and figures that will be useful to cardiologists and trainees.PubMedCrossRefGoogle Scholar
- 22.•• Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. 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. 2010;23(7):685–713. This is a compendium of nearly every echocardiographic technique ever published for evaluation of the right ventricle; it should be a standard reference in every echo laboratory. However, it provides minimal guidance as to what is and is not actually useful.PubMedCrossRefGoogle Scholar
- 24.•• Tamborini G, Marsan NA, Gripari P, Maffessanti F, Brusoni D, Muratori M, et al. Reference values for right ventricular volumes and ejection fraction with real-time three-dimensional echocardiography: evaluation in a large series of normal subjects. J Am Soc Echocardiogr. 2010;23(2):109–15. Few cardiologists have much experience with three-dimensional echocardiographic evaluation of the right ventricle. For those who wish to begin using these techniques, this provides useful tables of normal values.PubMedCrossRefGoogle Scholar
- 25.Leibundgut G, Rohner A, Grize L, Bernheim A, Kessel-Schaefer A, Bremerich J, et al. 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. 2010;23(2):116–26.PubMedCrossRefGoogle Scholar
- 30.Meris A, Faletra F, Conca C, Klersy C, Regoli F, Klimusina J, et al. Timing and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr. 2010;23(8):823–31.PubMedCrossRefGoogle Scholar
- 33.Park JH, Park YS, Kim YJ, Lee IS, Kim JH, Lee JH, et al. Differentiation between acute and chronic cor pulmonales with midventricular systolic strain of the right ventricle in the emergency department. Heart Vessels. 2010. doi: 10.1007/s00380-010-0072-6.
- 40.• Ristow B, Schiller NB. Obtaining accurate hemodynamics from echocardiography: achieving independence from right heart catheterization. Curr Opin Cardiol. 2010;25(5):437–44. This is a comprehensive overview of echocardiographic assessment of RV and LV hemodynamics from a leader in the field; unusually and refreshingly conservative in its recommendations.PubMedCrossRefGoogle Scholar
- 42.•• Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, et al. Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009;179(7):615–21. This depressing but very influential report has reduced the confidence pulmonary hypertension specialists place in echocardiographic estimation pulmonary pressures, and has substantially increased referrals for right heart catheterization.PubMedCrossRefGoogle Scholar
- 47.Nogami M, Ohno Y, Koyama H, Kono A, Takenaka D, Kataoka T, et al. Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: comparison with right heart catheterization and echocardiography. J Magn Reson Imaging. 2009;30(5):973–80.PubMedCrossRefGoogle Scholar
- 49.Mielniczuk LM, Birnie D, Ziadi MC, deKemp RA, DaSilva JN, Burwash I, et al. The relationship between right ventricular function and increased right ventricular [18F] fluorodeoxyglucose accumulation in patients with heart failure. Circ Cardiovasc Imaging. 2011;4(1):59–66.Google Scholar
- 50.•• Strain Rate Imaging [http://folk.ntnu.no/stoylen/strainrate/#Motion]. This is an outstanding website with numerous examples and animated explanations of deformation imaging; not a specific emphasis on the right ventricle, but still very useful.