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Assessment of the Right Ventricle

  • Denisa MuraruEmail author
  • Monica Luiza de Alcantara
  • Elena Surkova
  • Basma Elnagar
Chapter

Abstract

Right ventricular (RV) size and function have been found to be important predictors of cardiovascular morbidity and mortality in patients with various clinical conditions. However, assessment of the RV using conventional two-dimensional echocardiography is a challenging task due to the complex anatomy and the location of the RV in the chest. Although cardiac magnetic resonance is considered a “gold standard” for RV assessment, the development of three-dimensional echocardiography (3DE) opened new exciting opportunities in RV imaging. 3DE has proven accurate in measuring RV volumes and ejection fraction when compared with cardiac magnetic resonance. During the last decade, the added prognostic value of using 3DE to assess RV geometry and function over conventional two-dimensional and Doppler echocardiography has been increasingly reported.

Keywords

Right ventricular volume Right ventricular ejection fraction Right ventricular shape Three-dimensional echocardiography Reference values Normal values 

Supplementary material

Video 17.1

Multislice (12-slice) display of transthoracic 3DE data set of the right ventricle. LV left ventricle, RV right ventricle, RVOT right ventricular outflow tract (AVI 14842 kb)

Video 17.2

Triplane display of the right ventricle (AVI 8325 kb)

Video 17.3a

Longitudinal cut plane of a volume-rendered transthoracic data set of the right ventricle to appreciate its anatomy and complex geometry (AVI 9582 kb)

Video 17.3b

Transversalcut plane of a volume-rendered transthoracic data set of the right ventricle to appreciate its anatomy and complex geometry. AW right ventricular anterior wall, IW right ventricular inferior wall, LV left ventricle, RV right ventricle, RVOT right ventricular outflow tract, TV tricuspid valve (AVI 11485 kb)

Video 17.4

Longitudinal cropping of the 3DE right ventricular data set allows to assess the detailed anatomy of the right ventricular cavity and its three components: (1) Inlet; (2) apical trabecular; and (3) outlet. Ao aorta, IVSm membranous interventricular septum, MB moderator band, PV pulmonary valve, RA right atrium, TV tricuspid valve (AVI 600 kb)

References

  1. 1.
    Knauth AL, Gauvreau K, Powell AJ, et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart. 2008;94:211–6.CrossRefGoogle Scholar
  2. 2.
    van Wolferen SA, Marcus JT, Boonstra A, et al. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension. Eur Heart J. 2007;28:1250–7.CrossRefGoogle Scholar
  3. 3.
    Meyer P, Filippatos GS, Ahmed MI, et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation. 2010;121:252–8.CrossRefGoogle Scholar
  4. 4.
    Bourantas CV, Loh HP, Bragadeesh T, et al. Relationship between right ventricular volumes measured by cardiac magnetic resonance imaging and prognosis in patients with chronic heart failure. Eur J Heart Fail. 2011;13:52–60.CrossRefGoogle Scholar
  5. 5.
    Lang RM, Badano LP, 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.e14.CrossRefGoogle Scholar
  6. 6.
    Lang RM, Badano LP, Tsang W, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012;13:1–46.CrossRefGoogle Scholar
  7. 7.
    Vitarelli A, Barilla F, Capotosto L, et al. Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle-tracking echocardiography. J Am Soc Echocardiogr. 2014;27:329–38.CrossRefGoogle Scholar
  8. 8.
    Smith BC, Dobson G, Dawson D, Charalampopoulos A, Grapsa J, Nihoyannopoulos P. Three-dimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol. 2014;64:41–51.CrossRefGoogle Scholar
  9. 9.
    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;6:700–10.CrossRefGoogle Scholar
  10. 10.
    Zhang QB, Sun JP, Gao RF, et al. Feasibility of single-beat full-volume capture real-time three-dimensional echocardiography for quantification of right ventricular volume: validation by cardiac magnetic resonance imaging. Int J Cardiol. 2013;168:3991–5.CrossRefGoogle Scholar
  11. 11.
    Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008;117:1436–48.CrossRefGoogle Scholar
  12. 12.
    Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006;92(Suppl 1):i2–13.CrossRefGoogle Scholar
  13. 13.
    Haugaa KH, Basso C, Badano LP, et al. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy-an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017;18:237–53.CrossRefGoogle Scholar
  14. 14.
    Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;35:3033–69, 3069a–k.CrossRefGoogle Scholar
  15. 15.
    Quick S, Speiser U, Kury K, Schoen S, Ibrahim K, Strasser R. Evaluation and classification of right ventricular wall motion abnormalities in healthy subjects by 3-tesla cardiovascular magnetic resonance imaging. Neth Heart J. 2015;23:64–9.CrossRefGoogle Scholar
  16. 16.
    Badano LP, Ginghina C, Easaw J, et al. Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr. 2010;11:27–37.CrossRefGoogle Scholar
  17. 17.
    Shimada YJ, Shiota M, Siegel RJ, Shiota T. Accuracy of right ventricular volumes and function determined by three-dimensional echocardiography in comparison with magnetic resonance imaging: a meta-analysis study. J Am Soc Echocardiogr. 2010;23:943–53.CrossRefGoogle Scholar
  18. 18.
    Khoo NS, Young A, Occleshaw C, Cowan B, Zeng IS, Gentles TL. Assessments of right ventricular volume and function using three-dimensional echocardiography in older children and adults with congenital heart disease: comparison with cardiac magnetic resonance imaging. J Am Soc Echocardiogr. 2009;22:1279–88.CrossRefGoogle Scholar
  19. 19.
    Knight DS, Grasso AE, Quail MA, et al. Accuracy and reproducibility of right ventricular quantification in patients with pressure and volume overload using single-beat three-dimensional echocardiography. J Am Soc Echocardiogr. 2015;28(3):363–74.CrossRefGoogle Scholar
  20. 20.
    Sugeng L, Mor-Avi V, Weinert L, et al. Multimodality comparison of quantitative volumetric analysis of the right ventricle. JACC Cardiovasc Imaging. 2010;3:10–8.CrossRefGoogle Scholar
  21. 21.
    Muraru D, Spadotto V, Cecchetto A, et al. New speckle-tracking algorithm for right ventricular volume analysis from three-dimensional echocardiographic data sets: validation with cardiac magnetic resonance and comparison with the previous analysis tool. Eur Heart J Cardiovasc Imaging. 2016;17(11):1279–89.CrossRefGoogle Scholar
  22. 22.
    van der Zwaan HB, Helbing WA, McGhie JS, et al. Clinical value of real-time three-dimensional echocardiography for right ventricular quantification in congenital heart disease: validation with cardiac magnetic resonance imaging. J Am Soc Echocardiogr. 2010;23:134–40.CrossRefGoogle Scholar
  23. 23.
    Addetia K, Bhave NM, Tabit CE, et al. Sample size and cost analysis for pulmonary arterial hypertension drug trials using various imaging modalities to assess right ventricular size and function end points. Circ Cardiovasc Imaging. 2014;7:115–24.CrossRefGoogle Scholar
  24. 24.
    van der Zwaan HB, Geleijnse ML, Soliman OI, et al. Test-retest variability of volumetric right ventricular measurements using real-time three-dimensional echocardiography. J Am Soc Echocardiogr. 2011;24:671–9.CrossRefGoogle Scholar
  25. 25.
    Foppa M, Arora G, Gona P, et al. Right ventricular volumes and systolic function by cardiac magnetic resonance and the impact of sex, age, and obesity in a longitudinally followed cohort free of pulmonary and cardiovascular disease: the Framingham Heart Study. Circ Cardiovasc Imaging. 2016;9:e003810.CrossRefGoogle Scholar
  26. 26.
    Kawut SM, Lima JA, Barr RG, et al. Sex and race differences in right ventricular structure and function: the multi-ethnic study of atherosclerosis-right ventricle study. Circulation. 2011;123:2542–51.CrossRefGoogle Scholar
  27. 27.
    Laser KT, Karabiyik A, Korperich H, et al. Validation and reference values for three-dimensional echocardiographic right ventricular volumetry in children: a multicenter study. J Am Soc Echocardiogr. 2018. pii: S0894-7317(18)30150-0.  https://doi.org/10.1016/j.echo.2018.03.010. [Epub ahead of print].CrossRefGoogle Scholar
  28. 28.
    Maffessanti F, Gripari P, Tamborini G, et al. Evaluation of right ventricular systolic function after mitral valve repair: a two-dimensional Doppler, speckle-tracking, and three-dimensional echocardiographic study. J Am Soc Echocardiogr. 2012;25:701–8.CrossRefGoogle Scholar
  29. 29.
    Giusca S, Dambrauskaite V, Scheurwegs C, et al. Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring. Heart. 2010;96:281–8.CrossRefGoogle Scholar
  30. 30.
    Mocchegiani R, Badano L, Lestuzzi C, Nicolosi GL, Zanuttini D. Relation of right ventricular morphology and function in pectus excavatum to the severity of the chest wall deformity. Am J Cardiol. 1995;76:941–6.CrossRefGoogle Scholar
  31. 31.
    Nagata Y, Wu VC, Kado Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ Cardiovasc Imaging. 2017;10(2). pii: e005384.Google Scholar
  32. 32.
    Tamborini G, Muratori M, Brusoni D, et al. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. Eur J Echocardiogr. 2009;10:630–4.CrossRefGoogle Scholar
  33. 33.
    Badano LP, Miglioranza MH, Edvardsen T, et al. European Association of Cardiovascular Imaging/Cardiovascular Imaging Department of the Brazilian Society of Cardiology recommendations for the use of cardiac imaging to assess and follow patients after heart transplantation. Eur Heart J Cardiovasc Imaging. 2015;16:919–48.CrossRefGoogle Scholar
  34. 34.
    Kind T, Mauritz GJ, Marcus JT, van de Veerdonk M, Westerhof N, Vonk-Noordegraaf A. Right ventricular ejection fraction is better reflected by transverse rather than longitudinal wall motion in pulmonary hypertension. J Cardiovasc Magn Reson. 2010;12:35.CrossRefGoogle Scholar
  35. 35.
    Lakatos B, Toser Z, Tokodi M, et al. Quantification of the relative contribution of the different right ventricular wall motion components to right ventricular ejection fraction: the ReVISION method. Cardiovasc Ultrasound. 2017;15:8.CrossRefGoogle Scholar
  36. 36.
    Addetia K, Maffessanti F, Muraru D, et al. Morphologic analysis of the normal right ventricle using three-dimensional echocardiography-derived curvature indices. J Am Soc Echocardiogr. 2018;31(5):614–23.CrossRefGoogle Scholar
  37. 37.
    Addetia K, Maffessanti F, Yamat M, et al. Three-dimensional echocardiography-based analysis of right ventricular shape in pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging. 2016;17(5):564–75.CrossRefGoogle Scholar
  38. 38.
    Ishizu T, Seo Y, Atsumi A, et al. Global and regional right ventricular function assessed by novel three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr. 2017;30:1203–13.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Denisa Muraru
    • 1
    Email author
  • Monica Luiza de Alcantara
    • 2
  • Elena Surkova
    • 3
  • Basma Elnagar
    • 4
    • 5
  1. 1.University of Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, San Luca HospitalMilanoItaly
  2. 2.Department of EchocardiographyEcocardiografia Americas Medical City, Hospital Samaritano and Cardiologia ProechoRio de JaneiroBrazil
  3. 3.Department of Echocardiography, Cardiac DivisionRoyal Brompton Hospital, Royal Brompton and Harefield NHS Foundation TrustLondonUK
  4. 4.Tanta Faculty of MedicineTanta UniversityTantaEgypt
  5. 5.Department of CardiologyTanta University HospitalTantaEgypt

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