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Transthoracic Echocardiography: Improved Practice by Real-Time 3D Acquisition and Automation

  • Kuan-Chih Huang
  • Jiunn-Lee Lin
  • Lung-Chun Lin
Chapter

Abstract

Right ventricular ejection fraction (RVEF) has been approved of important prognostic in many cardiac diseases. However, RVEF in these studies was mostly evaluated by cardiac magnetic resonance imaging (CMR), radionuclide imaging or even angiography, but not the most accessible echocardiography. Most difficulties of right ventricular assessment by two-dimensional echocardiography come from the unusual crescent shape, the anterior location and the complex contraction mechanism. With recently available dedicated software, three-dimensional echocardiography should bring the innate accessibility in to full play, putting in the last piece, the right ventricle, of puzzle of ventricles.

Keywords

Automatic analysis Imaging acquisition Morphological remodeling Right ventricular ejection fraction Three-dimensional echocardiography 

References

  1. 1.
    Kawut SM, Al-Naamani N, Agerstrand C, Berman Rosenzweig E, Rowan C, Barst RJ, et al. Determinants of right ventricular ejection fraction in pulmonary arterial hypertension. Chest. 2009;135:752–9.  https://doi.org/10.1378/chest.08-1758.CrossRefPubMedGoogle Scholar
  2. 2.
    Moledina S, Pandya B, Bartsota M, Mortensen KH, McMillan M, Quyam S, et al. Prognostic significance of cardiac magnetic resonance imaging in children with pulmonary hypertension. Circ Cardiovasc Imaging. 2013;6:407–14.  https://doi.org/10.1161/CIRCIMAGING.112.000082.CrossRefPubMedGoogle Scholar
  3. 3.
    Medvedofsky D, Addetia K, Patel AR, Sedlmeier A, Baumann R, Mor-Avi V, et al. Novel approach to three-dimensional echocardiographic quantification of right ventricular volumes and function from focused views. J Am Soc Echocardiogr. 2015;28:1222–31.  https://doi.org/10.1016/j.echo.2015.06.013.CrossRefPubMedGoogle Scholar
  4. 4.
    Santamore WP, Dell’Italia LJ. Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis. 1998;40:289–308.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Vassalli G, Hess OM, Krogmann ON, Villari B, Corin WJ, Turina M, et al. Coronary artery size in mitral regurgitation and its regression after mitral valve surgery. Am Heart J. 1993;126:1091–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Sabe MA, Sabe SA, Kusunose K, Flamm SD, Griffin BP, Kwon DH. Predictors and prognostic significance of right ventricular ejection fraction in patients with ischemic cardiomyopathyclinical perspective. Circulation. 2016;134:656–65.  https://doi.org/10.1161/CIRCULATIONAHA.116.022339.CrossRefPubMedGoogle Scholar
  7. 7.
    Sugimoto T, Bandera F, Generati G, Alfonzetti E, Bussadori C, Guazzi M. Left atrial function dynamics during exercise in heart failure. JACC Cardiovasc Imaging. 2016;10(10 Pt B):1253–64.  https://doi.org/10.1016/j.jcmg.2016.09.021.CrossRefPubMedGoogle Scholar
  8. 8.
    Dell’Italia LJ. The right ventricle: anatomy, physiology, and clinical importance. Curr Probl Cardiol. 1991;16:653–720.PubMedPubMedCentralGoogle Scholar
  9. 9.
    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. J Am Soc Echocardiogr. 2010;23:685–713.  https://doi.org/10.1016/j.echo.2010.05.010.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990;66:493–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Currie PJ, Seward JB, Chan K-L, Fyfe DA, Hagler DJ, Mair DD, et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol. 1985;6:750–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ. Echocardiographic determination of mean pulmonary artery pressure. Am J Cardiol. 2003;92:1373–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol. 2003;41:1021–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Dahiya A, Vollbon W, Jellis C, Prior D, Wahi S, Marwick T. Echocardiographic assessment of raised pulmonary vascular resistance: application to diagnosis and follow-up of pulmonary hypertension. Heart. 2010;96:2005–9.  https://doi.org/10.1136/hrt.2010.204834.CrossRefPubMedGoogle Scholar
  15. 15.
    Sakuma M, Ishigaki H, Komaki K, Oikawa Y, Katoh A, Nakagawa M, et al. Right ventricular ejection function assessed by cineangiography. Circ J. 2002;66:605–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ghio S, Guazzi M, Scardovi AB, Klersy C, Clemenza F, Carluccio E, et al. Different correlates but similar prognostic implications for right ventricular dysfunction in heart failure patients with reduced or preserved ejection fraction: RV function in heart failure. Eur J Heart Fail. 2017;19:873–9.  https://doi.org/10.1002/ejhf.664.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Guazzi M, Dixon D, Labate V, Beussink-Nelson L, Bandera F, Cuttica MJ, et al. RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction. JACC Cardiovasc Imaging. 2017;10(10 Pt B):1211–21.  https://doi.org/10.1016/j.jcmg.2016.12.024.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    da Costa Junior AA, Ota-Arakaki JS, Ramos RP, Uellendahl M, Mancuso FJ, Gil MA, et al. Diagnostic and prognostic value of right ventricular strain in patients with pulmonary arterial hypertension and relatively preserved functional capacity studied with echocardiography and magnetic resonance. Int J Cardiovasc Imaging. 2017;33:39–46.  https://doi.org/10.1007/s10554-016-0966-1.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Haeck ML, Scherptong RW, Marsan NA, Holman ER, Schalij MJ, Bax JJ, et al. Prognostic value of right ventricular longitudinal peak systolic strain in patients with pulmonary hypertension. Circ Cardiovasc Imaging. 2012;5:628–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Cappelli F, Porciani MC, Bergesio F, Perlini S, Attana P, Moggi Pignone A, et al. Right ventricular function in AL amyloidosis: characteristics and prognostic implication. Eur Heart J Cardiovasc Imaging. 2012;13:416–22.  https://doi.org/10.1093/ejechocard/jer289.CrossRefPubMedGoogle Scholar
  21. 21.
    Dahou A, Clavel M-A, Capoulade R, Bartko PE, Magne J, Mundigler G, et al. Right ventricular longitudinal strain for risk stratification in low-flow, low-gradient aortic stenosis with low ejection fraction. Heart. 2016;102:548–54.  https://doi.org/10.1136/heartjnl-2015-308309.CrossRefPubMedGoogle Scholar
  22. 22.
    Guihaire J, Haddad F, Boulate D, Decante B, Denault AY, Wu J, et al. Non-invasive indices of right ventricular function are markers of ventricular-arterial coupling rather than ventricular contractility: insights from a porcine model of chronic pressure overload. Eur Heart J Cardiovasc Imaging. 2013;14:1140–9.  https://doi.org/10.1093/ehjci/jet092.CrossRefPubMedGoogle Scholar
  23. 23.
    Weyman AE. Principles and practice of echocardiography. 2nd ed. Philadelphia: LWW; 1994. p. 1335.Google Scholar
  24. 24.
    Zornoff LAM, Skali H, Pfeffer MA, St John Sutton M, Rouleau JL, Lamas GA, et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol. 2002;39:1450–5.CrossRefPubMedGoogle Scholar
  25. 25.
    van der Maas N, Braam RL, van der Zaag-Loonen HJ, Meerman J, Cozijnsen L, Scholte AJ. Right ventricular ejection fraction measured by multigated planar equilibrium radionuclide ventriculography is an independent prognostic factor in patients with ischemic heart disease. J Nucl Cardiol. 2012;19:1162–9.  https://doi.org/10.1007/s12350-012-9613-y.CrossRefPubMedGoogle Scholar
  26. 26.
    La Vecchia L, Varotto L, Zanolla L, Spadaro GL, Fontanelli A. Right ventricular function predicts transplant-free survival in idiopathic dilated cardiomyopathy. J Cardiovasc Med. 2006;7:706–10.CrossRefGoogle Scholar
  27. 27.
    Kawata T, Daimon M, Kimura K, Nakao T, Lee SL, Hirokawa M, et al. Echocardiographic assessment of right ventricular function in routine practice: which parameters are useful to predict one-year outcome in advanced heart failure patients with dilated cardiomyopathy? J Cardiol. 2017;70:316–22.  https://doi.org/10.1016/j.jjcc.2017.02.007.CrossRefPubMedGoogle Scholar
  28. 28.
    Mikami Y, Jolly U, Heydari B, Peng M, Almehmadi F, Zahrani M, et al. Right ventricular ejection fraction is incremental to left ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction. Circ Arrhythm Electrophysiol. 2017;10(1):e004067.  https://doi.org/10.1161/CIRCEP.116.004067.CrossRefPubMedGoogle Scholar
  29. 29.
    Tamaki S, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, et al. Risk stratification of patients with chronic heart failure using cardiac iodine-123 metaiodobenzylguanidine imaging: incremental prognostic value over right ventricular ejection fraction. ESC Heart Fail. 2015;2:116–21.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Iacoviello M, Monitillo F, Citarelli G, Leone M, Grande D, Antoncecchi V, et al. Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients. Int J Cardiol. 2017;241:318–21.  https://doi.org/10.1016/j.ijcard.2017.04.051.CrossRefPubMedGoogle Scholar
  31. 31.
    Antoni ML, Scherptong RW, Atary JZ, Boersma E, Holman ER, van der Wall EE, et al. Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging. 2010;3:264–71.  https://doi.org/10.1161/CIRCIMAGING.109.914366.CrossRefPubMedGoogle Scholar
  32. 32.
    Larose E, Ganz P, Reynolds HG, Dorbala S, Di Carli MF, Brown KA, et al. Right ventricular dysfunction assessed by cardiovascular magnetic resonance imaging predicts poor prognosis late after myocardial infarction. J Am Coll Cardiol. 2007;49:855–62.CrossRefPubMedGoogle Scholar
  33. 33.
    Murata M, Tsugu T, Kawakami T, Kataoka M, Minakata Y, Endo J, et al. Prognostic value of three-dimensional echocardiographic right ventricular ejection fraction in patients with pulmonary arterial hypertension. Oncotarget. 2016;7:86781–90.  https://doi.org/10.18632/oncotarget.13505.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Courand PY, Pina Jomir G, Khouatra C, Scheiber C, Turquier S, Glérant JC, et al. Prognostic value of right ventricular ejection fraction in pulmonary arterial hypertension. Eur Respir J. 2015;45:139–49.  https://doi.org/10.1183/09031936.00158014.CrossRefPubMedGoogle Scholar
  35. 35.
    Jensen AS, Broberg CS, Rydman R, Diller G-P, Li W, Dimopoulos K, et al. Impaired right, left, or biventricular function and resting oxygen saturation are associated with mortality in eisenmenger syndrome: a clinical and cardiovascular magnetic resonance study. Circ Cardiovasc Imaging. 2015;10(1):e003596.  https://doi.org/10.1161/CIRCIMAGING.115.003596.CrossRefGoogle Scholar
  36. 36.
    Bodez D, Ternacle J, Guellich A, Galat A, Lim P, Radu C, et al. Prognostic value of right ventricular systolic function in cardiac amyloidosis. Amyloid. 2016;23:158–67.CrossRefPubMedGoogle Scholar
  37. 37.
    Bootsma IT, de Lange F, Koopmans M, Haenen J, Boonstra PW, Symersky T, et al. Right ventricular function after cardiac surgery is a strong independent predictor for long-term mortality. J Cardiothorac Vasc Anesth. 2017;31(5):1656–62.  https://doi.org/10.1053/j.jvca.2017.02.008.CrossRefPubMedGoogle Scholar
  38. 38.
    Le Tourneau T, Deswarte G, Lamblin N, Foucher-Hossein C, Fayad G, Richardson M, et al. Right ventricular systolic function in organic mitral regurgitation: impact of biventricular impairment. Circulation. 2013;127:1597–608.  https://doi.org/10.1161/CIRCULATIONAHA.112.000999.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Burri H, Domenichini G, Sunthorn H, Fleury E, Stettler C, Foulkes I, et al. Right ventricular systolic function and cardiac resynchronization therapy. Europace. 2010;12:389–94.  https://doi.org/10.1093/europace/eup401.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Alpendurada F, Guha K, Sharma R, Ismail TF, Clifford A, Banya W, et al. Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy. J Cardiovasc Magn Reson. 2011;13:68.  https://doi.org/10.1186/1532-429X-13-68.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Jenkins C, Chan J, Bricknell K, Strudwick M, Marwick TH. Reproducibility of right ventricular volumes and ejection fraction using real-time three-dimensional echocardiography: comparison with cardiac MRI. Chest. 2007;131:1844–51.CrossRefPubMedGoogle Scholar
  42. 42.
    Ostenfeld E, A Flachskampf F. Assessment of right ventricular volumes and ejection fraction by echocardiography: from geometric approximations to realistic shapes. Echo Res Pract. 2015;2:R1–R11.  https://doi.org/10.1530/ERP-14-0077.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    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.  https://doi.org/10.1016/j.jacc.2014.01.084.CrossRefPubMedGoogle Scholar
  44. 44.
    Garimella RV, Swartz BK. Curvature estimation for unstructured triangulations of surfaces. Los Alamos Natl Lab. 2003. https://www.researchgate.net/profile/Rao_Garimella/publication/245825677_Curvature_Estimation_for_Unstructured_Triangulations_of_Surfaces.
  45. 45.
    Sciancalepore MA, Maffessanti F, Patel AR, Gomberg-Maitland M, Chandra S, Freed BH, et al. Three-dimensional analysis of interventricular septal curvature from cardiac magnetic resonance images for the evaluation of patients with pulmonary hypertension. Int J Cardiovasc Imaging. 2012;28:1073–85.  https://doi.org/10.1007/s10554-011-9913-3.CrossRefPubMedGoogle Scholar
  46. 46.
    Addetia K, Maffessanti F, Yamat M, Weinert L, Narang A, Freed BH, et al. Three-dimensional echocardiography-based analysis of right ventricular shape in pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging. 2016;17:564–75.  https://doi.org/10.1093/ehjci/jev171.CrossRefPubMedGoogle Scholar
  47. 47.
    Addetia K, Uriel N, Maffessanti F, Sayer G, Adatya S, Kim GH, et al. 3D morphological changes in LV and RV during LVAD ramp studies. JACC Cardiovasc Imaging. 2017.  https://doi.org/10.1016/j.jcmg.2016.12.019.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of CardiologyHeart Center, Cheng Hsin General HospitalTaipeiRepublic of China
  2. 2.Section of Cardiology, Department of Internal MedicineNational Taiwan University HospitalTaipeiRepublic of China

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