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Step R for Right Ventricular Function in Stress Echocardiography

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Abstract

There are several approaches to measure global right ventricular function: tricuspid annular plane systolic excursion with M-mode, fractional area change with 2-dimensional echocardiography, ejection fraction with real-time three-dimensional echocardiography, peak systolic S-wave velocity with Doppler tissue imaging of the lateral tricuspid annular motion, and free wall longitudinal strain with deformation imaging. The tricuspid annular plane systolic excursion is the simplest and most validated index, to date. It measures the descent of the right ventricular base from the apical 4-chamber view. In left-sided heart failure, for any given left ventricular function, the worse the right contractile reserve the poorer the prognosis. In precapillary pulmonary hypertension, for any given pulmonary pressure, the worse the right ventricular contractile reserve the poorer the prognosis. The ratio of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure is an index of right ventriculoarterial coupling and can be assessed at rest and also dynamically during exercise. Stress echocardiography with exercise or dobutamine focused on the right ventricular contractile reserve allows better phenotyping of the patient, to regrade disease severity based on resting findings and refining risk stratification. It is especially important in dilated cardiomyopathy, left heart failure, pulmonary hypertension, and congenital heart diseases such as repaired tetralogy of Fallot.

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Acknowledgments

The authors would like to acknowledge the contributions of Drs. Ekkehard Grunig, Alberto San Roman, Kwan Damon, and Nelson B. Schiller for their contributions to the previous editions of this chapter.

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Rodriguez-Zanella, H., Picano, E. (2023). Step R for Right Ventricular Function in Stress Echocardiography. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_10

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  • DOI: https://doi.org/10.1007/978-3-031-31062-1_10

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