Skip to main content

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

  • Chapter
  • First Online:
Right Heart Pathology

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.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  4. Santamore WP, Dell’Italia LJ. Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis. 1998;40:289–308.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Dell’Italia LJ. The right ventricle: anatomy, physiology, and clinical importance. Curr Probl Cardiol. 1991;16:653–720.

    PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  23. Weyman AE. Principles and practice of echocardiography. 2nd ed. Philadelphia: LWW; 1994. p. 1335.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lung-Chun Lin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Huang, KC., Lin, JL., Lin, LC. (2018). Transthoracic Echocardiography: Improved Practice by Real-Time 3D Acquisition and Automation. In: Dumitrescu, S., Ţintoiu, I., Underwood, M. (eds) Right Heart Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-73764-5_33

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-73764-5_33

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-73763-8

  • Online ISBN: 978-3-319-73764-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics