assessment of right ventricular function

8/3/2019 Assessment of Right Ventricular Function

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Dr M S ADITYA


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RV is not just a conduit of bloodflow

Has its unique functionPrognostic significance in

various clinical settingsRisk stratification or guide to

optimal therapy


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Evaluation of the right ventricle ishampered by its unusual crescent

shape in minor axis and aparellelopiped shape in orthogonalaxis

Irregular Endocardial surfaceComplex contraction mechanismLocation of the right ventricle almost

directly behind the sternum


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Difficult to standardize theevaluation method of RVfunction

Variations in the direction orlocation of the RV are common

Easily affected by preload,

afterload, or LV functionDifferent complex contraction-

relaxation mechanism among

the segments of the RV


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The pattern has been compared withthe action of a bellows

Minor axis shortening is combinedwith significant long-axis shorteningto draw the tricuspid annulus towardthe apex.

The low resistance of the pulmonaryvascular circuit permits the rightventricle to eject a large volume ofblood

Relatively small movements of the


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2 D and M-modeechocardiography

1.Chamber size or wall thickness2.RV area or fractional area

change3.RV volume or EF4.Tricuspid annular systolic plane

excursion (TAPSE) Doppler echocardiography 3 Dimensional


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Normal: lessthan 0.5 cm

Measure at thelevel of TVchordae and atthe peak of R

wave ofECG onsubcostal view

Well correlated

with peak RV


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Degree of systolic excursion ofTV lateral annulus

1.5-2.0 cm in normalValue less than 1.5 cm is

considered as abnormal Well correlated with RVEF

measured by RVGReproducibleStrong predictor of prognosis in

patients with CHF


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CW Doppler of TR jetMeasure of systolic pulmonary

artery pressureMeasure of the velocity of early RV

systolic pressure riseSystolic time intervalPulmonary artery flow acceleration

time Index of myocardial performance

(IMP or Tei index) Tissue Doppler imaging (TDI)Strain rate imaging


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Continuous wave Doppler is used toestimate pulmonary artery systolic

and mean diastolic pressure bymeasuring the pressure drop acrossTricuspid and pulmonary valve

Pulsed doppler recordings ofpulmonary valve flow accelerationtime ( PAat),pre ejection period

( PEP), and ejection time ( PAeT) can


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IMP or Tei index Initially described by Tei to

measure global LV function

Recently introduced to measure RVfunctionAdvantages Independent of geometryUseful in patients with inadequate

RV image Less affected by HR, loading

condition, and degree of TRGood predictor of prognosis in

patients with congenital heart


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Allows quantitative assessment of RVsystolic and diastolic function bymeasurement of myocardial velocities

Peak systolic velocity (PSV)

1.PSV < 11.5 cm/s identifies the presence ofRV dysfunction2.Sensitivity of 90%, specificity of 85%3.Less affected by HR, loading condition,

and degree of TR

Tricuspid lateral annular velocities1.Reduced in patients with inferior MI andRV involvement

2.Associated with the severity of RVdysfunction in patients with heart failure


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RV longitudinal strain in apical view Feasible in clinical setting Baso-apical gradient with higher

velocities at the base RV velocities are consistently higher as

compared to LV Strain and strain rate values1.More inhomogeneously distributed in the

RV2.Reverse baso-apical gradient, reaching

the highest values in the apical segmentsand outflow tract

Acute increase in RV afterload1.Increase in RV myocardial strain rate2.Decrease in peak systolic strain,


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Advantages of RT3DEVolume analysis does not rely on

geometric assumptions

Little artifacts associated withmotion or respiration Multiple slices may be obtained

from the base to the apex of theheart as in the method of discs

Measure entire RV volumeWell correlated with RV volume

measured by MRI


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RV function is an importantparameter in cardiac disease

2DE is a relatively feasiblemethod to assess RV dysfunctionin clinical practice

Several new Echocardiographictechniques such as TDI, SRI,

RT3DE may give us furtherinformation in assessing RV

f i

assessment of right ventricular function

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