echocardiographic evaluation of right ventricular function ... · echocardiographic evaluation of...

22nd Annual Conference of the Saudi Heart Association

Echocardiographic Evaluation of RightEchocardiographic Evaluation of RightEchocardiographic Evaluation of RightEchocardiographic Evaluation of RightRiyadh, Saudi Arabia

Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Ventricular Function in Ventricular Function in

Congenital Heart DiseaseCongenital Heart Disease

Echocardiographic Evaluation of Right Echocardiographic Evaluation of Right Ventricular Function in Ventricular Function in

Congenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseBenjamin W Eidem, MD, FACC, FASEBenjamin W Eidem, MD, FACC, FASE

P f f P di t i & M di iP f f P di t i & M di iBenjamin W Eidem, MD, FACC, FASEBenjamin W Eidem, MD, FACC, FASE

P f f P di t i & M di iP f f P di t i & M di iProfessor of Pediatrics & Medicine Professor of Pediatrics & Medicine Divisions of Pediatric Cardiology& Cardiovascular Diseases Divisions of Pediatric Cardiology& Cardiovascular Diseases

Mayo ClinicMayo Clinic

Professor of Pediatrics & Medicine Professor of Pediatrics & Medicine Divisions of Pediatric Cardiology& Cardiovascular Diseases Divisions of Pediatric Cardiology& Cardiovascular Diseases

Mayo ClinicMayo ClinicMayo ClinicMayo ClinicMayo ClinicMayo Clinic

No Disclosures

Assessment of RV FunctionAssessment of RV FunctionObj tiObj ti

Assessment of RV FunctionAssessment of RV FunctionObj tiObj tiObjectivesObjectivesObjectivesObjectives

•• Review common nonReview common non--invasive methods of invasive methods of RV functional assessmentRV functional assessment

•• Review common nonReview common non--invasive methods of invasive methods of RV functional assessmentRV functional assessment•• 22--dimensional & 3dimensional & 3--dimensional imagingdimensional imaging•• DopplerDoppler--derived indicesderived indices•• 22--dimensional & 3dimensional & 3--dimensional imagingdimensional imaging•• DopplerDoppler--derived indicesderived indices

•• Advantages & limitations of quantitative Advantages & limitations of quantitative RV assessmentRV assessment

•• Advantages & limitations of quantitative Advantages & limitations of quantitative RV assessmentRV assessment

•• Emerging techniques to improve functional Emerging techniques to improve functional assessment of RV performanceassessment of RV performance

•• Emerging techniques to improve functional Emerging techniques to improve functional assessment of RV performanceassessment of RV performancepppp

Right Ventricular FunctionRight Ventricular FunctionB k dB k d

Right Ventricular FunctionRight Ventricular FunctionB k dB k dBackgroundBackgroundBackgroundBackground

•• Knowledge of RV Knowledge of RV function lags behind LVfunction lags behind LV

•• I d iti fI d iti f

•• Knowledge of RV Knowledge of RV function lags behind LVfunction lags behind LV

•• I d iti fI d iti f•• Increased recognition of Increased recognition of importance of RV importance of RV dysfunction in CV dysfunction in CV didi

•• Increased recognition of Increased recognition of importance of RV importance of RV dysfunction in CV dysfunction in CV dididiseasedisease

•• Challenges in the Challenges in the quantitative assessmentquantitative assessment

diseasedisease•• Challenges in the Challenges in the

quantitative assessmentquantitative assessment •• Publications (to present)Publications (to present)quantitative assessment quantitative assessment of RV structure & of RV structure & function function

quantitative assessment quantitative assessment of RV structure & of RV structure & function function

•• LV function (23,769)LV function (23,769)•• RV function (2,927)RV function (2,927)

Redington A, Cardiol Clin 2002Redington A, Cardiol Clin 2002

Right Ventricular FunctionRight Ventricular FunctionBackgroundBackground

Right Ventricular FunctionRight Ventricular FunctionBackgroundBackgroundBackgroundBackgroundBackgroundBackground

•• RV Anatomy & FunctionRV Anatomy & Function•• RV Anatomy & FunctionRV Anatomy & Functionyy•• Chamber geometry is Chamber geometry is complexcomplex

I l t ( i )I l t ( i )

yy•• Chamber geometry is Chamber geometry is complexcomplex

I l t ( i )I l t ( i )•• Inlet (sinus)Inlet (sinus)•• Outlet (conus)Outlet (conus)

•• Longitudinal > radialLongitudinal > radial

•• Inlet (sinus)Inlet (sinus)•• Outlet (conus)Outlet (conus)

•• Longitudinal > radialLongitudinal > radialLongitudinal > radial Longitudinal > radial shorteningshortening•• RV RV -- LV interactionsLV interactions

Longitudinal > radial Longitudinal > radial shorteningshortening•• RV RV -- LV interactionsLV interactions

•• Shared wall Shared wall IVSIVS•• Mutually encircling Mutually encircling epicardial fibersepicardial fibers

•• Shared wall Shared wall IVSIVS•• Mutually encircling Mutually encircling epicardial fibersepicardial fibersepicardial fibersepicardial fibers•• Share pericardial spaceShare pericardial spaceepicardial fibersepicardial fibers•• Share pericardial spaceShare pericardial space

Right Ventricular FunctionRight Ventricular FunctionB k dB k d

Right Ventricular FunctionRight Ventricular FunctionB k dB k dBackgroundBackgroundBackgroundBackground

•• RV PhysiologyRV Physiology•• RV cardiac output = LV cardiac outputRV cardiac output = LV cardiac output

V diff t l b dV diff t l b d

•• RV PhysiologyRV Physiology•• RV cardiac output = LV cardiac outputRV cardiac output = LV cardiac output

V diff t l b dV diff t l b d•• Very different vascular bedsVery different vascular beds•• RV external work is 25% of LV workRV external work is 25% of LV work

Diff tDiff t l l ti hil l ti hi

•• Very different vascular bedsVery different vascular beds•• RV external work is 25% of LV workRV external work is 25% of LV work

Diff tDiff t l l ti hil l ti hi•• Different pressure Different pressure -- volume relationshipsvolume relationships•• RV is very efficient systemRV is very efficient system•• Critically dependent upon low hydraulicCritically dependent upon low hydraulic

•• Different pressure Different pressure -- volume relationshipsvolume relationships•• RV is very efficient systemRV is very efficient system•• Critically dependent upon low hydraulicCritically dependent upon low hydraulic•• Critically dependent upon low hydraulic Critically dependent upon low hydraulic impedance of normal pulmonary vascular impedance of normal pulmonary vascular bedbed

•• Critically dependent upon low hydraulic Critically dependent upon low hydraulic impedance of normal pulmonary vascular impedance of normal pulmonary vascular bedbed

Right Ventricular FunctionRight Ventricular FunctionBackgroundBackground

Right Ventricular FunctionRight Ventricular FunctionBackgroundBackgroundBackgroundBackgroundBackgroundBackground

•• LV is a “square wave” pumpLV is a “square wave” pump•• RV performs under different RV performs under different

pressurepressure volume conditionsvolume conditions

•• LV is a “square wave” pumpLV is a “square wave” pump•• RV performs under different RV performs under different

pressurepressure volume conditionsvolume conditionspressure pressure -- volume conditionsvolume conditions•• RV ejection very efficientRV ejection very efficient

•• Begins early during Begins early during

pressure pressure -- volume conditionsvolume conditions•• RV ejection very efficientRV ejection very efficient

•• Begins early during Begins early during pressure risepressure rise•• Occurs beyond Occurs beyond development of peak RV development of peak RV

pressure risepressure rise•• Occurs beyond Occurs beyond development of peak RV development of peak RV p pp ppressurepressure•• Continues as RV Continues as RV pressure fallspressure falls

p pp ppressurepressure•• Continues as RV Continues as RV pressure fallspressure fallspressure fallspressure fallspressure fallspressure falls


Right Ventricular FunctionRight Ventricular FunctionRight Ventricular FunctionRight Ventricular FunctionggEchocardiographic AssessmentEchocardiographic Assessment

ggEchocardiographic AssessmentEchocardiographic Assessment

•• Unique challenges with morphologic RVUnique challenges with morphologic RV•• GeometryGeometry

•• Unique challenges with morphologic RVUnique challenges with morphologic RV•• GeometryGeometryGeometryGeometry•• Anatomic locationAnatomic location•• Different hemodynamics compared to LVDifferent hemodynamics compared to LV

GeometryGeometry•• Anatomic locationAnatomic location•• Different hemodynamics compared to LVDifferent hemodynamics compared to LVDifferent hemodynamics compared to LVDifferent hemodynamics compared to LV

•• BeatBeat--toto--beat changes with respirationbeat changes with respiration•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed

Different hemodynamics compared to LVDifferent hemodynamics compared to LV•• BeatBeat--toto--beat changes with respirationbeat changes with respiration•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed

•• Right Right -- left heart interactionleft heart interaction•• Pulmonary vs systemic vascular bedPulmonary vs systemic vascular bed

•• Right Right -- left heart interactionleft heart interaction

Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionCongenital Heart DiseaseCongenital Heart Disease

Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart DiseaseCongenital Heart Disease

Challenges in congenitalChallenges in congenitalChallenges in congenitalheart diseaseChallenges in congenitalheart disease

• Complex anatomy• Complex anatomy• Complex anatomy• Variable loading

conditions

• Complex anatomy• Variable loading

conditionsconditions• Regional myocardial

f ti

conditions• Regional myocardial

f tifunction• RV function as relevant

LV f ti

function• RV function as relevant

LV f tias LV functionas LV function

Assessment of RV FunctionAssessment of RV FunctionQ lit ti Vi l A tQ lit ti Vi l A tAssessment of RV FunctionAssessment of RV FunctionQ lit ti Vi l A tQ lit ti Vi l A tQualitative Visual AssessmentQualitative Visual AssessmentQualitative Visual AssessmentQualitative Visual Assessment

Evaluation of Congenital Heart DiseaseEvaluation of Congenital Heart DiseaseSegmental ApproachSegmental Approach

Evaluation of Congenital Heart DiseaseEvaluation of Congenital Heart DiseaseSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach

Situs & PositionSitus & Position

Systemic & Pulmonary Systemic & Pulmonary Venous ConnectionsVenous Connections

Venous ConnectionsVenous Connections

Atrial & AV ConnectionAtrial & AV Connection

Ventricular morphologyVentricular morphology

VA ConnectionVA Connection

H l ti L ft H tH l ti L ft H tGreat ArteriesGreat Arteries

Hypoplastic Left HeartHypoplastic Left Heart

Assessment of Assessment of LeftLeft Ventricular FunctionVentricular FunctionSegmental ApproachSegmental Approach

Assessment of Assessment of LeftLeft Ventricular FunctionVentricular FunctionSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach

LV systolic functionLV systolic function LV global functionLV global function• LVSF % and LVEF %• Stress-velocity index• LVSF % and LVEF %• Stress-velocity index

• Myocardialperformance index


• LV dP / dtLV diastolic function

• LV dP / dtLV diastolic function

LV longitudinal function• Tissue Doppler

LV longitudinal function• Tissue Doppler

• Mitral inflow Doppler• Pulmonary venous• Mitral inflow Doppler• Pulmonary venous

LV regional function• Strain and strain rate

LV regional function• Strain and strain rate

Doppler• Color flow

propagation

Doppler• Color flow

propagation

• Myocardial twist & torsion

• Myocardial twist & torsion

propagationpropagation

Assessment of Assessment of RightRight Ventricular FunctionVentricular FunctionSegmental ApproachSegmental Approach

Assessment of Assessment of RightRight Ventricular FunctionVentricular FunctionSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach

RV systolic functionRV systolic function RV global functionRV global function• RV FAC and RVEF %• RV dP / dt• RV FAC and RVEF %• RV dP / dt



• TAPSERV diastolic function

• TAPSERV diastolic function

• 3-D EchoRV longitudinal function

• 3-D EchoRV longitudinal function

• Tricuspid inflow Doppler


• Tissue DopplerRV regional function

• Tissue DopplerRV regional function

• Hepatic venous Doppler

• RVOT Doppler


• RVOT Doppler

• Strain and strain rate• Strain and strain rate

C di MRIC di MRI• RVOT Doppler• RVOT Doppler Cardiac MRICardiac MRI

Evaluation of RV FunctionEvaluation of RV FunctionRV Fractional Area & Volume ChangeRV Fractional Area & Volume Change

Evaluation of RV FunctionEvaluation of RV FunctionRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume Change

•• 22--Dimensional AnalysisDimensional Analysis•• 22--Dimensional AnalysisDimensional Analysis•• 22--Dimensional AnalysisDimensional Analysis•• Single plane methodSingle plane method•• Biplane volume methodsBiplane volume methods

•• 22--Dimensional AnalysisDimensional Analysis•• Single plane methodSingle plane method•• Biplane volume methodsBiplane volume methodspp

•• Area Area -- length methodlength method•• Simpson’s methodSimpson’s method

pp•• Area Area -- length methodlength method•• Simpson’s methodSimpson’s method

•• A4C + Subcostal 4CA4C + Subcostal 4C•• Limitations = manyLimitations = many

•• GeometricGeometric

•• A4C + Subcostal 4CA4C + Subcostal 4C•• Limitations = manyLimitations = many

•• GeometricGeometric•• GeometricGeometric•• Anterior RV free wallAnterior RV free wall•• Inclusion of RVOTInclusion of RVOT

•• GeometricGeometric•• Anterior RV free wallAnterior RV free wall•• Inclusion of RVOTInclusion of RVOT

55--231231--071071

Inclusion of RVOTInclusion of RVOTInclusion of RVOTInclusion of RVOT

Assessment of RV FunctionAssessment of RV Function33 Dimensional EchocardiographyDimensional EchocardiographyAssessment of RV FunctionAssessment of RV Function

33 Dimensional EchocardiographyDimensional Echocardiography33--Dimensional EchocardiographyDimensional Echocardiography33--Dimensional EchocardiographyDimensional Echocardiography

•• RV AssessmentRV Assessment•• VolumeVolume

•• EDVEDV•• ESVESV

•• Stroke volumeStroke volume•• RV EF %RV EF %

Courtesy Phillips & G ShiraliCourtesy Phillips & G Shirali

Assessment of RV FunctionAssessment of RV Function33 Di i l E h di hDi i l E h di hAssessment of RV FunctionAssessment of RV Function

33 Di i l E h di hDi i l E h di h33--Dimensional Echocardiography Dimensional Echocardiography 33--Dimensional Echocardiography Dimensional Echocardiography

•• AdvantagesAdvantages•• AdvantagesAdvantages •• LimitationsLimitations•• LimitationsLimitations•• AdvantagesAdvantages•• QuantitativeQuantitative•• Global functionGlobal function

•• AdvantagesAdvantages•• QuantitativeQuantitative•• Global functionGlobal function

•• LimitationsLimitations•• AvailabilityAvailability•• Image qualityImage quality

•• LimitationsLimitations•• AvailabilityAvailability•• Image qualityImage quality•• Global functionGlobal function

•• Incorporates RV Incorporates RV inflow & outflowinflow & outflow

•• Global functionGlobal function•• Incorporates RV Incorporates RV inflow & outflowinflow & outflow

•• Image qualityImage quality•• Learning curveLearning curve•• Load dependentLoad dependent

•• Image qualityImage quality•• Learning curveLearning curve•• Load dependentLoad dependent

•• No geometric No geometric limitationslimitations•• No geometric No geometric limitationslimitations

Load dependentLoad dependent•• Regional functionRegional function

Load dependentLoad dependent•• Regional functionRegional function

•• ReproducibleReproducible•• Close correlation Close correlation with MRI volumeswith MRI volumes

•• ReproducibleReproducible•• Close correlation Close correlation with MRI volumeswith MRI volumeswith MRI volumeswith MRI volumeswith MRI volumeswith MRI volumes

Assessment of RV FunctionAssessment of RV FunctionDoppler EchocardiographyDoppler Echocardiography

Assessment of RV FunctionAssessment of RV FunctionDoppler EchocardiographyDoppler EchocardiographyDoppler Echocardiography Doppler Echocardiography Doppler Echocardiography Doppler Echocardiography

Ch ll i A t f RVCh ll i A t f RVCh ll i A t f RVCh ll i A t f RV•• Challenges in Assessment of RV Challenges in Assessment of RV physiologyphysiology•• Respiratory variationRespiratory variation

•• Challenges in Assessment of RV Challenges in Assessment of RV physiologyphysiology•• Respiratory variationRespiratory variation•• Respiratory variationRespiratory variation

•• Doppler measurements Doppler measurements 55--10% with 10% with inspirationinspiration

•• Respiratory variationRespiratory variation•• Doppler measurements Doppler measurements 55--10% with 10% with inspirationinspirationinspirationinspiration

•• PA systolic velocity & RVOT gradientPA systolic velocity & RVOT gradient•• TR velocityTR velocity

inspirationinspiration•• PA systolic velocity & RVOT gradientPA systolic velocity & RVOT gradient•• TR velocityTR velocityyy•• Tricuspid inflow DopplerTricuspid inflow Doppler

•• Inability to detect small changes in RV Inability to detect small changes in RV t tt t

yy•• Tricuspid inflow DopplerTricuspid inflow Doppler

•• Inability to detect small changes in RV Inability to detect small changes in RV t tt tstatusstatusstatusstatus

Assessment of RV FunctionAssessment of RV FunctionRV dP / dtRV dP / dt

Assessment of RV FunctionAssessment of RV FunctionRV dP / dtRV dP / dtRV dP / dtRV dP / dtRV dP / dtRV dP / dt

•• Rate of rise of RV systolic Rate of rise of RV systolic pressure (dP /dt)pressure (dP /dt)

•• Rate of rise of RV systolic Rate of rise of RV systolic pressure (dP /dt)pressure (dP /dt)p ( )p ( )•• Velocity curve transferred to Velocity curve transferred to

pressure gradient curve via pressure gradient curve via modified Bernoulli equation modified Bernoulli equation

p ( )p ( )•• Velocity curve transferred to Velocity curve transferred to

pressure gradient curve via pressure gradient curve via modified Bernoulli equation modified Bernoulli equation od ed e ou equat ood ed e ou equat o(mean dP / dT)(mean dP / dT)

•• LV > 1200 mmHg / secLV > 1200 mmHg / sec•• RV > 400 mmHg / secRV > 400 mmHg / sec

od ed e ou equat ood ed e ou equat o(mean dP / dT)(mean dP / dT)

•• LV > 1200 mmHg / secLV > 1200 mmHg / sec•• RV > 400 mmHg / secRV > 400 mmHg / sec•• RV > 400 mmHg / secRV > 400 mmHg / sec•• RV > 400 mmHg / secRV > 400 mmHg / sec

Assessment of RV FunctionAssessment of RV FunctionRV dP / dtRV dP / dt

Assessment of RV FunctionAssessment of RV FunctionRV dP / dtRV dP / dtRV dP / dt RV dP / dt RV dP / dt RV dP / dt

•• AdvantagesAdvantages•• AdvantagesAdvantagesAdvantagesAdvantages•• DopplerDoppler--derivedderived•• ReproducibleReproducible

AdvantagesAdvantages•• DopplerDoppler--derivedderived•• ReproducibleReproducibleReproducibleReproducible•• Global functionGlobal function•• Clinical outcomeClinical outcome

ReproducibleReproducible•• Global functionGlobal function•• Clinical outcomeClinical outcome

•• LimitationsLimitations•• Signal qualitySignal quality

•• LimitationsLimitations•• Signal qualitySignal qualitySignal qualitySignal quality•• Signal availabilitySignal availability•• Normal valuesNormal values

Signal qualitySignal quality•• Signal availabilitySignal availability•• Normal valuesNormal values RV dP / dt = 640 mmHg / secRV dP / dt = 640 mmHg / secNormal valuesNormal values•• Load dependentLoad dependent

Normal valuesNormal values•• Load dependentLoad dependent

Evaluation of RV FunctionEvaluation of RV FunctionVisual RV FunctionVisual RV Function

Evaluation of RV FunctionEvaluation of RV FunctionVisual RV FunctionVisual RV FunctionVisual RV FunctionVisual RV FunctionVisual RV FunctionVisual RV Function

8 yo critical PS s/p RVOT reconstruction8 yo critical PS s/p RVOT reconstruction

Assessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume ChangeRV Fractional Area & Volume Change

RV FAC = 42%RV FAC = 42%RV FAC = 42%RV FAC = 42%

Assessment of RV FunctionAssessment of RV FunctionRV Diastolic FunctionRV Diastolic Function

Assessment of RV FunctionAssessment of RV FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic FunctionRV Diastolic Function

F d fl ith t i l t lF d fl ith t i l t lForward flow with atrial systoleForward flow with atrial systole

Assessment of RV Diastolic FunctionAssessment of RV Diastolic FunctionDoppler EchocardiographyDoppler Echocardiography

Assessment of RV Diastolic FunctionAssessment of RV Diastolic FunctionDoppler EchocardiographyDoppler EchocardiographyDoppler Echocardiography Doppler Echocardiography Doppler Echocardiography Doppler Echocardiography

•• Assessment of RV Assessment of RV physiology physiology -- ChallengesChallenges

RV i “ ” tRV i “ ” t

•• Assessment of RV Assessment of RV physiology physiology -- ChallengesChallenges

RV i “ ” tRV i “ ” t•• RV is an “open” system RV is an “open” system in diastolein diastole

•• Restrictive RVRestrictive RV

•• RV is an “open” system RV is an “open” system in diastolein diastole

•• Restrictive RVRestrictive RV •• Restrictive RV Restrictive RV conduitconduit•• Antegrade diastolic Antegrade diastolic

•• Restrictive RV Restrictive RV conduitconduit•• Antegrade diastolic Antegrade diastolic ggforward flow into PA forward flow into PA during atrial systoleduring atrial systole

ggforward flow into PA forward flow into PA during atrial systoleduring atrial systole

Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance IndexMyocardial Performance IndexAssessment of RV FunctionAssessment of RV FunctionMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance Index

•• DopplerDoppler--derived index derived index •• DopplerDoppler--derived index derived index •• Ratio of total time spent in Ratio of total time spent in

isovolumic activity divided isovolumic activity divided by the time spent inby the time spent in

•• Ratio of total time spent in Ratio of total time spent in isovolumic activity divided isovolumic activity divided by the time spent inby the time spent inby the time spent in by the time spent in ventricular ejectionventricular ejection

•• Increasing valuesIncreasing values of the of the MPI indicate orseningMPI indicate orsening

by the time spent in by the time spent in ventricular ejectionventricular ejection

•• Increasing valuesIncreasing values of the of the MPI indicate orseningMPI indicate orseningMPI indicate worsening MPI indicate worsening global ventricular functionglobal ventricular function

•• MPI has high correlationMPI has high correlation

MPI indicate worsening MPI indicate worsening global ventricular functionglobal ventricular function

•• MPI has high correlationMPI has high correlationMPI has high correlation MPI has high correlation with cath invasive with cath invasive measurements measurements (+) dP/dT ((+) dP/dT (--) dP/dT tau) dP/dT tau

MPI has high correlation MPI has high correlation with cath invasive with cath invasive measurements measurements (+) dP/dT ((+) dP/dT (--) dP/dT tau) dP/dT tau

MPI = (ICT + IRT) / ET(+) dP/dT, ((+) dP/dT, (--) dP/dT, tau) dP/dT, tau

•• Correlation with outcomeCorrelation with outcome(+) dP/dT, ((+) dP/dT, (--) dP/dT, tau) dP/dT, tau

•• Correlation with outcomeCorrelation with outcome

Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance Index (n=243)Myocardial Performance Index (n=243)

Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)Myocardial Performance Index (n=243)

•• Clinical Outcome Clinical Outcome •• Clinical Outcome Clinical Outcome •• Clinical Outcome Clinical Outcome •• Clinical Outcome Clinical Outcome •• LV dysfunctionLV dysfunction

•• DCM / HCM / ICMDCM / HCM / ICM•• AMIAMI

•• LV dysfunctionLV dysfunction•• DCM / HCM / ICMDCM / HCM / ICM•• AMIAMI

•• Congenital heart diseaseCongenital heart disease•• Ebstein anomalyEbstein anomaly•• ASD, PSASD, PS

•• Congenital heart diseaseCongenital heart disease•• Ebstein anomalyEbstein anomaly•• ASD, PSASD, PSAMIAMI

•• AmyloidosisAmyloidosis•• Valvar diseasesValvar diseases•• Systemic diseasesSystemic diseases

AMIAMI•• AmyloidosisAmyloidosis•• Valvar diseasesValvar diseases•• Systemic diseasesSystemic diseases

•• DD--TGA, CCTGA, CC--TGATGA•• TOF, VSDTOF, VSD

•• Acquired heart diseaseAcquired heart disease

•• DD--TGA, CCTGA, CC--TGATGA•• TOF, VSDTOF, VSD

•• Acquired heart diseaseAcquired heart disease•• Systemic diseasesSystemic diseases•• OHT rejectionOHT rejection

•• RV dysfunctionRV dysfunction

•• Systemic diseasesSystemic diseases•• OHT rejectionOHT rejection


qq•• AnthracyclinesAnthracyclines

•• Fetal heart diseaseFetal heart disease•• CHF, ductal CHF, ductal

qq•• AnthracyclinesAnthracyclines

•• Fetal heart diseaseFetal heart disease•• CHF, ductal CHF, ductal

•• Pulmonary Pulmonary hypertensionhypertension

•• Pulmonary embolismPulmonary embolism

•• Pulmonary Pulmonary hypertensionhypertension

•• Pulmonary embolismPulmonary embolism

,,constrictionconstriction

•• Functional classFunctional class•• Exercise performanceExercise performance

,,constrictionconstriction

•• Functional classFunctional class•• Exercise performanceExercise performance

•• Systemic diseasesSystemic diseases•• Systemic diseasesSystemic diseasespp

•• Response to medical & Response to medical & surgical therapy surgical therapy

pp•• Response to medical & Response to medical &

surgical therapy surgical therapy

Assessment of RV FunctionAssessment of RV FunctionMyocardial Performance IndexMyocardial Performance IndexAssessment of RV FunctionAssessment of RV FunctionMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance Index

•• Normal LV ValuesNormal LV ValuesFetalFetal 0.36 +/0.36 +/-- 0.060.06

•• Normal LV ValuesNormal LV ValuesFetalFetal 0.36 +/0.36 +/-- 0.060.06PedsPeds 0.35 +/0.35 +/-- 0.030.03AdultAdult 0.39 +/0.39 +/-- 0.050.05PedsPeds 0.35 +/0.35 +/-- 0.030.03AdultAdult 0.39 +/0.39 +/-- 0.050.05

•• Normal RV ValuesNormal RV ValuesFetalFetal 0.35 +/0.35 +/-- 0.050.05

•• Normal RV ValuesNormal RV ValuesFetalFetal 0.35 +/0.35 +/-- 0.050.05PedsPeds 0.32 +/0.32 +/-- 0.030.03AdultAdult 0.28 +/0.28 +/-- 0.040.04PedsPeds 0.32 +/0.32 +/-- 0.030.03AdultAdult 0.28 +/0.28 +/-- 0.040.04

Assessment of RV FunctionAssessment of RV FunctionM di l P f I dM di l P f I dAssessment of RV FunctionAssessment of RV FunctionM di l P f I dM di l P f I dMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance IndexMyocardial Performance Index

AdAdAdAd Li it tiLi it tiLi it tiLi it ti•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• Simple to performSimple to perform

•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• Simple to performSimple to perform

•• LimitationsLimitations•• NonNon--simultaneous simultaneous acquisitionacquisition

•• LimitationsLimitations•• NonNon--simultaneous simultaneous acquisitionacquisition•• Simple to performSimple to perform

•• ReproducibleReproducible•• NonNon--geometricgeometric

•• Simple to performSimple to perform•• ReproducibleReproducible•• NonNon--geometricgeometric

acquisitionacquisition•• RhythmRhythm•• Load dependentLoad dependent

acquisitionacquisition•• RhythmRhythm•• Load dependentLoad dependentNonNon geometricgeometric

•• Global functionGlobal function•• Clinical outcomeClinical outcome

NonNon geometricgeometric•• Global functionGlobal function•• Clinical outcomeClinical outcome

pp•• HR, age, BSA HR, age, BSA dependentdependent

NN ifiifi

pp•• HR, age, BSA HR, age, BSA dependentdependent

NN ifiifi•• NonNon--specificspecific•• Systole vs diastoleSystole vs diastole

•• PseudoPseudo--normalizationnormalization

•• NonNon--specificspecific•• Systole vs diastoleSystole vs diastole

•• PseudoPseudo--normalizationnormalization•• PseudoPseudo--normalizationnormalization•• PseudoPseudo--normalizationnormalization

Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionEvaluation of Ventricular FunctionEvaluation of Ventricular FunctionNew ModalitiesNew ModalitiesNew ModalitiesNew Modalities

Tissue DopplerTissue Doppler Strain & strain rateimaging

Strain & strain rateimaging

Tissue Doppler Tissue Doppler Tissue Doppler Tissue Doppler ppppImagingImaging

ppppImagingImaging

20 20

SystoleSystole

IVCIVC Peak systolePeak systolecm/scm/s

IVRTIVRT20 cm/s20 cm/s

IVRTIVRT

EE AA

DiastoleDiastole

Pulsed Wave Tissue DopplerPulsed Wave Tissue DopplerPulsed Wave Tissue DopplerPulsed Wave Tissue DopplerppppLongitudinal VelocitiesLongitudinal Velocities

ppppLongitudinal VelocitiesLongitudinal Velocities

Lateral mitralLateral mitralLateral mitralannulus

Lateral mitralannulus

Septal annulusSeptal annulusTricuspid annulusTricuspid annulusTricuspid annulusTricuspid annulus

Assessment of RV FunctionAssessment of RV FunctionTissue Doppler (n = 9 491)Tissue Doppler (n = 9 491)

Assessment of RV FunctionAssessment of RV FunctionTissue Doppler (n = 9 491)Tissue Doppler (n = 9 491)Tissue Doppler (n = 9,491)Tissue Doppler (n = 9,491)Tissue Doppler (n = 9,491)Tissue Doppler (n = 9,491)

•• Clinical OutcomeClinical Outcome•• Clinical OutcomeClinical Outcome •• Clinical OutcomeClinical Outcome•• Clinical OutcomeClinical Outcome•• LV dysfunctionLV dysfunction

•• HCM / DCM / ICM / LVNCHCM / DCM / ICM / LVNC•• HypertensionHypertension

Rh th di dRh th di d

•• LV dysfunctionLV dysfunction•• HCM / DCM / ICM / LVNCHCM / DCM / ICM / LVNC•• HypertensionHypertension

Rh th di dRh th di d

•• Congenital heart diseaseCongenital heart disease•• ASD / VSD / PDAASD / VSD / PDA•• Valvar diseasesValvar diseases

DD TGA CCTGA CC TGATGA

•• Congenital heart diseaseCongenital heart disease•• ASD / VSD / PDAASD / VSD / PDA•• Valvar diseasesValvar diseases

DD TGA CCTGA CC TGATGA•• Rhythm disordersRhythm disorders•• AmyloidosisAmyloidosis•• Valvar diseasesValvar diseases•• Systemic diseasesSystemic diseases

•• Rhythm disordersRhythm disorders•• AmyloidosisAmyloidosis•• Valvar diseasesValvar diseases•• Systemic diseasesSystemic diseases

•• DD--TGA, CCTGA, CC--TGATGA•• UVHUVH•• Post op CHDPost op CHD•• Eisenmenger / ACHDEisenmenger / ACHD

•• DD--TGA, CCTGA, CC--TGATGA•• UVHUVH•• Post op CHDPost op CHD•• Eisenmenger / ACHDEisenmenger / ACHD•• Systemic diseasesSystemic diseases

•• OHT rejectionOHT rejection•• ObesityObesity


•• Systemic diseasesSystemic diseases•• OHT rejectionOHT rejection•• ObesityObesity


•• Eisenmenger / ACHDEisenmenger / ACHD•• Fetal heart DiseaseFetal heart Disease

•• CHFCHF•• Hydrops / ExtracardiacHydrops / Extracardiac

•• Eisenmenger / ACHDEisenmenger / ACHD•• Fetal heart DiseaseFetal heart Disease

•• CHFCHF•• Hydrops / ExtracardiacHydrops / ExtracardiacRV dysfunctionRV dysfunction

•• Pulmonary hypertensionPulmonary hypertension•• ARVDARVD•• Pulmonary fibrosisPulmonary fibrosis

RV dysfunctionRV dysfunction•• Pulmonary hypertensionPulmonary hypertension•• ARVDARVD•• Pulmonary fibrosisPulmonary fibrosis

Hydrops / ExtracardiacHydrops / Extracardiac•• Exercise PerformanceExercise Performance•• PostPost--operative Outcomeoperative Outcome•• Loading ConditionsLoading Conditions

Hydrops / ExtracardiacHydrops / Extracardiac•• Exercise PerformanceExercise Performance•• PostPost--operative Outcomeoperative Outcome•• Loading ConditionsLoading Conditionsyy

•• Sleep apneaSleep apnea•• Systemic diseasesSystemic diseases

yy•• Sleep apneaSleep apnea•• Systemic diseasesSystemic diseases

gg•• PreloadPreload•• AfterloadAfterload

gg•• PreloadPreload•• AfterloadAfterload

Assessment of RV FunctionAssessment of RV FunctionTi D lTi D l

Assessment of RV FunctionAssessment of RV FunctionTi D lTi D lTissue Doppler Tissue Doppler Tissue Doppler Tissue Doppler

AdvantagesAdvantagesAdvantagesAdvantages Li it tiLi it tiLi it tiLi it ti•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• QuantitativeQuantitative

•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• QuantitativeQuantitative

•• LimitationsLimitations•• Angle dependentAngle dependent•• Load dependentLoad dependent

•• LimitationsLimitations•• Angle dependentAngle dependent•• Load dependentLoad dependentQQ

•• SystolicSystolic•• DiastolicDiastolic

M di lM di l

QQ•• SystolicSystolic•• DiastolicDiastolic

M di lM di l

•• Load dependentLoad dependent•• Cardiac tetheringCardiac tethering•• Cardiac translationCardiac translation

•• Load dependentLoad dependent•• Cardiac tetheringCardiac tethering•• Cardiac translationCardiac translation•• MyocardialMyocardial

•• Less load dependentLess load dependent•• Longitudinal & radialLongitudinal & radial

•• MyocardialMyocardial•• Less load dependentLess load dependent•• Longitudinal & radialLongitudinal & radial

Cardiac translationCardiac translationCardiac translationCardiac translation

Longitudinal & radial Longitudinal & radial functionfunction•• Early identification of Early identification of RV dysfunctionRV dysfunction

Longitudinal & radial Longitudinal & radial functionfunction•• Early identification of Early identification of RV dysfunctionRV dysfunction V2RV dysfunctionRV dysfunction•• Clinical outcomeClinical outcomeRV dysfunctionRV dysfunction•• Clinical outcomeClinical outcome

V1

V

Strain Rate ImagingStrain Rate ImagingVelocitiesVelocities Natural Strain RateNatural Strain Rate Natural StrainNatural Strain

vv ..rr

v1v1

v2v2

..

Calculate spatialCalculate spatial IntegrateIntegrateCalculate spatial gradient

Calculate spatial gradient

IntegratetemporallyIntegrate

temporally

Strain (rate) estimation =Strain (rate) estimation =Strain (rate) estimation velocity estimation + post processingStrain (rate) estimation velocity estimation + post processing

Strain Rate ImagingLongitudinal FunctionStrain Rate ImagingLongitudinal FunctionLongitudinal FunctionLongitudinal Function

SYSSYS DIASTDIASTShorteningShortening

Strain rateStrain rateLengtheningLengtheningShorteningShortening

(sec-1)(sec-1)Peak systolic strain ratePeak systolic strain rate

-20 Strain(%)

Strain(%)

Peak systolic strainPeak systolic strainPeak systolic strainPeak systolic strain

Strain Rate ImagingPostoperative Tetralogy of Fallot

Strain Rate ImagingPostoperative Tetralogy of FallotPostoperative Tetralogy of FallotPostoperative Tetralogy of Fallot

• Variable degree of pulmonary

it ti

• Variable degree of pulmonary

it tiregurgitation

• Can lead to RV

regurgitation

• Can lead to RV dilatation and dysfunctiondilatation and dysfunction

• Pulmonary valve replacement ??

• Pulmonary valve replacement ??

Tetralogy of FallotTetralogy of FallotRV Longitudinal FunctionRV Longitudinal Function

Tetralogy of FallotTetralogy of FallotRV Longitudinal FunctionRV Longitudinal FunctionRV Longitudinal FunctionRV Longitudinal FunctionRV Longitudinal FunctionRV Longitudinal Function

12

** ** **Velocity(cm/s)

Velocity(cm/s)

Normals4

** ** **Strain rate

Strain rate

4

(s-1)(s-1)

StrainStrain

TOF

60

** ** **Strain(%)

Strain(%)

*P<0.001*P<0.00120

BaseBase MidMid ApexApexWeidemann F: AJC, 2002Weidemann F: AJC, 2002

Effect of PR on Effect of PR on . Strain & SRStrain & SR.

cc

3.0

4.0

30

40 r=-0.53P<0.001r=-0.53P<0.001 r=-0.35

P<0.01r=-0.35P<0.01

se (%

)se

(%)

base

/sec

base

/sec

2.020

n R

V ba

sn

RV

bas

ate

RV

bat

e R

V b

0 0

1.0

0

10

Stra

inSt

rain

Stra

in ra

Stra

in ra

0.00 20 40 60 80

00 20 40 60 80

PR fraction (%)PR fraction (%)

SS

PR fraction (%)PR fraction (%)

Eyskens B et al: AEPC, 2004Eyskens B et al: AEPC, 2004

( )( ) ( )( )

Assessment of RV FunctionAssessment of RV FunctionSt i & St i R t I iSt i & St i R t I i

Assessment of RV FunctionAssessment of RV FunctionSt i & St i R t I iSt i & St i R t I iStrain & Strain Rate Imaging Strain & Strain Rate Imaging Strain & Strain Rate Imaging Strain & Strain Rate Imaging

Ad tAd tAd tAd t Li it tiLi it tiLi it tiLi it ti•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• QuantitativeQuantitative

•• AdvantagesAdvantages•• DopplerDoppler--derivedderived•• QuantitativeQuantitative

•• LimitationsLimitations•• Angle dependentAngle dependent•• Load dependentLoad dependent

•• LimitationsLimitations•• Angle dependentAngle dependent•• Load dependentLoad dependentQuantitativeQuantitative

•• SystolicSystolic•• DiastolicDiastolic

QuantitativeQuantitative•• SystolicSystolic•• DiastolicDiastolic

•• Load dependentLoad dependent•• AliasingAliasing•• High frame ratesHigh frame rates

•• Load dependentLoad dependent•• AliasingAliasing•• High frame ratesHigh frame rates•• MyocardialMyocardial

•• Less load dependentLess load dependent•• Longitudinal & radialLongitudinal & radial

•• MyocardialMyocardial•• Less load dependentLess load dependent•• Longitudinal & radialLongitudinal & radial

High frame ratesHigh frame rates•• Data analysisData analysis

High frame ratesHigh frame rates•• Data analysisData analysis

Longitudinal & radial Longitudinal & radial functionfunction•• Early identification of Early identification of RV dysfunctionRV dysfunction

Longitudinal & radial Longitudinal & radial functionfunction•• Early identification of Early identification of RV dysfunctionRV dysfunctionRV dysfunctionRV dysfunction•• Clinical outcomeClinical outcomeRV dysfunctionRV dysfunction•• Clinical outcomeClinical outcome

Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionS kl T kiS kl T ki

Evaluation of Ventricular FunctionEvaluation of Ventricular FunctionS kl T kiS kl T kiSpeckle TrackingSpeckle TrackingSpeckle TrackingSpeckle Tracking

Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionPP V l R l ti hiV l R l ti hi

Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionPP V l R l ti hiV l R l ti hiPressure Pressure -- Volume RelationshipVolume RelationshipPressure Pressure -- Volume RelationshipVolume Relationship

RV PRV P V l LV l L


RV Pressure RV Pressure -- Volume LoopVolume Loop LV Pressure LV Pressure -- Volume LoopVolume Loop

Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionyyStrain & Strain RateStrain & Strain Rate

yyStrain & Strain RateStrain & Strain Rate

•• Systemic RV Systemic RV •• Circumferential >Circumferential >

•• Systemic RV Systemic RV •• Circumferential >Circumferential >•• Circumferential > Circumferential > longitudinal RV longitudinal RV strainstrain

•• Circumferential > Circumferential > longitudinal RV longitudinal RV strainstrain

•• Similar to Similar to normal LV strain normal LV strain •• Similar to Similar to normal LV strain normal LV strain patternpatternpatternpattern

Petterson E, JACC 2007Petterson E, JACC 2007

Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D TGATGAEvaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D TGATGAVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGAVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGA

•• Normal LV & RVNormal LV & RV•• Normal LV & RVNormal LV & RV•• Clockwise rotation of Clockwise rotation of basebase

C t l k iC t l k i

•• Clockwise rotation of Clockwise rotation of basebase

C t l k iC t l k i•• Counterclockwise Counterclockwise rotation of apexrotation of apex

Systemic RVSystemic RV

•• Counterclockwise Counterclockwise rotation of apexrotation of apex

Systemic RVSystemic RV•• Systemic RVSystemic RV•• Absence of rotationAbsence of rotation•• Absence of torsionAbsence of torsion

•• Systemic RVSystemic RV•• Absence of rotationAbsence of rotation•• Absence of torsionAbsence of torsionAbsence of torsionAbsence of torsion

•• SubSub--pulmonary LVpulmonary LV•• rotationrotation

Absence of torsionAbsence of torsion

•• SubSub--pulmonary LVpulmonary LV•• rotationrotation

Petterson E, JACC 2007Petterson E, JACC 2007

•• rotationrotation•• torsiontorsion•• rotationrotation•• torsiontorsion

Evaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGAEvaluation of Systemic RV FunctionEvaluation of Systemic RV FunctionVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGAVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGAVentricular Rotation & Torsion in DVentricular Rotation & Torsion in D--TGATGA•• Systemic RV FunctionSystemic RV Function•• Systemic RV FunctionSystemic RV Function

•• Adaptive changes in systemic RVAdaptive changes in systemic RV•• Shift from longitudinal Shift from longitudinal

•• Adaptive changes in systemic RVAdaptive changes in systemic RV•• Shift from longitudinal Shift from longitudinal circumferential shortening (not RV circumferential shortening (not RV “dysfunction”)“dysfunction”)

RVRV LV d f ti ttLV d f ti tt

circumferential shortening (not RV circumferential shortening (not RV “dysfunction”)“dysfunction”)

RVRV LV d f ti ttLV d f ti tt•• sRV sRV LV deformation patternLV deformation pattern•• Myocardial dysfunction in systemic RVMyocardial dysfunction in systemic RV

•• sRV sRV LV deformation patternLV deformation pattern•• Myocardial dysfunction in systemic RVMyocardial dysfunction in systemic RV

•• strain ratestrain rate•• Absence of twist & torsionAbsence of twist & torsion

•• strain ratestrain rate•• Absence of twist & torsionAbsence of twist & torsion

•• compensatory RV compensatory RV -- LV interactionLV interaction•• compensatory RV compensatory RV -- LV interactionLV interactionPetterson E, JACC 2007Petterson E, JACC 2007

Assessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionCardiac MRICardiac MRICardiac MRICardiac MRI

Gold StandardGold Standard

Assessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionAssessment of RV FunctionCardiac MRICardiac MRICardiac MRICardiac MRI

PostPost--operative Tetralogy of Fallotoperative Tetralogy of Fallot

Assessment of RV FunctionAssessment of RV FunctionCardiac MRICardiac MRI

Assessment of RV FunctionAssessment of RV FunctionCardiac MRICardiac MRICardiac MRI Cardiac MRI Cardiac MRI Cardiac MRI

•• AdvantagesAdvantages•• AdvantagesAdvantages •• LimitationsLimitations•• LimitationsLimitationsgg•• NonNon--geometricgeometric•• Quantitative global Quantitative global functionfunction

gg•• NonNon--geometricgeometric•• Quantitative global Quantitative global functionfunction

•• AvailabilityAvailability•• CostCost•• AvailabilityAvailability•• CostCost

functionfunction•• RV EF %RV EF %•• Gold standardGold standard

functionfunction•• RV EF %RV EF %•• Gold standardGold standard

•• Patient issuesPatient issues•• Metallic devicesMetallic devices

Access / portabilityAccess / portability

•• Patient issuesPatient issues•• Metallic devicesMetallic devices

Access / portabilityAccess / portability•• ReproducibleReproducible•• Clinical outcomeClinical outcome•• Emerging capabilitiesEmerging capabilities

•• ReproducibleReproducible•• Clinical outcomeClinical outcome•• Emerging capabilitiesEmerging capabilities

•• Access / portabilityAccess / portability•• Access / portabilityAccess / portability

•• Emerging capabilitiesEmerging capabilities•• Regional functionRegional function•• Shunt calculationShunt calculation

•• Emerging capabilitiesEmerging capabilities•• Regional functionRegional function•• Shunt calculationShunt calculation•• Regurgitant volumeRegurgitant volume•• Regurgitant volumeRegurgitant volume

Assessment of RV FunctionAssessment of RV FunctionSummarySummary

Assessment of RV FunctionAssessment of RV FunctionSummarySummarySummarySummarySummarySummary

AvailableAvailable Ease of Ease of useuse

ReliabilityReliability OutcomeOutcome Regional Regional FunctionFunction

Loading Loading ConditionCondition

OverallOveralluseuse FunctionFunction ConditionCondition

2D FAC2D FAC ++++++ ++ ++ ++++ -- ++ ++3D EF %3D EF % ++ ++++ ++++++ ++ ++ ++++ ++++++DopplerDoppler ++++++ ++++++ ++ ++++++ -- ++ ++++MPIMPI ++++++ ++++++ ++++ ++++++ -- ++ ++++dP/dtdP/dt ++++ ++++++ ++++ ++ ++ ++dP/dtdP/dt ++++ ++++++ ++++ ++ -- ++ ++TDITDI ++++++ ++++++ ++++ ++++++ ++++ ++++ ++++++IVAIVA ++++ ++++ ++++++ ++++ ++++ ++++++ ++++++IVAIVA ++++ ++++ ++++++ ++++ ++++ ++++++ ++++++Strain/SRStrain/SR ++++ ++ ++++++ ++++ ++++++ ++++++ ++++++TorsionTorsion ++++ ++ ++++++ ++++ ++++++ ++++++ ++++++MRIMRI ++ ++++ ++++++ ++++++ ++++++ ++++ ++++++

Assessment of Assessment of RightRight Ventricular FunctionVentricular FunctionSegmental ApproachSegmental Approach

Assessment of Assessment of RightRight Ventricular FunctionVentricular FunctionSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental ApproachSegmental Approach

RV systolic functionRV systolic function RV global functionRV global function• RV FAC and RVEF %• 3-D Echo• RV FAC and RVEF %• 3-D Echo



• RV dP / dtRV diastolic function

• RV dP / dtRV diastolic function

RV longitudinal function• Tissue Doppler

RV longitudinal function• Tissue Doppler



RV regional function• Strain and strain rate

RV regional function• Strain and strain rate


• RVOT Doppler


• RVOT Doppler

• Twist & Torsion• Twist & Torsion

• RVOT Doppler• RVOT Doppler Serial EvaluationSerial Evaluation

echocardiographic evaluation of right ventricular function ... · echocardiographic evaluation of...

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