| Summary: | The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease. However, the systematic assessment of right heart function is not uniformly carried out. This is due partly to the enormous attention given to the evaluation of the left heart, a lack of familiarity with ultrasound techniques that can be used in imaging the right heart.
Aim: The parameters recommended for Assessment of RV systolic function & RV diastolic function by Echocardiography.
Methods: The study population consisted of 285 patients (age: 25–65 years; 56% male) with different cardiovascular diseases referred for echocardiographic assessment at Diagnostic Ultrasound Centre, Echocardiography lab, Cairo University Hospitals. All patients were examined by Transthoracic Echocardiography. Using the parasternal views, apical views & subcostal views. Detailed examinations of the RA & RV were performed. Measurements were taken for RA Dimensions, RV Dimensions & IVC. RV Systolic Function and RV Diastolic Function were described using different techniques. RV Systolic Function was described globally and regionally according to the Complex Coronary Artery Supply. Pressures were measured: Right ventricular systolic pressure (RVSP), Pulmonary artery systolic & diastolic pressures, pulmonary resistance, RA pressures.
Results: TAPSE should be used routinely as a simple method of estimating RV function, with a lower reference value for impaired RV systolic function of 16 mm.
Two-dimensional Fractional Area Change is one of the recommended methods of quantitatively estimating RV function, with a lower reference value for normal RV systolic function of 35%.
Interrogation of S’ by pulsed tissue Doppler: simple and reproducible measure to assess RV function. S′ < 10 cm/s should raise the suspicion for abnormal RV function, particularly in a younger adult patients.
Offline analysis by color-coded tissue Doppler currently remains a research tool, with less data and wider confidence intervals for normal values.
MPI used as an Initial and serial measurements as an estimate of RV function. MPI < 0.40 using the pulsed Doppler, <0.55 using the pulsed tissue Doppler. It should not be used as the sole quantitative method for evaluation of RV function and should not be used with irregular heart rates.
Recommendations: In studies in patients with conditions affected by RV function, RV IVA may be used, and when used, it should be measured at the lateral tricuspid annulus.
RV IVA is not recommended as a screening parameter for RV systolic function in the general echocardiography laboratory population. Because of the broad confidence interval around its lower reference limit, no reference value can be recommended.
The estimation of PVR is not for routine use but may be considered in subjects in whom pulmonary systolic pressure may be exaggerated by high stroke volume or misleadingly low (despite increased PVR) by reduced stroke volume.
PVR should not a substitute for the invasive evaluation of PVR when this value is important to guide therapy.
Measurement of RV diastolic function, Transtricuspid E/A ratio, E/E’ ratio, and RA size have been most validated and are the preferred measures.
Conclusions: In all studies we should examine the right heart using multiple acoustic windows, and the report should represent an assessment based on qualitative and quantitative parameters.
The parameters recommended are: (RV) size, right atrial (RA) size, RV systolic function (at least one of the following: fractional area change [FAC], S′, tricuspid annular plane systolic excursion [TAPSE]; with or without RV index of myocardial performance [RIMP]), and systolic pulmonary artery pressure (SPAP) with estimate of RA pressure on the basis of inferior vena cava (IVC) size and collapse.
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