Timing and Magnitude of Regional Right Ventricular Function: A Speckle Tracking-Derived Strain Study of Normal Subjects and Patients with Right Ventricular Dysfunction

doi:10.1016/j.echo.2010.05.009

Journal of the American Society of Echocardiography

Volume 23, Issue 8, August 2010, Pages 823-831

https://doi.org/10.1016/j.echo.2010.05.009 Get rights and content

Background

The aim of this study was to evaluate the timing and magnitude of global and regional right ventricular (RV) function by means of speckle tracking–derived strain in normal subjects and patients with RV dysfunction.

Methods

Peak longitudinal systolic strain (PLSS) and time to PLSS in 6 RV segments (the basal, mid, and apical segments of the RV free wall and septum) were obtained in 100 healthy volunteers and 76 patients with RV dysfunction by tracking speckles inside the myocardium using grayscale images. Global PLSS and time to PLSS were based on the average of the 6 regional values.

Results

There was a significant and close correlation between RV contractility as measured by PLSS and tricuspid annular plane systolic excursion (r = −0.83, P < .001). In normal subjects, PLSS was significantly greater in the free wall than in the septum (−28.7 ± 4.1% vs −19.8 ± 3.4%, P < .001), whereas time to PLSS was similar in the different regions of the right ventricle. In patients with RV dysfunction, global and regional PLSS was significantly less than in normal subjects (−13.7 ± 3.6% vs −24.2 ± 2.9%, P < .001), and a global PLSS cutoff value of −19% was helpful in distinguishing the two groups. Furthermore, time to PLSS in all of the RV septal segments and dispersion in RV contraction timing were significantly longer. Global PLSS in the patients with RV dysfunction was also significantly less in the presence of moderate to severe pulmonary hypertension (−12.7 ± 3.6% vs −14.4 ± 3.4%, P = .038).

Conclusions

Speckle tracking not only makes it possible to quantify global RV function but also illustrates the physiology of RV contraction and the pattern of activation at regional level. Speckle tracking–derived strain could become an important new means of assessing and following up patients with impaired RV function and increased pulmonary pressure.

Section snippets

Study Population

Between January and December 2007, 100 healthy volunteers (defined as having no histories of cardiac disease, alcohol or drug abuse, and pathologic physical examinations or abnormal 12-lead electrocardiographic findings) were prospectively enrolled at Fondazione Cardiocentro Ticino in Lugano, Switzerland. Subjects aged >40 years were eligible only if they had negative results on scintigraphy, or the absence of coronary artery disease (CAD) was documented by angiography or 64-multislice computed

Baseline Characteristics

Table 1 shows the baseline characteristics of the normal subjects and the patients with RV dysfunction. The normal subjects were younger and more likely to be female. As expected, the patients with RV dysfunction had larger left and right ventricles and depressed LV function. Among the patients with reduced TAPSE, RV FAC and RV fractional shortening were equally abnormal, and about 40% had pulmonary hypertension.

RV Global Function

The normal subjects' mean global PLSS of the 6 RV segments (basal, mid, and apical

Discussion

A number of the findings of this study shed new light on RV performance: (1) there was a good correlation between global PLSS and the traditional measurements of global RV systolic function; (2) normal subjects showed significantly greater global and regional PLSS and shorter times to PLSS with less dispersion in contraction timing than patients with RV dysfunction; (3) when TAPSE was used as a reference parameter, a global PLSS cutoff value of −19% identified impaired RV contractility; (4)

Conclusions

Global RV PLSS is a reliable means of measuring global RV function because it correlates well with other more established measurements of global RV systolic function (ie, TAPSE and RV FAC). Furthermore, regional RV PLSS makes it possible to study regional RV function, and the time to PLSS allows the assessment of intraventricular RV dyssynchrony. RV strain derived from B-mode images by means of speckle tracking can therefore be considered a new and useful method of studying RV function and

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Clinical InvestigationRight Ventricular FunctionTiming and Magnitude of Regional Right Ventricular Function: A Speckle Tracking-Derived Strain Study of Normal Subjects and Patients with Right Ventricular Dysfunction

Background

Methods

Results

Conclusions

Section snippets

Study Population

Baseline Characteristics

RV Global Function

Discussion

Conclusions

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

Am J Cardiol

J Am Soc Echocardiogr

Am J Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

Am J Cardiol

J Heart Lung Transplant

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

J Am Coll Cardiol

Survival in patients with primary pulmonary hypertension. Results from a national prospective registry

Ann Intern Med

Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure

J Heart Lung Transplant

Clinical Investigation
Right Ventricular Function
Timing and Magnitude of Regional Right Ventricular Function: A Speckle Tracking-Derived Strain Study of Normal Subjects and Patients with Right Ventricular Dysfunction