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      Echocardiographic Evaluation of the Right Heart

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          Abstract

          The appropriate use of echocardiography may reduce the need for invasive diagnostic cardiac procedures. The right side of the heart has recently gained interest among cardiologists as it became clear that abnormalities of the right heart morphology and function are associated with increased morbidity and mortality. Echocardiography is easy to perform, relatively cheap, readily available and do not pose the risk of ionizing radiation. Conventional 2D and, more recently, 3D echocardiography provides pertinent anatomic and physiologic information about the right side of the heart. Because of the advantages and simplicity of echocardiography it continues to be an excellent tool for evaluating the structure and function of the right side of the heart. This review outlines the uses of echocardiography in evaluating the right heart structure and function.

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          Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension.

          Ronald J. Raymond, Alan L Hinderliter, Park W. Willis … (2002)
          The aim of this study was to evaluate the relationships between echocardiographic findings and clinical outcomes in patients with severe primary pulmonary hypertension (PPH). Primary pulmonary hypertension is associated with abnormalities of right heart structure and function that contribute to the poor prognosis of the disease. Echocardiographic abnormalities associated with PPH have been described, but the prognostic significance of these findings remains poorly characterized. Echocardiographic studies, invasive hemodynamic measurements and 6-min walk tests were performed and outcomes prospectively followed in 81 patients with severe PPH. Subjects were participants in a 12-week randomized trial examining the effects of prostacyclin plus conventional therapy compared with conventional therapy alone. During the mean follow-up period of 36.9 +/- 15.4 months, 20 patients died and 21 patients underwent transplantation. Pericardial effusion (p = 0.003) and indexed right atrial area (p = 0.005) were predictors of mortality. Pericardial effusion (p = 0.017), indexed right atrial area (p = 0.012) and the degree of septal shift in diastole (p = 0.004) were predictors of a composite end point of death or transplantation. In multivariable analyses incorporating clinical, hemodynamic and echocardiographic variables, pericardial effusion and an enlarged right atrium remained predictors of adverse outcomes. Six-minute walk results, mixed venous oxygen saturation and initial treatment randomization were also independently associated with a poor prognosis. Pericardial effusion, right atrial enlargement and septal displacement are echocardiographic abnormalities that reflect the severity of right heart failure and predict adverse outcomes in patients with severe PPH. These characteristics may help identify patients appropriate for more intensive medical therapy or earlier transplantation.
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            Anatomy, echocardiography, and normal right ventricular dimensions.

            Tung-Yuan Ho, P Nihoyannopoulos (2006)
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              Assessment of right ventricular function using two-dimensional echocardiography.

              Sanjiv Kaul, Chuwa Tei, James Hopkins … (1984)
              With the use of two-dimensional echocardiography (2DE), we analyzed apical and subcostal four-chamber views for evaluation of right ventricular (RV) function in 30 individuals as compared to RV ejection fraction (RVEF) obtained by radionuclide angiography. In addition to previously reported parameters of changes in areas and chords, a new simple measurement of tricuspid annular excursion was correlated with RVEF. A close correlation was noted between tricuspid annular plane systolic excursion (TAPSE) and RVEF (r = 0.92). The RV end-diastolic area (RVEDA) and percentage of systolic change in area in the apical four-chamber view also showed close correlation with RVEF (r = -0.76 and 0.81); however, the entire RV endocardium could only be traced in about half of our patients. The end-diastolic transverse chord length and the percentage of systolic change in chord length in the apical view showed a poor correlation with RVEF. The correlation between RVEF and both areas and chords measured in the subcostal view was poor. It is concluded that the measurement of TAPSE offers a simple echocardiographic parameter which reflects RVEF. This measurement is not dependent on either geometric assumptions or traceable endocardial edges. When the endocardial outlines could be traced, the apical four-chamber view was superior to the subcostal view in assessment of RV function.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Ultrasound
                Journal ID (iso-abbrev): J Cardiovasc Ultrasound
                Journal ID (publisher-id): JCU
                Title: Journal of Cardiovascular Ultrasound
                Publisher: Korean Society of Echocardiography
                ISSN (Print): 1975-4612
                ISSN (Electronic): 2005-9655
                Publication date (Print): September 2016
                Publication date (Electronic): 26 September 2016
                Volume: 24
                Issue: 3
                Pages: 183-190
                Affiliations
                [1 ]Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
                [2 ]Department of Medicine, McGuire VA Medical Center, Richmond, VA, USA.
                Author notes
                Address for Correspondence: Asghar Ali, Department of Medicine, McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA. Tel: +1-804-675-6439, Fax: +1-804-675-5601, mirasgharali@ 123456yahoo.com
                Article
                DOI: 10.4250/jcu.2016.24.3.183
                PMC ID: 5050302
                PubMed ID: 27721944
                SO-VID: 50dab6f5-81c7-4569-89ff-a710f7104105
                Copyright © Copyright © 2016 Korean Society of Echocardiography
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 July 2015
                Date revision received : 03 May 2016
                Date accepted : 26 July 2016
                Categories
                Subject: Review

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: right heart,right ventricle,echocardiography
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: right heart, right ventricle, echocardiography

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