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Echocardiography 5 minutes before starting  


Overview


[Echocardiographic examinations]


[Cardiac function and PA-pressure]
[Systolic LV function]
[Diastolic LV function]
[Longitudinal function]
[RV function]
[PA-pressure]


[Examples of pathological findings]


RV function


[Parameters]   [Algorithm]  [3D volumetry]


The assessment of the right ventricle (RV) is in a continuos state of "work in progress". Parameters, values and algorithm presented here may be interpreted differently in the future.

Due to complex RV morphology, a quantitative assessment of systolic RV function is not possible with established methods, since a required cylindrical form is not available. Therefore, systolic RV function is assessed only qualitatively. A regional or global RV dilatation must be documented, as well as the diameter and respiratory behavior of the inferior vena cava.

It is not known if available parameters to assess diastolic LV function would have the same value when assessing diastolic RV function. However, other have found its place, e.g. parameters for assessment of global function (Tei-index) or longitudinal systolic function (TAPSE, TASV, RV-strain). A review can be found at Advances in Pulmonary Hypertension.




Parameters for quantitative assessment: TAPSE, TASV, Tei-Index, LV-EI

For normal values see Table 4 on Guidelines for the Echocardiographic Assessment of the Right Heart in Adults. Following values can provide fast orientation in the diagnosis of a right ventricular dysfunction.


TAPSE (tricuspid annular plane systolic excursion) < 2 cm

TASV (tricuspid annular systolic velocity) < 15 cm/s

Tei-Index (myocardial performance index) > 0,50

LV-EI (LV eccentricity index) > 1



The assessment of RV function starts with the measurement of RV dimentions and the qualitative evaluation of its function.

Left: the right ventricle appears normal in size and systolic function. Notice the smaller RV surface compared to the LV (aprox. 1:2 to 1:3).

Right: massive dilated RV with severely reduced systolic function.

Left: TAPSE can be assessed with M-mode, measuring the distance of tricuspid annular movement between end-diastole to end- systole.

Right: the velocity of this move- ment can be measured with TDI.

Left: color encoded tissue Doppler imaging (TDI).

Right: Tei-index, also known as "myocardial performance index" (MPI) can be assessed with PW- Doppler in RVOT and RV inflow, and also with TDI, with the formula (a-b)/b.

Left: ventricular interdependence can be clearly recognize here. The LV is impaired in its function through a significant septal inden- tation.

Right: eccentricity index (Lei), systolic and diastolic, is an im- portant parameter that can be determined with the formula: Lei = D1/D2. Normal value = 1.





Assessment of RV function with 3D-echo

RV function can accurately be assessed with three-dimensional echocardiography. Requirements are: a matrix-array ultrasound probe and a current software for offline analysis of 3D data.

Here some examples of examinations with 2D and 3D echocardiography.

Abbreviations: EDV, end-diastolic volumen; ESV, end-systolic volumen; EF, ejection fraction.


Left: dilated RV with 3D volu- metry, here seen from the front. Red represents the apex, green the inflow and yellow the outflow track.

Right: the same RV, here seen from behind. Grey surfaces repre- sent tricuspid and pulmonary valves.

Left: here the 2D examination of the same case, from the apical four-chamber view. Qualitative assessment show a severe impairment of RV function.

Right: here the quantitative results of 3D volumetry.

Left: the RV only mildly dilated and its function is slightly im- paired, here seen from the front.

Right: same case seen from behind.

Left: 2D examination of the same case, from the apica four-chamber view. Qualitative assessment show a mildly impaired RV function.

Right: quantitative results of 3D volumetry confirm the qualitative estimation of RV function.



[overview]