Right ventricular echocardiographic parameters in patients with early cardiac graft dysfunction.

It was with great interest that we read the recent article by Siniawski et al. [1] entitled ”Clinical, haemodynamic and echocardiographic features of early cardiac graft dysfunction” published in the October issue of ”Kardiologia Polska”. They aimed to establish haemodynamic and echocardiographic criteria of early graft failure to define patients who should be considered for assist device support or re-transplantation. This study is successful in planning and presenting the results. We believe that these findings will enlighten further studies about echocardiographic haemodynamic findings of early graft failure. Thanks to the authors for their contribution. They defined the latent right ventricular (RV) dysfunction (RV-D) group if the patients had RV dilation and/or dysfunction (RV > 35 mm in parasternal view, EF < 50%) and had normal or hyperkinetic systolic function of the left ventricle (EF > 65%), small left ventricle chamber (< 39 mm) and systolic velocity of the posterior wall exceeding 12 cm/s recorded from the parasternal view. RV function was evaluated by using RV linear dimension and volumetric assessment. Echocardiographic assessment of the RV has been largely qualitative, because of the difficulty of estimating RV volume and function with two-dimensional echocardiography because of its unusual shape [2]. RV function can be assessed echocardiographically by using several parameters including RV index of myocardial performance (RV MPI), tricuspid annular plane systolic excursion (TAPSE), myocardial acceleration during isovolumic contraction (RV IVA), RV fractional area change (RV FAC), three-dimensional ejection fraction (3D RVEF), tissue Doppler-derived tricuspid lateral annular systolic velocity (Tri S), and longitudinal strain and strain rate [3]. We think that it might be helpful if the RV functions were assessed using these quantitative parameters in further studies.