Right Ventricular Outflow Tract Systolic Excursion and Fractional Shortening for the Assessment of Right Ventricular Function

Dear Sir, The report on “Right ventricular outflow tract (RVOT) systolic excursion (SE) and fractional shortening (FS)” is very interesting.[1] Allam et al. raised an interesting question, “Can these echocardiographic parameters be used for the assessment of right ventricular (RV) function?” Clinically, RV function assessment is useful for initial assessment, diagnosis, and follow-up of the patients with any right heart pathology. The assessment on the parameters RVOT SE and RVOT FS can be useful in many disorders including to cardiac failure, pulmonary hypertension, pulmonary embolism, myocardial infarction, and congenital heart disease.[2] The new parameters are helpful for evaluating RV systolic function that is not well evaluated by routine RV function evaluation.[3] In the present report, Allam et al. concluded that “RVOT FS is a simple valuable parameter that can be used for the assessment of RV function. However, RVOT SE is less accurate than RVOT FS in RV function assessment.”[1] Indeed, any parameters might be usable for assessment, but the main question should be “Which parameter is appropriate?” There are several factors to consider for judging a technique including diagnostic property, cost, turnaround time, and ability to use as well as interpret the result. Regarding diagnostic accuracy, the results in different reports might be different. For example, the accuracy of RVOT SE in a previous report is very good (sensitivity 100%, specificity 100%),[4] whereas an inferior property is reported in another study (sensitivity 98%, specificity 96%).[3] Experience of a practitioner in interpreting the results might be the main factor to be mentioned. Focusing the consideration on diagnostic property, it requires more studies with large sample size to make the final conclusion on the accuracy of the parameters. Finally, the authors would like to leave open questions about the appropriateness of the two methods for the readers to think and share on the question, “Which is more appropriate?” The additional issues to be discussed include cost, time-consuming, accuracy, and easy to interpret for the practitioner.