Accurate and Reproducible Measurements of Right Ventricular Function in Daily Practice

Traditionally right ventricle (RV) has been considered as a conduit or passive-dependent chamber mainly affected by loading conditions. 1) Therefore, except for special situations such as pulmonary hypertension or complex congenital heart disease, main interest has been focused on left ventricle (LV). One of the reasons of eagerness for left sided parameters may come from complexity of RV morphology and different movement of RV during systole and diastole compared to LV. 3) Therefore accurate measurement of RV volume and function in daily practice has lots of barriers to overcome. However, more and more evidences have suggested RV myocardial function itself has independent prognostic value not only in primary RV disease but also in LV diseases such as dilated cardio-myopathy or ischemic cardiomyopathy. Therefore need for reporting RV function is increasing in several disease entities. The causes of RV dysfunction in LV dysfunction can be explained by multiple mechanisms. Firstly, LV failure increase in pulmonary venous and arterial pressure, partly as a protective mechanism against pulmonary edema, then induce RV dys-function; secondly, the same cardiomyopathy process may simultaneously affect the RV; thirdly, RV myocardial ischemia due to concomitant coronary artery disease; fourthly, ventricu-lar interdependence due to septal dysfunction or limited peri-cardial compartment. 3) RV dysfunction ultimately cause sys-temic venous congestion and reduced renal perfusion, thereby it deteriorates neurohormal status. 6) Current gold standard for accurate measurements of RV sys-tolic function is cardiac magnetic resonance imaging (CMR)-derived ejection fraction from stacked short axis cine images scanned with steady-state free precession sequence. 7) The most advantage of CMR is accurate 3-dimensional measurements of RV systolic and diastolic volume without geometric assumption. However, CMR-derived RV volume measurement takes time and needs more learning period than conventional 2-dimensional echocardiographic measurements because of handling of RV inflow plane and outflow plane. Most of all, patients need undergo additional expensive exam. In this point of view easy and reproducible way of measurements are deadly needed with conventional echocardiography. Currently, RV fractional area change, tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular velocity are widely used. 8) However, RV fractional area change has limitations in terms of poor endocardial border delineation and negligence of geometric change. As RV changes from eccentric-crescent shape to oval shape as increase in preload or afterload, this limitation might be augmented in really sick RV. Easy and practical method is measurement of TAPSE or tricuspid annular velocity by tissue Doppler imaging based …