Abstract
SummaryRight ventricular (RV) function has prognostic value in acute, chronic and peri‐operative disease, although the complex RV contractile pattern makes rapid assessment difficult. Several two‐dimensional (2D) regional measures estimate RV function, however the optimal measure is not known. High‐resolution three‐dimensional (3D) cardiac magnetic resonance cine imaging was acquired in 300 healthy volunteers and a computational model of RV motion created. Points where regional function was significantly associated with global function were identified and a 2D, optimised single‐point marker (SPM‐O) of global function developed. This marker was prospectively compared with tricuspid annular plane systolic excursion (TAPSE), septum‐freewall displacement (SFD) and their fractional change (TAPSE‐F, SFD‐F) in a test cohort of 300 patients in the prediction of RV ejection fraction. RV ejection fraction was significantly associated with systolic function in a contiguous 7.3 cm2 patch of the basal RV freewall combining transverse (38%), longitudinal (35%) and circumferential (27%) contraction and coinciding with the four‐chamber view. In the test cohort, all single‐point surrogates correlated with RV ejection fraction (p < 0.010), but correlation (R) was higher for SPM‐O (R = 0.44, p < 0.001) than TAPSE (R = 0.24, p < 0.001) and SFD (R = 0.22, p < 0.001), and non‐significantly higher than TAPSE‐F (R = 0.40, p < 0.001) and SFD‐F (R = 0.43, p < 0.001). SPM‐O explained more of the observed variance in RV ejection fraction (19%) and predicted it more accurately than any other 2D marker (median error 2.8 ml vs 3.6 ml, p < 0.001). We conclude that systolic motion of the basal RV freewall predicts global function more accurately than other 2D estimators. However, no markers summarise 3D contractile patterns, limiting their predictive accuracy.
Highlights
Right ventricular (RV) function has prognostic value in acute [1, 2] and chronic [3,4,5,6] cardiorespiratory disease and in the peri-operative period [7,8,9], rapid and accurate assessment is challenging due to the right ventricle’s complex geometry and motion [10, 11]
Longitudinal shortening may account for the majority of RV function [13] and can be measured by tricuspid annular plane systolic excursion (TAPSE)
Determining the individual contribution made to global function by the excursion of each point of the right ventricle requires a computational model of cardiac motion
Summary
Right ventricular (RV) function has prognostic value in acute [1, 2] and chronic [3,4,5,6] cardiorespiratory disease and in the peri-operative period [7,8,9], rapid and accurate assessment is challenging due to the right ventricle’s complex geometry and motion [10, 11]. Identifying the optimal two-dimensional (2D) index of systolic function is difficult as some regions are easy to identify on imaging, some are influential on ventricular function and some are affected by dysfunction. These three areas do not necessarily coincide [18] and may change because of disease processes [19]. We decided to apply these techniques in order to determine which area of the right ventricle best reflects global function in the general population, and tested its predictive performance against conventional indices such as TAPSE and septum-freewall displacement (SFD)
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