Is Echocardiographic Assessment Right Ventricular Function Routinely Performed?

Abstract

Assessment of right chamber function has become increasingly popular and important in recent decades, complementing the evaluation of left chamber functional parameters. The late adoption and integration of right ventricular (RV) function into a complete evaluation of cardiac function could be due in part to the difficulty in visualization of the whole right ventricle, inconsistency in the analysis of RV parameters, and poor understanding of the impact of RV function to prognosis. From M-mode to 2-dimensional (2D) measurements of RV size and function, several parameters, such as fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and RV free wall strain assessed by 2D speckle tracking echocardiography provide important information of the right ventricle. However, there are limitations of using 2D echocardiography to quantify RV volume and ejection fraction (EF), and currently accurate measurements of RV volumes and EF can be relied on cardiac magnetic resonance (CMR) imaging. CMR derived RVEF has been reported to provide incremental prognostic value over left ventricular ejection fraction in patients with idiopathic and ischemic dilated cardiomyopathy. With use of 3-dimensional (3D) echocardiography in conjunction with updated version of RV quantification software, the measurements of RV volumes and EF have become feasible and reproducible. It accuracy has been validated against CMR. With the establishment of reference values in the recent publications, 3D echocardiography determined RV volumes and EF have the potential for our better understanding of RV function and exploration of its significance for outcome research in various clinical scenarios. Thus, it is a prime time to assess RV function with 2D and preferentially 3D echocardiography in routine echocardiography examinations.