Abstract
Three main mechanisms contribute to global right ventricular (RV) function: longitudinal shortening, radial displacement of the RV free wall (bellows effect), and anteroposterior shortening (as a consequence of left ventricular contraction). Since the importance of these mechanisms may vary in different cardiac conditions, a technology being able to assess their relative influence on the global RV pump function could help to clarify the pathophysiology and the mechanical adaptation of the chamber. Previously, we have introduced our 3D echocardiography (3DE)-based solution—the Right VentrIcular Separate wall motIon quantificatiON (ReVISION) method—for the quantification of the relative contribution of the three aforementioned mechanisms to global RV ejection fraction (EF). Since then, our approach has been applied in several clinical scenarios, and its strengths have been demonstrated in the in-depth characterization of RV mechanical pattern and the prognostication of patients even in the face of maintained RV EF. Recently, various new features have been implemented in our software solution to enable the convenient, standardized, and more comprehensive analysis of RV function. Accordingly, in our current technical paper, we aim to provide a detailed description of the latest version of the ReVISION method with special regards to the volumetric partitioning of the RV and the calculation of longitudinal, circumferential, and area strains using 3DE datasets. We also report the results of the comparison between 3DE- and cardiac magnetic resonance imaging-derived RV parameters, where we found a robust agreement in our advanced 3D metrics between the two modalities. In conclusion, the ReVISION method may provide novel insights into global and also segmental RV function by defining parameters that are potentially more sensitive and predictive compared to conventional echocardiographic measurements in the context of different cardiac diseases.
Highlights
For many years, emphasis in clinical cardiology was placed on left ventricular (LV) performance, overshadowing the study of the right ventricle (RV)
We developed the Right VentrIcular Separate wall motIon quantificatiON (ReVISION) method a few years ago, which is a 3D echocardiography (3DE)-based solution for the quantification of the relative contribution of longitudinal, radial, and anteroposterior shortening to global right ventricular (RV) ejection fraction (EF) [9]
Reproducibility of global end-diastolic volume (EDV), End-systolic volumes (ESV), and decomposed ESVs were high, which is consistent with our previous reports using the earlier versions of the ReVISION software [10, 11, 13]
Summary
Emphasis in clinical cardiology was placed on left ventricular (LV) performance, overshadowing the study of the right ventricle (RV). RV function has been recently proven to be an important prognostic factor in heart failure with reduced or preserved ejection fraction (EF) and pulmonary hypertension [1,2,3,4]. The precise assessment of RV function has emerged as a cornerstone of patient management in specific subgroups, such as in patients with mechanical circulatory support devices or grown-up congenital heart disease [5,6,7]. The detailed evaluation of RV function to detect even subtle but prognostic changes and to support clinical decision-making represents a compelling demand. Since the importance of these mechanisms may vary in different cardiac conditions, a technology being able to assess their relative influence on the global RV pump function could help to clarify the pathophysiology and the mechanical adaptation of the RV [3]
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