Quantitative assessment of the entire right ventricle from one acoustic window: An attractive approach in patients with congenital heart disease in daily practice

An M.L Van Berendoncks,Daniel J Bowen,Jackie Mcghie,Judith Cuypers,Robert M Kauling,Jolien Roos-Hesselink,Annemien E Van Den Bosch

doi:10.1016/j.ijcard.2021.01.050

An M.L Van Berendoncks, Daniel J Bowen + Show 5 more

Open Access

https://doi.org/10.1016/j.ijcard.2021.01.050

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Abstract

BackgroundRight ventricular (RV) function is recognized as an important prognostic factor in adult congenital heart disease (ACHD). The accuracy of established parameters including tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC) and tissue Doppler imaging (TDI S′) is limited as only a small RV region is reflected. We previously introduced a novel four-view approach with different RV walls visualized from one apical view using electronic plane rotation, also known as iRotate. AimTo evaluate the entire RV function using electronic plane rotation echocardiography within the spectrum of ACHD compared with healthy subjects. Methods and resultsOne hundred and forty-two ACHD patients were recruited from the outpatient clinic and 89 healthy subjects. All subjects underwent a transthoracic echocardiogram with evaluation of TAPSE, TDI S′ and peak systolic longitudinal RV strain (RV-LS) from all RV walls using the four-view electronic plane rotation model. With exception of TDI S′ in inferior coronal view, all parameters were lower in ACHD vs healthy subjects (p < 0.001). Within the ACHD patients, RV strain was lower in anterior (−15.9 ± 4.9) and inferior coronal view (−15.1 ± 4.5) versus lateral (−17.6 ± 5.0) and inferior wall (−17.2 ± 4.7) (p < 0.05). RV-LS values of systemic RV were lower (p < 0.05), but no difference was observed between subpulmonic RV loading conditions. ConclusionThe four-view electronic plane rotation model represents a reproducible, easily applicable and complete RV assessment in daily practice. RV function is significantly decreased in the ACHD group using both regional and global assessment parameters. Complete RV strain analysis reveals regional differences.

Highlights

Life-long evaluation and protection of the right ventricle (RV) has proven to be a cornerstone in CHD prognosis [1,2,3]
This study demonstrates for the first time a comprehensive multiplane analysis of the right ventricle in a spectrum of adult congenital heart disease (ACHD) patients with normal loading, volume or pressure overload of the Right ventricular (RV)
RV function is significantly decreased in the ACHD group, with a remarkable diminished function of the systemic RV in patients with transposition of the great arteries

Summary

Introduction

Life-long evaluation and protection of the right ventricle (RV) has proven to be a cornerstone in CHD prognosis [1,2,3]. The accuracy of established parameters as tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC) and tissue Doppler imaging (TDI S′) are limited as the parameters reflect only a small region of the RV. We previously introduced a novel fourview approach with different RV walls visualized in their long axis from one apical view using 2D-transthoracic echocardiographic (TTE) electronic plane rotation (iRotate) mode [6]. In healthy subjects, this technique has proven to be applicable and to allow fast and reproducible assessment of regional and global RV function.

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