Reply to the editorial comment from Van der Wall concerning 'The right ventricle: always normal in normal subjects?'.

Abstract

To the Editor, We read the comment referring to the challenges in imaging the right ventricle with great interest [1]. The difficulties in distinguishing wall motion abnormalities in healthy subjects from those in diseased patients are very well summarised. The author cites the article by Doesch et al. [2] presenting 20 healthy subjects with CMR-derived measurement of the tricuspid annular plane systolic excursion (TAPSE) with a reference point outside the ventricle (TAPSEout), which might be used for screening right ventricular motion. We could demonstrate TAPSE in cardiac magnetic resonance (CMR), being a fast and easily obtainable parameter correlating well to volumetric quantification of right ventricular ejection fraction (RVEF), with low interobserver and intraobserver variables. Therefore, we investigated 76 patients (age: 58 ± 17 years) with mean RVEF of 42 ± 14 %, assessed by the standardised slice-summation method. CMR-TAPSE was determined to be 19 ± 6 mm and correlated well in linear regression analysis with volumetric RVEF (r = 0.72, p < 0.001). However, we could also show that CMR-TAPSE is not only a fast tool in healthy subjects, but it also discriminates well between patients with impaired and normal RVEF. Multiplying CMR-TAPSE measurements by 2.5 leads to values close to the RVEF by volumetry. Furthermore, CMR-TAPSE correlates well with TAPSE determined using transthoracic echocardiography [3].