Subclinical Right Ventricular Dysfunction by Strain Analysis

Abstract

The peculiar shape of the right ventricle (RV), its position within the chest, and the thinness of its free wall have always represented a formidable challenge for the assessment of RV size and function by conventional 2-dimensional echocardiography. Over time, a large number of 2D echocardiography and Doppler parameters have been proposed to describe RV geometry and function.1,2 However, most of them are limited by geometric assumptions about RV shape, load dependency, or suboptimal reproducibility, resulting in a limited contribution of conventional echocardiography to the understanding of the role played by the RV in many clinical conditions. See Article by Mukherjee et al In the last decade, the advent of 2D speckle-tracking echocardiography (2DSTE) has fueled the application of strain imaging to measure the RV myocardial deformation, particularly for an early detection of subclinical myocardial dysfunction, when global ventricular function indices are still normal. The possibility to derive strain parameters from conventional gray-scale images with excellent reproducibility and the relative ease of use of the technique have encouraged researchers to apply 2DSTE for elucidating the extent of RV involvement in a wide variety of cardiac and noncardiac conditions. A PubMed search found >800 articles published on RV strain imaging by echocardiography since 2008. In this issue of Circulation: Cardiovascular Imaging , Mukherjee et al3 from the Johns Hopkins University School of Medicine report on the ability of 2DSTE longitudinal strain to detect occult abnormalities in regional and global myocardial function of RV free wall in patients with systemic sclerosis (SSc). Conventional 2DE parameters of RV function (eg, tricuspid annular plane systolic excursion and fractional area change) were similar in patients with SSc versus age- and sex-matched controls, whereas RV free wall …