Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography

Abstract

Right ventricular (RV) systolic dysfunction has been identified as an independent prognostic marker of many cardiovascular diseases. However, there are problems in measuring RV systolic function objectively and identification of RV dysfunction using conventional echocardiography. Strain echocardiography is a new imaging modality to measure myocardial deformation. It can measure intrinsic myocardial function and has been used to measure regional and global left ventricular (LV) function. Although the RV has different morphologic characteristics than the LV, strain analysis of the RV is feasible. After strain echocardiography was introduced to measure RV systolic function, it became more popular and was incorporated into recent echocardiographic guidelines. Recent studies showed that RV global longitudinal strain (RVGLS) can be used as an objective index of RV systolic function with prognostic significance. In this review, we discuss RVGLS measurement, normal reference values, and the clinical importance of RVGLS.

Keywords: Prognosis; Right ventricle; Strain echocardiography; Systolic function.

Figure 1. (A) Measurement of right ventricular (RV) systolic function with conventional echocardiographic method: RV fractional area change is calculated from the division of the subtraction of the RV end-systolic area (RVESA) to the RV end-diastolic area (RVEDA) by RVEDA. (B) Tricuspid annular systolic excursion (TAPSE) is the distance between end-diastolic and peak systolic points of the lateral tricuspid annulus. (C) Tricuspid annular S’ velocity can be measured by tissue Doppler application of the lateral tricuspid annulus. (D) The RV Tei index can be measured conventionally by pulsed Doppler [(tricuspid valve closure to opening time (TCO) − ejection time of pulmonic valve (PVET)) / PVET] or the tissue Doppler method [(isovolumic contraction time (ICT) + isovolumic relaxation time (IVRT)) / ejection time (ET)] from the tricuspid annulus.

Figure 2. Demonstration of right ventricular strain measurement by GE EchoPAC software (A) and velocity vector imaging (B).