Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography

  • Lee, Ju-Hee (Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine) ;
  • Park, Jae-Hyeong (Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine)
  • Received : 2018.08.23
  • Accepted : 2018.09.04
  • Published : 2018.09.27
⟨ Previous Next ⟩

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

References

  1. de Groote P, Millaire A, Foucher-Hossein C, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 1998;32:948-54.
  2. Ghio S, Gavazzi A, Campana C, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 2001;37:183-8.
  3. Forfia PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 2006;174:1034-41.
  4. Tadic M. Multimodality evaluation of the right ventricle: an updated review. Clin Cardiol 2015;38:770-6.
  5. Pirat B, McCulloch ML, Zoghbi WA. Evaluation of global and regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method. Am J Cardiol 2006;98:699-704.
  6. Cho GY, Marwick TH, Kim HS, Kim MK, Hong KS, Oh DJ. Global 2-dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol 2009;54:618-24.
  7. Choi SW, Park JH, Sun BJ, et al. Impaired two-dimensional global longitudinal strain of left ventricle predicts adverse long-term clinical outcomes in patients with acute myocardial infarction. Int J Cardiol 2015;196:165-7.
  8. Sarvari SI, Haugaa KH, Anfinsen OG, et al. Right ventricular mechanical dispersion is related to malignant arrhythmias: a study of patients with arrhythmogenic right ventricular cardiomyopathy and subclinical right ventricular dysfunction. Eur Heart J 2011;32:1089-96.
  9. Thomas JD, Popovic ZB. Assessment of left ventricular function by cardiac ultrasound. J Am Coll Cardiol 2006;48:2012-25.
  10. Geyer H, Caracciolo G, Abe H, et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 2010;23:351-69.
  11. Nahum J, Bensaid A, Dussault C, et al. Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients. Circ Cardiovasc Imaging 2010;3:249-56.
  12. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 2016;37:1196-207.
  13. Negishi K, Negishi T, Hare JL, Haluska BA, Plana JC, Marwick TH. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr 2013;26:493-8.
  14. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14.
  15. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: Anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 2008;117:1436-48.
  16. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.
  17. Potter E, Marwick TH. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging 2018;11:260-74.
  18. Jamal F, Bergerot C, Argaud L, Loufouat J, Ovize M. Longitudinal strain quantitates regional right ventricular contractile function. Am J Physiol Heart Circ Physiol 2003;285:H2842-7.
  19. Lu KJ, Chen JX, Profitis K, et al. Right ventricular global longitudinal strain is an independent predictor of right ventricular function: a multimodality study of cardiac magnetic resonance imaging, real time three-dimensional echocardiography and speckle tracking echocardiography. Echocardiography 2015;32:966-74.
  20. Wang J, Prakasa K, Bomma C, et al. Comparison of novel echocardiographic parameters of right ventricular function with ejection fraction by cardiac magnetic resonance. J Am Soc Echocardiogr 2007;20:1058-64.
  21. Vizzardi E, Bonadei I, Sciatti E, et al. Quantitative analysis of right ventricular (RV) function with echocardiography in chronic heart failure with no or mild RV dysfunction: comparison with cardiac magnetic resonance imaging. J Ultrasound Med 2015;34:247-55.
  22. Freed BH, Tsang W, Bhave NM, et al. Right ventricular strain in pulmonary arterial hypertension: a 2D echocardiography and cardiac magnetic resonance study. Echocardiography 2015;32:257-63.
  23. Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart 2006;92 Suppl 1:i2-13.
  24. Park JH, Negishi K, Kwon DH, Popovic ZB, Grimm RA, Marwick TH. Validation of global longitudinal strain and strain rate as reliable markers of right ventricular dysfunction: comparison with cardiac magnetic resonance and outcome. J Cardiovasc Ultrasound 2014;22:113.
  25. Focardi M, Cameli M, Carbone SF, et al. Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance. Eur Heart J Cardiovasc Imaging 2015;16:47-52.
  26. Lemarie J, Huttin O, Girerd N, et al. Usefulness of speckle-tracking imaging for right ventricular assessment after acute myocardial infarction: a magnetic resonance imaging/echocardiographic comparison within the relation between aldosterone and cardiac remodeling after myocardial infarction Study. J Am Soc Echocardiogr 2015;28:818-27.e4.
  27. Park SJ, Park JH, Lee HS, et al. Impaired RV global longitudinal strain is associated with poor long-term clinical outcomes in patients with acute inferior STEMI. JACC Cardiovasc Imaging 2015;8:161-9.
  28. Meris A, Faletra F, Conca C, et al. Timing and magnitude of regional right ventricular function: a speckle tracking-derived strain study of normal subjects and patients with right ventricular dysfunction. J Am Soc Echocardiogr 2010;23:823-31.
  29. Cho GY, Chan J, Leano R, Strudwick M, Marwick TH. Comparison of two-dimensional speckle and tissue velocity based strain and validation with harmonic phase magnetic resonance imaging. Am J Cardiol 2006;97:1661-6.
  30. Fine NM, Shah AA, Han IY, et al. Left and right ventricular strain and strain rate measurement in normal adults using velocity vector imaging: an assessment of reference values and intersystem agreement. Int J Cardiovasc Imaging 2013;29:571-80.
  31. Longobardo L, Suma V, Jain R, et al. Role of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters. J Am Soc Echocardiogr 2017;30:937-46.e6.
  32. Muraru D, Onciul S, Peluso D, et al. Sex- and method-specific reference values for right ventricular strain by 2-dimensional speckle-tracking echocardiography. Circ Cardiovasc Imaging 2016;9:e003866.
  33. Park JH, Choi JO, Park SW, et al. Normal references of right ventricular strain values by two-dimensional strain echocardiography according to the age and gender. Int J Cardiovasc Imaging 2018;34:177-83.
  34. Fine NM, Chen L, Bastiansen PM, et al. Reference values for right ventricular strain in patients without cardiopulmonary disease: a prospective evaluation and meta-analysis. Echocardiography 2015;32:787-96.
  35. Zornoff LA, Skali H, Pfeffer MA, et al. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. J Am Coll Cardiol 2002;39:1450-5.
  36. Rajagopalan N, Simon MA, Shah H, Mathier MA, Lopez-Candales A. Utility of right ventricular tissue Doppler imaging: correlation with right heart catheterization. Echocardiography 2008;25:706-11.
  37. Puwanant S, Park M, Popovic ZB, et al. Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 2010;121:259-66.
  38. Park JH, Park YS, Park SJ, et al. Midventricular peak systolic strain and Tei index of the right ventricle correlated with decreased right ventricular systolic function in patients with acute pulmonary thromboembolism. Int J Cardiol 2008;125:319-24.
  39. Park JH, Park YS, Kim YJ, et al. Differentiation between acute and chronic cor pulmonales with midventricular systolic strain of the right ventricle in the emergency department. Heart Vessels 2011;26:435-9.
  40. Ikeda S, Tsuneto A, Kojima S, et al. Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension. Life Sci 2014;111:12-7.
  41. Park JH, Kusunose K, Kwon DH, et al. Relationship between right ventricular longitudinal strain, invasive hemodynamics, and functional assessment in pulmonary arterial hypertension. Korean Circ J 2015;45:398-407.
  42. Motoji Y, Tanaka H, Fukuda Y, et al. Efficacy of right ventricular free-wall longitudinal speckle-tracking strain for predicting long-term outcome in patients with pulmonary hypertension. Circ J 2013;77:756-63.
  43. Fukuda Y, Tanaka H, Sugiyama D, et al. Utility of right ventricular free wall speckle-tracking strain for evaluation of right ventricular performance in patients with pulmonary hypertension. J Am Soc Echocardiogr 2011;24:1101-8.
  44. Fine NM, Chen L, Bastiansen PM, et al. Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging 2013;6:711-21.
  45. Lee JH, Park JH, Park KI, et al. A comparison of different techniques of two-dimensional speckle-tracking strain measurements of right ventricular systolic function in patients with acute pulmonary embolism. J Cardiovasc Ultrasound 2014;22:65-71.
  46. D'Andrea A, Stanziola A, D'Alto M, et al. Right ventricular strain: An independent predictor of survival in idiopathic pulmonary fibrosis. Int J Cardiol 2016;222:908-10.
  47. Mukherjee M, Chung SE, Ton VK, et al. Unique abnormalities in right ventricular longitudinal strain in systemic sclerosis patients. Circ Cardiovasc Imaging 2016;9:pii: e003792.
  48. Holman WL, Kormos RL, Naftel DC, et al. Predictors of death and transplant in patients with a mechanical circulatory support device: a multi-institutional study. J Heart Lung Transplant 2009;28:44-50.
  49. Argiriou M, Kolokotron SM, Sakellaridis T, et al. Right heart failure post left ventricular assist device implantation. J Thorac Dis 2014;6 Suppl 1:S52-9.
  50. Vivo RP, Cordero-Reyes AM, Qamar U, et al. Increased right-to-left ventricle diameter ratio is a strong predictor of right ventricular failure after left ventricular assist device. J Heart Lung Transplant 2013;32:792-9.
  51. Grant AD, Smedira NG, Starling RC, Marwick TH. Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation. J Am Coll Cardiol 2012;60:521-8.
  52. Goldraich L, Kawajiri H, Foroutan F, et al. Tricuspid valve annular dilation as a predictor of right ventricular failure after implantation of a left ventricular assist device. J Card Surg 2016;31:110-6.
  53. Cameli M, Lisi M, Righini FM, et al. Right ventricular longitudinal strain correlates well with right ventricular stroke work index in patients with advanced heart failure referred for heart transplantation. J Card Fail 2012;18:208-15.
  54. Lisi M, Cameli M, Righini FM, et al. RV longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure. JACC Cardiovasc Imaging 2015;8:514-22.
  55. Morris DA, Krisper M, Nakatani S, et al. Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: a multicentre study. Eur Heart J Cardiovasc Imaging 2017;18:212-23.
  56. Teske AJ, Cox MG, Te Riele AS, et al. Early detection of regional functional abnormalities in asymptomatic ARVD/C gene carriers. J Am Soc Echocardiogr 2012;25:997-1006.
  57. Vitarelli A, Cortes Morichetti M, Capotosto L, et al. Utility of strain echocardiography at rest and after stress testing in arrhythmogenic right ventricular dysplasia. Am J Cardiol 2013;111:1344-50.
  58. Aneq MA, Engvall J, Brudin L, Nylander E. Evaluation of right and left ventricular function using speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy and their first degree relatives. Cardiovasc Ultrasound 2012;10:37.
  59. D'Andrea A, Caso P, Bossone E, et al. Right ventricular myocardial involvement in either physiological or pathological left ventricular hypertrophy: an ultrasound speckle-tracking two-dimensional strain analysis. Eur J Echocardiogr 2010;11:492-500.
  60. D'Andrea A, Limongelli G, Baldini L, et al. Exercise speckle-tracking strain imaging demonstrates impaired right ventricular contractile reserve in hypertrophic cardiomyopathy. Int J Cardiol 2017;227:209-16.
  61. Negishi K, Lucas S, Negishi T, Hamilton J, Marwick TH. What is the primary source of discordance in strain measurement between vendors: imaging or analysis? Ultrasound Med Biol 2013;39:714-20.
  62. Park JH, Kusunose K, Motoki H, et al. Assessment of right ventricular longitudinal strain in patients with ischemic cardiomyopathy: head-to-head comparison between two-dimensional speckle-based strain and velocity vector imaging using volumetric assessment by cardiac magnetic resonance as a “gold standard”. Echocardiography 2015;32:956-65.
  63. Yang H, Marwick TH, Fukuda N, et al. Improvement in strain concordance between two major vendors after the strain standardization initiative. J Am Soc Echocardiogr 2015;28:642-8.e7.
  64. Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 2018;19:591-600.
  65. van der Zwaan HB, Geleijnse ML, Soliman OI, et al. Test-retest variability of volumetric right ventricular measurements using real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2011;24:671-9.
  66. Schwarz K, Singh S, Dawson D, Frenneaux MP. Right ventricular function in left ventricular disease: pathophysiology and implications. Heart Lung Circ 2013;22:507-11.
  67. Belenkie I, Horne SG, Dani R, Smith ER, Tyberg JV. Effects of aortic constriction during experimental acute right ventricular pressure loading. Further insights into diastolic and systolic ventricular interaction. Circulation 1995;92:546-54.

Cited by

  1. Assessment of Right Ventricular Function in Pulmonary Hypertension with Multimodality Imaging vol.26, pp.4, 2018, https://doi.org/10.4250/jcvi.2018.26.e28
  2. Cardiac strain in right ventricular myocardial infarction and pulmonary embolism vol.25, pp.2, 2018, https://doi.org/10.15829/1560-4071-2020-2-3731
  3. Incremental Value of ePLAR—The Echocardiographic Pulmonary to Left Atrial Ratio in the Assessment of Sub-Massive Pulmonary Emboli vol.9, pp.1, 2018, https://doi.org/10.3390/jcm9010247
  4. Echocardiographic Screening Methods for Pulmonary Hypertension: A Practical Review vol.28, pp.1, 2020, https://doi.org/10.4250/jcvi.2019.0104
  5. Transthoracic echocardiographic assessment of the right ventricle before and after caesarean delivery: A preliminary investigation vol.48, pp.2, 2018, https://doi.org/10.1177/0310057x20903056
  6. Speckle tracking for predicting outcomes of balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension vol.37, pp.6, 2020, https://doi.org/10.1111/echo.14709
  7. How to do right ventricular strain vol.21, pp.8, 2018, https://doi.org/10.1093/ehjci/jeaa126
  8. Advanced myocardial characterization in hypertrophic cardiomyopathy: feasibility of CMR-based feature tracking strain analysis in a case-control study vol.30, pp.11, 2020, https://doi.org/10.1007/s00330-020-06922-6
  9. Diastolic strain time as predictor for systolic dysfunction among patients with active breast cancer vol.37, pp.11, 2018, https://doi.org/10.1111/echo.14791
  10. Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function vol.37, pp.11, 2018, https://doi.org/10.1111/echo.14877
  11. Sport disciplines and cardiac remodeling in elite university athletes competing in 2017 Taipei Summer Universiade vol.99, pp.45, 2018, https://doi.org/10.1097/md.0000000000023144
  12. Echocardiographic characteristics of patients with SARS-CoV-2 infection vol.109, pp.12, 2020, https://doi.org/10.1007/s00392-020-01727-5
  13. Associations of 2D speckle tracking echocardiography-based right heart deformation parameters and invasively assessed hemodynamic measurements in patients with pulmonary hypertension vol.18, pp.1, 2018, https://doi.org/10.1186/s12947-020-00197-z
  14. Diagnostic yield of CT pulmonary angiography for pulmonary embolism in clinically suspected patients vol.100, pp.22, 2018, https://doi.org/10.1097/md.0000000000026213
  15. Pericardiocentesis induced right ventricular changes in patients with and without pulmonary hypertension vol.38, pp.5, 2018, https://doi.org/10.1111/echo.15046
  16. Preoperative Right Ventricular Free‐Wall Longitudinal Strain as a Prognosticator in Isolated Surgery for Severe Functional Tricuspid Regurgitation vol.10, pp.9, 2018, https://doi.org/10.1161/jaha.120.019856
  17. How to Determine Right Ventricular Dysfunction in Pulmonary Hypertension vol.29, pp.3, 2018, https://doi.org/10.4250/jcvi.2021.0035
  18. Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study vol.34, pp.8, 2021, https://doi.org/10.1016/j.echo.2021.05.010
  19. Right Ventricular Strain Is Common in Intubated COVID-19 Patients and Does Not Reflect Severity of Respiratory Illness vol.36, pp.8, 2018, https://doi.org/10.1177/08850666211006335
  20. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations vol.10, pp.15, 2021, https://doi.org/10.3390/jcm10153229
  21. Prognostic Value of Complementary Echocardiography and Magnetic Resonance Imaging Quantitative Evaluation for Isolated Tricuspid Regurgitation vol.14, pp.9, 2021, https://doi.org/10.1161/circimaging.120.012211
  22. Predicting Outcomes for Isolated Tricuspid Regurgitation : Multimodality Imaging and Clinical Assessment vol.14, pp.9, 2018, https://doi.org/10.1161/circimaging.121.013349
  23. The Interventricular Septum Is Biomechanically Distinct from the Ventricular Free Walls vol.8, pp.12, 2018, https://doi.org/10.3390/bioengineering8120216