scholarly journals Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: A meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256547
Author(s):  
Tom Kai Ming Wang ◽  
Richard A. Grimm ◽  
L. Leonardo Rodriguez ◽  
Patrick Collier ◽  
Brian P. Griffin ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Healthy Subjects ◽  
Reference Range ◽  
Meta Analysis ◽  
Systolic Strain ◽  
Area Change ◽  
Strain Measurements ◽  
Fractional Area Change ◽  
Factors Associated ◽  
Fractional Area

Background Right ventricular (RV) systolic strain has recently demonstrated prognostic value in various cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the mean and LLN of two- (2D) and three-dimensional (3D) right ventricular global (RVGLS), free wall (RVFWLS) and interventricular septal wall (IVSLS) longitudinal strains in healthy individuals and factors that affect strain measurements. Methods In this meta-analysis, Pubmed, Embase and Cochrane databases were searched until 31 July 2020 for eligible studies reporting RVGLS, RVFWLS and/or IVSLS in at least 30 healthy subjects. We pooled the means and LLNs of RV strains by two- (2D) and three- (3D) dimensional echocardiography, and performed meta-regression analyses. Results From 788 articles screened, 45 eligible studies totaling 4439 healthy subjects were eligible for analysis. Pooled means and LLNs with 95% confidence intervals for 2D- RV strains were RVGLS -23.4% (-24.2%, -22.6%) and -16.4% (-17.3%, -15.5%) in 27 studies; RVFWLS -26.9% (-28.0%, -25.9%) and -18.0% (-19.2%, -16.9%) in 32 studies; and IVSLS –20.4% (-22.0%, -18.9%) and -11.5% (-13.6%, -9.6%) in 10 studies, and similar results for 3D- RV strains. Right ventricular fractional area change and vendor software were associated with 2D-RVGLS and RVFWLS means and LLNs. Conclusion We reported the pooled means and LLNs of RV systolic strains in healthy subjects, to define thresholds for abnormal, borderline and normal strains. Important factors associated with RV systolic strains include right ventricular fractional area change and vendor software.

Abstract 12606: Meta-analysis of the Normal Ranges of Right Ventricular Strains by Echocardiography in Healthy Adults

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Richard A Grimm ◽  
Leonardo L Rodriguez ◽  
Patrick H Collier ◽  
Brian P Griffin ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Healthy Subjects ◽  
Meta Analysis ◽  
Area Change ◽  
Strain Measurements ◽  
Fractional Area Change ◽  
Factors Associated ◽  
Fractional Area ◽  
Normal Ranges ◽  
Longitudinal Strains

Background: Right ventricular (RV) systolic strain has been increasingly shown to be prognostic in some cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the means and LLNs of two- (2D) and three-dimensional (3D) right ventricular global (RVGLS), free wall (RVFWLS) and septal wall (RVSWLS) longitudinal strains in healthy individuals and factors affecting strain measurements. Methods: Pubmed, Embase and Cochrane databases were searched until 31 December 2019 for eligible studies reporting RVGLS, RVFWLS and/or RVSWLS in at least 30 healthy subjects. We pooled the means and LLNs of RV strains by two- (2D) and three- (3D) dimensional echocardiography, and performed meta-regression analyses. Results: From 591 articles screened, 37 eligible studies totaling 2970 subjects were analyzed. Pooled means and LLNs (95% confidence intervals) for 2D- strains were RVGLS -23.3% (-24.3%, -22.3%) and -16.2% (-17.2%, -15.1%) in 22 studies; RVFWLS -27.2% (-28.5%, -25.9%) and 18.5% (-20.0%, -17.1%) in 23 studies; RVSWLS -20.4% (-22.0%, -18.9%) and -11.5% (-13.6%, -9.6%) in 10 studies; and similar results for 3D- RV strains (Table). Right ventricular fractional area change and vendor software were associated with 2D-RVGLS and RVFWLS means and LLNs. Conclusion: We reported the pooled means and LLNs of RV systolic strains in healthy subjects, to define thresholds for abnormal, borderline and normal strains. Important factors associated with RV systolic strains include right ventricular fractional area change and vendor software.

Abstract 16722: Comparison of Tricuspid Annular Plane Systolic Excursion to Fractional Area Change for Evaluation of Right Ventricular Systolic Function: Systematic Review and Meta-analysis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Justin Z Lee ◽  
See-Wei Low ◽  
Seongseok Yun ◽  
Parinita Dherange ◽  
Ankit A Desai ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Meta Analysis ◽  
Correlation Coefficients ◽  
Right Ventricular Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Area Change ◽  
Fractional Area Change ◽  
Fractional Area

Introduction: Right ventricular (RV) systolic function is prognostically important, but its assessment by echocardiography remains challenging. Tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) have been evaluated as echocardiographic indices for RV ejection fraction (RVEF), but their correlation with the gold-standard cardiac magnetic resonance imaging (CMRI) remains unclear. The aim of this meta-analysis is to pool and compare data from all studies that evaluated reliability of TAPSE and FAC in comparison to CMRI-derived RVEF. Hypothesis: We assessed the hypothesis that FAC is superior to TAPSE as an echocardiographic index for measurement of RV systolic function. Methods: A systematic literature search of 4493 potentially relevant citations from PubMed, and EMBASE databases yielded 25 eligible studies. The means of TAPSE and FAC, CMRI-derived RVEF, and correlation coefficients were pooled from each study for analysis. Results: A total of 25 studies were included in the final analysis, with a total of 1,858 patients who underwent 2D-echocardiography and cardiac MRI. FAC, compared to TAPSE, exhibited numerically superior correlation to CMRI RVEF (R2 = 0.63, and R2 = 0.15 respectively). Subgroup analysis revealed that FAC’s correlation was also numerically superior in patients with reduced right ventricular ejection fraction of less than 45% (R2 = 0.4 and R2 = 0.17, respectively). In patients with pulmonary hypertension (PH), TAPSE and FAC had mean correlation coefficients of 0.57±0.1 and 0.60±0.13, and were not statistically different (p=0.85). Conclusions: FAC is superior to TAPSE as an echocardiographic index for measurement of RV systolic function, even in patients with reduced right ventricular ejection fraction, but not in patients with PH. The adaptation to increased afterload of PH likely culminates in distinct and asymmetric patterns of RV dysfunction, which are not well assessed by FAC or TAPSE.

Clinical utility of right ventricular fractional area change in preterm infants

2016 ◽  
Vol 92 ◽  
pp. 19-23 ◽  
Author(s):  
Adam T. James ◽  
John David Corcoran ◽  
Orla Franklin ◽  
Afif Faisal EL-Khuffash
Keyword(s):  
Right Ventricular ◽  
Preterm Infants ◽  
Clinical Utility ◽  
Area Change ◽  
Fractional Area Change ◽  
Fractional Area

Worsened Tricuspid Regurgitation Following Pericardiectomy for Constrictive Pericarditis

2021 ◽  
Author(s):  
Ray S. Tabucanon ◽  
Tom Kai Ming Wang ◽  
Michael Chetrit ◽  
Muhammad M. Furqan ◽  
Nicholas Chan ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Constrictive Pericarditis ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Atrial Volume ◽  
Area Change ◽  
Fractional Area Change ◽  
Fractional Area

Background: Worsening tricuspid regurgitation (TR) severity may occur after pericardiectomy surgery for constrictive pericarditis patients; however, its mechanisms and predictors are not well established. We evaluated the clinical characteristics, associated factors, and outcomes of worsening TR after pericardiectomy. Methods: Consecutive patients undergoing pericardiectomy for constrictive pericarditis without tricuspid valve surgery and with pre- and postoperative echocardiography available during 2000 to 2017 were retrospectively studied. Clinical, imaging, hemodynamic, and mortality characteristics were analyzed by those with and without worsening TR by at least one grade. Results: Among 381 patients (age 61 [17] years, 318 [83.5%] male), 193 (50.7%) had worsening TR post-operatively, and 75 died during the 2.5 (5.4) years follow-up. In univariable analysis, worsening TR was associated with a history of congestive heart failure (47.2% versus 31.9%, P =0.003), increased left atrial volume indexed (23 versus 20 mL/m 2 , P =0.020), reduced right ventricular fractional area change (47% versus 54%, P <0.001), and worsening mitral regurgitation (39.7% versus 16.6%, P <0.001). Worsened TR had a trend toward reduced survival during follow-up (log-rank P =0.080), especially those with worsened TR but no recovery of TR grade on subsequent echocardiography within the first year compared with those without worsened TR (log-rank P =0.02). In multivariable analysis, right ventricular fractional area change, left atrial volume indexed, left ventricular mass indexed, pulmonary artery systolic pressure, and right atrial pressure/pulmonary capillary wedge pressure ratio were most associated with worsened TR, while blood urea nitrogen, hematocrit, lateral and medial e’ tissue Doppler and heart rate were most associated with mortality during follow-up. Conclusions: Worsening TR severity was prevalent after pericardiectomy and had a trend toward reduced survival, especially if TR severity did not recover on subsequent echocardiography. Presence of parameters associated with worsened TR and reduced survival should alert clinicians to carefully manage these patients during follow-up.

Semi-automated speckle-tracking for quantitative right ventricular assessment in children and adolescents

2019 ◽  
Vol 29 (09) ◽  
pp. 1149-1159 ◽  
Author(s):  
Aron K. McCloud ◽  
Joanna Lowisz ◽  
David A. Roberson ◽  
Cheryl A. Lefaiver ◽  
Jamie S. Penk
Keyword(s):  
Right Ventricular ◽  
Intraclass Correlation ◽  
Qualitative Assessment ◽  
Area Change ◽  
Fractional Area Change ◽  
Fractional Area ◽  
Automated Method ◽  
Functional Measures ◽  
Significant Difference ◽  
Automated Software

AbstractBackground:Assessment of right ventricular size and function is an important part of the clinical cardiac evaluation; however, these quantitative measures are challenging by echocardiography. Automated software could be useful in place of manual measurements and qualitative assessment. This study evaluates a semi-automated software by comparing automated to manual measures in normal children.Methods:Neonates to adolescents with normal echocardiograms were prospectively enrolled. Measurements were performed using manual techniques and semi-automated software (EchoInsight®, Epsilon Imaging, Ann Arbor, Michigan, United States of America). Right ventricular measurements included end-diastolic and end-systolic area, fractional area change, chamber dimensions, and tricuspid annular plane systolic excursion. Agreement between manual and semi-automated measures was compared.Results:Echocardiograms for 233 patients were included in the analysis. Intra- and inter-observer reliabilities for semi-automated measures were good with intraclass correlation coefficients all over 0.9 and 0.85, respectively. There was very strong correlation between manual and semi-automated methods for areas and dimensions (r = 0.93–0.99) and low bias (1.4–10.8%). For functional measures, tricuspid annular plane systolic excursion measures correlated well (r = 0.84), but fractional area change did not (r = 0.50). Both demonstrated significant bias (33.5–43.0%). The semi-automated method consistently underestimated fractional area change with a mean of 26.6% versus a manual mean of 36.1%.Conclusions:The semi-automated software is capable of generating quantitative right ventricular measures in children with good reliability. The software demonstrates very good correlation and low bias when compared to manual methods for right ventricular areas and dimensions. There is a significant difference between manual and semi-automated techniques for the functional measures.

Abstract 16964: Triplane Measurement of Fractional Area Change to Assess Single Right Ventricular Function

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammad Y Qureshi ◽  
Chelsea L Reece ◽  
Angela R Miller ◽  
Rebecca K Lindquist ◽  
Patrick W O’Leary
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Short Axis ◽  
Single Plane ◽  
Ventricular Ejection Fraction ◽  
Area Change ◽  
Fractional Area Change ◽  
Fractional Area ◽  
Cavopulmonary Anastomosis ◽  
3D Echo

Background: Echocardiographic (echo) functional assessment of single systemic right ventricle (RV) lacks a reliable parameter and does not provide a substitute of volumetric ejection fraction (EF). RV volumes by 3D-echo are challenging and not widely used. Apical RV fractional area change (FAC) has shown some relation to CMR EF, but the strength of correlation has been suboptimal. Adding additional planes to apical FAC may improve this correlation. Our objective was to assess correlation of triplane FAC (apical, short-axis, and inflow-outflow) with CMR EF and to compare the tri- and single plane methods of measuring FAC to each other. Methods: Subjects with hypoplastic left heart syndrome (after superior or total cavopulmonary anastomosis) were prospectively recruited. CMR was performed and right ventricular ejection fraction was calculated. Transthoracic echo studies were performed close to the time of the CMR scan (median interval: 1 d). FAC was measured in apical 4-chamber view, parasternal short axis view at the mid ventricular level, and para-apical right ventricular inflow-outflow view. Triplane FAC was calculated by the average of the three FAC. Comparison was made between FAC and CMR-derived ejection fraction. Results: A total of 25 subjects underwent testing. Triplane FAC could not be assessed in 5, due to lack of optimal acoustic windows. Mean age was 10 ± 8 y (range 9 m to 24 y). Out of the uniplanar methods, apical FAC had the closest relationship to CMR EF. Triplane FAC showed even better correlation coefficient and R 2 values; although in this small group the difference did not reach significance. Results are summarized in the Table. Conclusion: In patients with single systemic RV, triplane FAC offers improved correlation with CMR EF relative to single plane evaluations. This approach may be useful if 3D echo is unavailable or of suboptimal quality and warrants further study.

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