Introduction:
Right Ventricular (RV) function has significant prognostic importance
for a variety of heart diseases and their clinical outcomes. RV function
assessment is frequently conducted for staging and prognostic purposes,
especially in cardiac diseases with a right heart involvement. Of note,
RV dysfunction can affect the left ventricular (LV) Forward stroke
volume by restricting the preload of LV, as well as alter LV systolic
and diastolic function secondary to the interaction with the
interventricular septum and pericardium, and eventually lead to
biventricular failure . This is ascribed to the physiological function
of RV to maintain adequate pulmonary perfusion pressure and a low
systemic venous pressure.
Current clinical management has largely relied on non-invasive
modalities like echocardiography for RV function assessment.
Conventionally, one-dimensional echocardiography parameters such as
tricuspid annular peak systolic excursion (TAPSE), lateral tricuspid
annular systolic velocity (S’) and two-dimensional (2D) parameters such
as RV functional area change (FAC) are being used. However, these
parameters are still subject to limitations due to the complex
anatomical structure and geometric shape of RV. The RV rendering volume
readings by echocardiography are susceptible to errors due to the
distinctive cavity geometry of the RV as opposed to the ellipsoid shape
of LV, and the change in longitudinal contraction pattern in diseased
states.
Cardiac magnetic resonance imaging (CMR) is considered as the gold
standard for RV function assessment. CMR provides accurate results in
quantifying heart function and structure and has become widely used for
different heart diseases. In RV assessment, RV volumes obtained by CMR
indicate a strong correlation with clinical assessment, and there is an
excellent accuracy and consistency of the volume measurements. Despite
the high accuracy and reproducibility, CMR has its constraints including
cost, availability, time-consuming, and skill-consuming as it requires
drawing endocardial contour manually, and also requires defining the
most basal short-axis slice and the endocardial border, which is
complicated by thin free wall and extensive trabeculations .
With the recent advance of speckle-tracking echocardiography, direct
measurement of myocardial deformation by strain becomes a great
alternative tool for RV function assessment . RV strain has been
reported as a technique with high accuracy and reproducibility and is
closely correlated with prognosis. However, only limited studies have
compared all these parameters with CMR. The purpose of this study is to
evaluate the accuracy of echocardiographic parameters in assessing RV
systolic function and specifically to compare standard echo parameters
to RV strain imaging and MRI to identify the best echo parameter(s) to
assess RV systolic function