Study limitations:
Our study aims to provide a general picture of RV dysfunction
assessments by different echocardiographic parameters in different
diseases, so a disease-specific analysis was not performed.
Statistically, the ROC analysis showing the accuracy gives a
satisfactory correlation. However, the inherent limitations of
measurement of variables exist. The study did not use three-dimensional
echocardiography, and the right ventricle’s unique geometry makes it
difficult to obtain images using two-dimensional planes. RVEF is a
function of both longitudinal and concentric myocardial fibers, while
tricuspid annular systolic motion principally indicates the longitudinal
fibers’ function only. The angle of interrogation and cardiac motion
influence the velocity measurement, especially from the apical
four-chamber view during long axis assessment limiting the accuracy of
S’. As mentioned above, RVEF measured by MRI can account for some
unknown extent of variability of data. Lack of 3D echocardiographic
assessment of RV function in our dataset remains a limitation in our
study. Prior studies have shown a good correlation 3D TTE with MRI for
the assessment of RV function. Good 3D assessment of RV function
requires excellent image quality, lack of arrhythmia and long breath
holds during image acquisition. It is prone to stich artifacts, needs
cumbersome software processing, has low frame rate and significant
inter-vendor variability, hampering routine use of 3D RV assessment in
contemporary practice.