Assessment of right ventricular systolic function: comparison between cardiac magnetic resonance derived ejection fraction and pulsed-wave tissue Doppler imaging of the tricuspid annulus.
BACKGROUND
Systolic right ventricular (RV) function is an important predictor in the course of various congenital and acquired heart diseases. Its practical determination by echocardiography remains challenging. We compared routine assessment of lateral tricuspid annular systolic motion velocity (TV(lat), cm/s) using pulsed-wave tissue Doppler imaging from the apical 4-chamber view with cardiac magnetic resonance (CMR) as reference method.


RESULTS
254 individuals (43 ± 18 years) underwent both CMR (contiguous short axis slices; retrogated cine steady state free precession technique; manual contour tracing) and echocardiography within 2 ± 2 months. Seventy-five had coronary artery disease, 87 congenital heart disease, 17 dilated cardiomyopathy, 15 pulmonary artery hypertension, and 47 normal findings. RV ejection fraction (EF) by CMR was 51 ± 12% (range 17-78%). There was a linear correlation between RVEF and TV(lat) (r=0.60; p<0.0001). A TV(lat) cut-off of 12 cm/s identified patients with normal EF (≥50%) with 81% sensitivity and 68% specificity, and a threshold of TV(lat) <9 cm/s identified patients with severely reduced RVEF (<30%) with 82% sensitivity and 86% specificity.


CONCLUSIONS
Systolic long-axis velocity measurements of the lateral tricuspid annulus allow a reliable assessment of RVEF in clinical routine. A threshold of TV(lat)<9 cm/s identifies patients with severely reduced RVEF (<30%) with high sensitivity and specificity.
Cardiology, University Hospital Bern, Switzerland. andreas.wahl@insel.ch
Andreas
A
Wahl
Fabien
F
Praz
Markus
M
Schwerzmann
Harald
H
Bonel
Simon C
SC
Koestner
Roger
R
Hullin
Jean-Paul
JP
Schmid
Thomas
T
Stuber
Etienne
E
Delacrétaz
Otto M
OM
Hess
Bernhard
B
Meier
Christian
C
Seiler
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods / Q000592:standards; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*