title: Right ventricular mechanics using a novel comprehensive three-view echocardiographic strain analysis in a normal population.
abstract: BACKGROUND
  Although quantitative right ventricular (RV) strain analysis may be useful in congenital and acquired heart disease populations with RV failure, a comprehensive, standardized approach is lacking. An 18-segment RV strain analysis obtained from three standardized RV apical echocardiographic images was used to determine the feasibility, normal values, and reproducibility of the method in normal adults.
  
  
  METHODS
  Forty healthy, prospectively enrolled volunteers with no cardiac histories and normal QRS durations underwent echocardiography optimized for strain analysis including three RV apical views. Two-dimensional speckle-tracking longitudinal strain analysis was performed using EchoPAC software. Eleven retrospectively identified subjects with RV disease were included as a pilot population. All had been imaged using the same protocol including the three RV apical views.
  
  
  RESULTS
  All control subjects had normal anatomic morphology and function by echocardiography. Feasibility of the RV strain analysis was good (adequate tracking in 696 of 720 segments [97%]). RV global peak systolic strain was -23 ± 2%. Peak strain was highest in the RV free wall and lowest in the septum. Dyssynchrony indices demonstrated no dyssynchrony using left ventricular criteria. Reproducibility of most strain measures was acceptable. This methodology identified important disease not seen in the four-chamber apical view alone in the pilot population of 11 patients with RV disease. Strain patterns and values were different from those in the control population, indicating that differences do exist from normal.
  
  
  CONCLUSIONS
  Eighteen-segment RV strain analysis is feasible, with strain measures falling into discrete ranges in this normal population. Those with RV disease illustrate the potential utility of this approach. These data indicate that this model can be used for more detailed studies evaluating abnormal RV populations, in which its full potential can be assessed.
authors: Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina. Electronic address: daniel.forsha@duke.edu.
authors: Daniel
authors: D
authors: Forsha
authors: Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark.
authors: Niels
authors: N
authors: Risum
authors: Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina.
authors: P Andrea
authors: PA
authors: Kropf
authors: Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina.
authors: Sudarshan
authors: S
authors: Rajagopal
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: P Brian
authors: PB
authors: Smith
authors: Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina.
authors: Ronald J
authors: RJ
authors: Kanter
authors: Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina.
authors: Zainab
authors: Z
authors: Samad
authors: Department of Cardiology, Aalborg University, Aalborg, Denmark.
authors: Peter
authors: P
authors: Sogaard
authors: Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina.
authors: Piers
authors: P
authors: Barker
authors: Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina.
authors: Joseph
authors: J
authors: Kisslo
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult
keywords: Echocardiography; Function; Right; Strain; Ventricle