title: Traditional and innovative echocardiographic parameters for the analysis of right ventricular performance in comparison with cardiac magnetic resonance.
abstract: OBJECTIVE
  Right ventricle fractional area change (RVFAC), tissue Doppler and M-mode measurements of tricuspid systolic motion [tricuspid Sm and tricuspid annular plane systolic excursion (TAPSE)], and 3D echocardiography are the current non-invasive methods for the quantification of RV systolic function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of RV performance. Using cardiac magnetic resonance (CMR) as the reference standard, this study aimed at exploring the correlation between the traditional (fractional shortening, s'RV, TAPSE) and innovative (strain) echocardiographic parameters and RV ejection fraction (RVEF) measured by CMR.
  
  
  RESULTS
  CMR and transthoracic echo-Doppler were performed in 63 patients referred for clinical assessment. Twenty-one presented the suspicion of myocarditis, 8 presented idiopathic dilated cardiomyopathy, 10 hypertrophic cardiomyopathy, 10 arrhythmogenic right ventricular dysplasia (ARVD), 5 infiltrative cardiomyopathy, and 9 other reasons. RVEF was measured by magnetic resonance imaging (MRI). RVFAC, tricuspid S', and TAPSE were calculated in all patients. RV longitudinal strain (RVLS) by STE was assessed by averaging RV free-wall segments (free-wall RVLS) and by averaging all segments (global RVLS). The ROC analysis was applied for the assessment of diagnostic accuracy. Good correlations were found for TAPSE, tricuspid S', and global RVLS with RVEF (r = 0.45, r = 0.52, and r = -0.71, respectively; P = 0.01 for all). Close correlations between free-wall RVLS and RVFAC with RVEF were found (r = -0.86 and r = 0.77, respectively; P < 0.0001 for both). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy [area under curve (AUC) 0.92] and good sensitivity and specificity of 96 and 93%, respectively, to predict reduced RVEF <45%, using a cut-off value of less than -17.0%.
  
  
  CONCLUSIONS
  In a heterogeneous group of patients referred to CMR evaluation, conventional (TAPSE, FAC, and tricuspid S') and novice (2D speckle-tracking-derived longitudinal strain) parameters of RV systolic function were compared and correlated with RVEF measured by MRI. All tested parameters were found to be independent predictors of reduced RVEF (<45%), but the strongest correlation was seen for the RV free-wall longitudinal strain.
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico 'Le Scotte', Siena 53100, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Focardi
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico 'Le Scotte', Siena 53100, Italy cameli@cheapnet.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Radiology Unit, University of Siena, Siena, Italy.
authors.forename: Salvatore Francesco
authors.initials: SF
authors.lastname: Carbone
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico 'Le Scotte', Siena 53100, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Massoni
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico 'Le Scotte', Siena 53100, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: De Vito
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico 'Le Scotte', Siena 53100, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lisi
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Policlinico 'Le Scotte', Siena 53100, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: Cardiac magnetic resonance; Echocardiography; Right ventricular function; Speckle-tracking echocardiography