Club 35 EACVI web spotlight: comments on right ventricle assessment in the new echocardiography recommendations

Matteo Cameli, Mohammed Khayyal, Francesco Marino, Daniel Augustine, Tony Forshaw, Sergio Mondillo, Ivan Stankovic, Elena Surkova, Tatjana Timeshova, Nuno Vasco, Luigi Badano, Julia Grapsa
2015 European Heart Journal-Cardiovascular Imaging  
In last month, an intriguing discussion has been raised by Dr Khayyal on the EACVI Club 35 LinkedIn platform 'Young Network of Cardiovascular Imaging' about the new ASE/EACVI recommendations for chamber quantification, 1 particularly concerning the evaluation of the right ventricle, the range values for defining it as normal and the severity grading of dilatation. In summary, in the new guidelines the RV basal diameter is normal up to 41 mm, mid-diameter up to 35 mm. Actually there is not a
more » ... inction in severity grades, so we could distinct only normal and abnormal RV. Conversely, in the 2005 guidelines, 2 the basal and middiameter limits were 28 and 33, respectively, and there were identified severity grades for RV dilatation. In response, Dr Badano has promptly explained that the new limits provided (i.e. 41 mm basal diameter, which before was considered a severe grade of dilatation) are the result of a recent meta-analysis of data from 695 healthy subjects collected from 12 different studies. Secondly, explaining that the distinction between different severity grades in the previous guidelines was based on expert consensus and not on published prognostic data. Nevertheless, Dr Khayyal and Dr Stankovic reflected that this lack of evidence-based data should not stop the expert and that it should be a reason to give a helpful expert statement. Therefore, regarding the assessment of RV measures, Dr Badano and Dr Augustine rightly reported that the evaluation of a larger population (over 600 subjects) makes the values more robust, values that are reported in another study 3 and in last recommendations for RV analysis, 4 as Dr Timeshova quotes. Regarding RV status, Drs Forshaw, Augustine, Badano, Vasco, and Professor Surkova agree that it is not absolutely reasonable to make a decision based on a single number; this is even more true considering the particular and complex RV structure; another issue is the role of RV functions that has been until now slightly undervalued. As such, in addition to the concept that 3D echocardiography RV analysis is promising and useful for the assessment of the RV morphology and dimension, as Dr Stankovic advised, we should also evaluate RV function with traditional and innovative techniques. In fact for this aim, we are supported by techniques such as tricuspid annular plane systolic excursion (TAPSE), Doppler tissue imaging (DTI)-derived S ′ wave, RV fractional area change (FAC) and, as Professors Surkova and Mondillo highlighted, we should also introduce the speckle tracking echocardiography technique and the free wall longitudinal strain, considering the recently demonstrated strong correlation with both RV function measured by cardiac magnetic resonance (CMR) and prognosis in patients with advanced heart failure. 5 -9 In conclusion, we may base our evaluation on general RV status, dimension, load, and function, because, reporting Professor Surkova's example, we should pay more attention to a patient with a dilated right ventricle which also has an important tricuspid regurgitation or elevated PAPs than a patient with the same ventricle dilatation but a mildly tricuspid regurgitation or normal PAPs. Conflict of interest : None declared. References 1. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16: 233 -71. 2. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification: a
doi:10.1093/ehjci/jev169 pmid:26202087 fatcat:jehpjjsctja6peijyskv2pji6e