Practical Aspects and Challenges in the Echocardiographic Assessment of Right Ventricle and Its Function

The aim of the present review article is to provide an overview of the evaluation of the right ventricle and its function using conventional measurements and newer echocardiographic modalities. Because of the complex geometry of the right ventricle calculation of volumes and ejection fraction using 2D measurements is not useful in clinical practice. Echocardiographic assessment of systolic right ventricular function using 2D guided M-mode measurements of systolic long axis motion of the tricuspid annulus (tricuspid annular plane systolic motion, TAPSE) is a simple and established tool also providing prognostic information in a number of settings. The main limitation of this method is that it only represents the inflow free wall segments but not outflow tract and the septum which also contribute to the overall function of the right ventricle. Additional measurements of the right ventricular outflow tract fractional shortening and fractional area change add great value in the assessment of the right ventricle function. Doppler tissue imaging is a relatively new echocardiographic tool for the assessment of right ventricular function, however, similarly to TAPSE its main caveat is its angle dependency. The most recent imaging technique is based on detecting speckles from the myocardium with 2D echocardiography analysing motion in different directions (longitudinal, radial and circumferential). One of the greatest advantages of speckle tracking compared to Doppler tissue imaging is the lack of angle dependency. Finally, 3D imaging for functional assessment and volume calculations overcomes the limitations of 2D echocardiography and has a similar accuracy as magnetic resonance imaging for the assessment of right ventricular function.