Advanced echo: Right Ventricular function #LIVES2017

Prof Anthony McLean from the Nepeam in Sydney delivered this excellent masterclass using a case from his unit as an example.

Assessing RV function using echocardiography is not easy- the gold standard is MRI

There are a number of tools available to us as echocardiographers to monitor RV function:

Wall motion

RV:LV ratio

Spectral Doppler through the right ventricular outflow tract

Fractional area change

myocardial performance index (Tei index)

Tissue Doppler imaging

Tricuspid annular plane systolic excursion (TAPSE)

And indirectly using the tricuspid regurgitation jet and IVC size/collapsibility.

The American society of Echocardiography has excellent guidelines on full assessment of RV function which are reviewed and simplified by Cardioserv here

ARDS has its own set of challenges and RV function needs to be assessed in conjunction with LV function

Prof McLean’s advice: measurements are all well and good but can be misleading in practice…

His summary:

RV assessment is complex. Both subjective and objective parameters are necessary to quantify its function. Be careful with patients on inotropes as they confound things.

Prof McLean’s daily “go-tos” are TAPSE, TR/PASP. If still unsure, he adds FAC and TDI (S’).

Upcoming methods in future: speckle tracking/strain with reference values here

Prof reckons if you have a machine in your unit that currently measures strain, you should start using it as it will become mainstream in a few years time…