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 https://t.co/CcJ0nBrDTP

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

Wall motion

RV:LV ratio https://t.co/d3eskf2N5n

Spectral Doppler through the right ventricular outflow tract

Fractional area change https://t.co/EerYxVytB0

myocardial performance index (Tei index) https://t.co/IEGrCMdkdk

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 https://t.co/1llzJSBszL which are reviewed and simplified by Cardioserv here https://t.co/Mz49Il1Oq0

ARDS has its own set of challenges and RV function needs to be assessed in conjunction with LV function https://t.co/JUkxw8HNN4

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 https://t.co/hNRuU6NDTg with reference values here https://t.co/GKq9dyeBYx

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…