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. 2001 Jul;86(1):31–38. doi: 10.1136/heart.86.1.31

Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy

L Lindstrom 1, U Wilkenshoff 1, H Larsson 1, B Wranne 1
PMCID: PMC1729817  PMID: 11410558

Abstract

OBJECTIVE—To evaluate new echocardiographic modes in the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).
DESIGN—Prospective observational study.
SETTING—University Hospital.
SUBJECTS—15 patients with ARVC and a control group of 25 healthy subjects.
METHODS—Transthoracic echocardiography included cross sectional measurements of the right ventricular outflow tract, right ventricular inflow tract, and right ventricular body. Wall motion was analysed subjectively. M mode and pulsed tissue Doppler techniques were used for quantitative measurement of tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow was also performed.
RESULTS—Assessed by M mode, the total amplitude of the tricuspid annular motion was significantly decreased in the lateral, septal, and posterior positions in the patients compared with the controls. The tissue Doppler velocity pattern showed decreased early diastolic peak annular (EA) velocity and an accompanying decrease in early (EA) to late diastolic (AA) velocity ratio in all positions; the systolic annular velocity was significantly decreased only in the lateral position. Four patients had normal right ventricular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flow E:A ratio.
CONCLUSIONS—Tricuspid annular measurements are valuable, easy to obtain, and allow quantitative assessment of right ventricular function. ARVC patients showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude ARVC, and subjective detection of early changes in wall motion may be difficult.


Keywords: annular motion; diastolic dysfunction; right ventricular function; tissue Doppler

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Figure 1  .

Figure 1  

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(A) Pulsed tissue Doppler recording of lateral tricuspid annulus motion. Guided by the cross sectional apical image, the sample volume was placed in the bright area of the tricuspid annulus, trying to align the cursor as parallel to the motion as possible. (B) Pulsed tissue Doppler recordings from a normal subject aged 26 years and a patient aged 27 years. (C) Pulsed tissue Doppler recordings from a normal subject aged 47 years and a patient aged 49 years. Note the decreased early diastolic annular velocity with increasing age in normal subjects and in patients with arrhythmogenic right ventricular cardiomyopathy compared with age matched normal controls. The systolic peak annular velocity is also slightly decreased in the patients. AA, late diastolic peak annular velocity; EA, early diastolic peak annular velocity; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; SA, systolic peak annular velocity.

Figure 2  .

Figure 2  

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Definition of wall segments and cavity dimensions of the right ventricle. (A) Parasternal long axis view of the left heart: right ventricular outflow tract, measured from the anterior right ventricular free wall to the right side of the interventricular septum. (B) Parasternal short axis view at the aortic root level. (C) Parasternal short axis view at the mitral valve level. (D) Parasternal long axis view of the right ventricular inflow tract. (E) Parasternal short axis view at the papillary muscle level. (F) Apical four chamber view: measurements of right ventricular inflow tract were taken within one third of the distance below the tricuspid annulus towards the right ventricular apex, and of the right ventricular body from the maximum short axis dimension in the middle third of the right ventricle. Segments R1, R2, and R3 correspond to the anterior wall of the outflow tract, R4, R6, and R7 to the anterior free wall, R5, R8, and R9 to the inferior wall, and R10, R11, and R12 to the lateral free wall of the right ventricle.13 LA, left atrium; LV, left ventricle; R, right ventricular segment; RA, right atrium; RV, right ventricle; RVB, right ventricular body; RVIT, right ventricular inflow tract; RVOT, right ventricular outflow tract.

Selected References

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