Table 4.
Current State of Knowledge, Knowledge Gaps, and Potential Future Roles of Commonly Used Right Ventricular Imaging Parameters
| Imaging Parameter | Current State | Disadvantages and Knowledge Gaps | Future Role |
|---|---|---|---|
| TAPSE | • Easy and quick assessment | • Less suitable for serial assessment (284, 285) | • 2D measures will still be used for assessment of RV function |
| • Cheap and widely available | • 2D measures are less suitable for serial assessment owing to the complex geometry of the RV | ||
| • High reproducibility (280, 281) | |||
| • Prognostic value at baseline (23, 141, 282, 283) | |||
| RVFAC | • Easy and quick assessment | • Less reproducible than TAPSE (280, 281, 285) | • See TAPSE |
| • Good relation with RVEF (280, 285, 286) | • Less suitable for serial assessment (285) | ||
| • Prognostic value at baseline in PAH (141, 282, 283) | |||
| Eccentricity index | • Easy and quick assessment | • Lack of information on serial assessment | • See TAPSE |
| • Prognostic value at baseline in PAH (282, 283) | |||
| Strain/strain rate | • Prognostic value in PAH (141, 283, 287) | • Strain assessment possible with echo (2D speckle tracking) and CMR (tagging) | • Shows potential to assess RV dysfunction in a very early stage |
| • Early detection of RV dysfunction; detects differences in RV function when other traditional measurements, including TAPSE, fail to do so (288) | • Tagging analyses time-consuming | ||
| Myocardial performance index (Tei index) | • No need to make geometric assumptions | • Doppler echocardiography only | • See TAPSE |
| • Prognostic value in PAH (141, 282) | |||
| RVEF | • Gold standard parameter for assessment of RV systolic function | • Assessment is time-consuming | • Likely to be useful in assessment of prognosis and treatment response |
| • RVEF is reproducible (289) | • Presence of tricuspid regurgitation can overestimate RVEF | • Automated assessment of RV volumes with CMR needed | |
| • Prognostic value at baseline and during follow-up (3, 21) | • Minimal clinical important difference unknown | • 3D echocardiography may enable accurate assessment; however, currently 3D echocardiography RV underestimates volumes and is less reproducible (290–294) | |
| RVSV/RVESV | • Prognostic value at baseline (129, 184) | • Assessment time-consuming | • May be an important parameter, although the measure shows a great similarity to RVEF |
| • Minimal clinical important difference unknown | |||
| • Reproducibility unknown | |||
| • Prognostic value of the change over time unknown | |||
| • Indexing to body size may be necessary but is not consistently done | |||
| RV volumes | • Prognostic value at baseline and at change during follow-up (3, 21, 157, 295) | • Assessment time-consuming | • Will play a role for assessment of prognosis and treatment response |
| • Minimal clinical important difference unknown (only assessed for RVSV [20]) | • Automated assessment of RV volumes with CMR needed | ||
| • Not consistently indexed to body size | • 3D echocardiography may enable accurate assessment; however, currently 3D echocardiography RV underestimates volumes and is less reproducible in comparison to CMR (290–294) | ||
| LGE | • LGE at interventricular insertion points and septum prognostic value at baseline (159). Possibility to assess myocardial pathologies (fibrosis) (296) | • MRI only | • LGE will probably be replaced by T1 mapping for assessment of myocardial pathologies in the future |
| • Need reference region of interest in myocardium, making LGE less suitable for assessing diffuse myocardial pathologies | |||
| Native T1 values | • Native T1 values at interventricular insertion points are related to measures of disease severity (227, 297) | • MRI only | • Shows potential to replace LGE |
| • Prognostic value unknown | • No administration of contrast agents needed for generating T1 maps | ||
| • Longitudinal changes unknown | • More suitable for detection of diffuse myocardial pathology | ||
| • Spatial resolution of T1 maps currently too low to assess total RV free wall (227) | • Future studies will need to assess its prognostic value | ||
| • Resolution and correction for partial volume effects (fat saturation pulse) in T1 mapping needs to be improved |
Definition of abbreviations: 2D = two-dimensional; 3D = three-dimensional; CMR = cardiac magnetic resonance imaging; LGE = late gadolinium enhancement; MRI = magnetic resonance imaging; PAH = pulmonary arterial hypertension; RV = right ventricular; RVEF = right ventricular ejection fraction; RVESV = right ventricular end-systolic volume; RVFAC = right ventricular fractional area change; RVSV = right ventricular stroke volume; TAPSE = tricuspid annular plane systolic excursion.