Fig. 2.

Calculation of the right ventricular load adaptation index (LAI_RV). a Measurement of the right ventricular (RV) end-diastolic area (A_ED) and long axis lengths in the apical 4 chamber view. b and c Measurement of the tricuspid regurgitation velocity–time integral (VTI_TR) using the continuous wave Doppler. The LAI_RV value of 17.0 is reduced and indicates that in this patient with pulmonary arterial hypertension (pulmonary arterial systolic and mean pressure: 48 mmHg and 37 mmHg, respectively), the RV dilation is more pronounced than one would expect on the basis of its present afterload. The limited adaptation possibilities to the increased afterload are exceeded, and a reduction of pulmonary vascular resistance is highly needed in order to prevent further aggravation of RV dysfunction