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Simplified parameter to attest systolic right ventricular function obtained by tissue Doppler imaging of the tricuspid annulus
Critical Care volume 10, Article number: P345 (2006)
The assessment of right ventricular (RV) function is difficult because of its complex geometry, its dependence on the load conditions and the absence of normal physiological values. Longitudinal shortening, the main component of its 'systolic function', can be studied by Doppler tissue imaging (DTI) of the tricuspid valve annular at the RV free wall, which analyses the longitudinal component of the RV 'function'.
To estimate the ability of the tricuspid valve annular DTI to diagnose a RV dysfunction.
Patients and methods
Forty intensive care patients without any cardiopulmonary pathology underwent an echographic exploration with DTI and form the reference group. This group allows one to test the feasibility of the technique and to confirm the normal values suggested by the literature. Forty-five other patients with a RV dysfunction attested by a dilation of the right ventricle, a RV/LV ratio >0.6, a dilation of the VCI without respiratory variation and the presence of pulmonary hypertension more than 45 mmHg underwent the same echo-Doppler study. Parameters obtained from DTI are: the systolic peak velocity (Stric) and the velocity time integral (VTITric) of the annular tricuspid free wall side.
The feasibility of the method is excellent, since all the patients could be analyzed. The reference group presents values that are in conformity with the data of the literature: Stric = 15.8 ± 5.45 cm/s and VTItric = 2.76 ± 0.48 cm, which correlated well together (r = 0.81, P < 0.001). The values of the RV dysfunction group are different: Stric = 8.87 ± 2.22 cm/s and VTItric = 1.33 ± 0.39 cm but correlated well together (r = 0.82, P < 0.001). Threshold values of Stric < 12 cm/s and VTIStric < 2 cm diagnose a RV dysfunction with, respectively, a sensitivity of 92% and 97% and a specificity of 95% and 96%.
On the other hand there is no correlation between these two parameters and the RV shortening fraction measured by echography or the pulmonary artery pressure attested by conventional Doppler. This underlines the difficulties to analyse the RV function with the conventional tools.
Recording the tricuspid annular velocity by pulsed-wave DTI at the free wall is easy and very simple. These parameters would allow one to diagnose early systolic RV dysfunction, a frequently underestimated pathology among patients with aggressive ventilation.
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Feissel, M., Robles, G., Badie, J. et al. Simplified parameter to attest systolic right ventricular function obtained by tissue Doppler imaging of the tricuspid annulus. Crit Care 10, P345 (2006). https://doi.org/10.1186/cc4692
- Right Ventricular
- Tricuspid Valve
- Doppler Tissue Imaging
- Free Wall
- Systolic Peak Velocity