Applicability of Automated Functional Imaging for Assessing Right Ventricular Function

Background: Understanding of right ventricular (RV) function has significantly improved in recent years; however, objective assessment remains problematic. This study sought to demonstrate that a novel speckle tracking method can be used to assess RV global systolic function when compared with traditional echocardiographic measures. Methods: A total of 125 patients (mean age 50 ± 16 years) with a wide range not only of systolic function for both ventricles but also pulmonary pressures and acoustic windows based on patient's body surface areas were studied. Standard parameters of left and RV systolic function were collected and echocardiographic images from four-chamber apical planes were analyzed by conventional manual tracing using a novel General Electric (GE) automated functional imaging (AFI) to measure myocardial strain. Results: Global longitudinal RV strain measurements obtained with manual tracing showed good correlation with traditional parameters of main RV chamber as well as right ventricular outflow tract (RVOT) systolic performance. In a stepwise multiple regression analysis, tricuspid annular systolic motion was the best independent variable that correlated with global AFI RV peak systolic strain followed by RV outflow tract systolic excursion. Receiver operating characteristic analysis showed a global RV AFI peak systolic strain value <−17% to be abnormal (sensitivity 73%, specificity 91%). Discussion: This new automated AFI method provides simultaneous quantitation of global and regional RV function that is angle independent and correlates with standard measures of RV performance without the need for additional derivative measurements, complex calculations, or tedious offline analysis.