Importance of Nonlongitudinal Motion Components in Right Ventricular Function: Three-Dimensional Echocardiographic Study in Healthy Volunteers

Bálint Károly Lakatos; Yosuke Nabeshima; Márton Tokodi; Yasufumi Nagata; Zoltán Tősér; Kyoko Otani; Tetsuji Kitano; Alexandra Fábián; Adrienn Ujvári; András Mihály Boros; Béla Merkely; Attila Kovács; Masaaki Takeuchi

doi:10.1016/j.echo.2020.04.002

Importance of Nonlongitudinal Motion Components in Right Ventricular Function: Three-Dimensional Echocardiographic Study in Healthy Volunteers

J Am Soc Echocardiogr. 2020 Aug;33(8):995-1005.e1. doi: 10.1016/j.echo.2020.04.002. Epub 2020 Jun 30.

Affiliations

¹ Semmelweis University, Heart and Vascular Center, Budapest, Hungary.
² Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
³ Argus Cognitive, Inc., Lebanon, New Hampshire.
⁴ Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
⁵ Semmelweis University, Heart and Vascular Center, Budapest, Hungary. Electronic address: attila.kovacs@med.semmelweis-univ.hu.

PMID: 32620323
DOI: 10.1016/j.echo.2020.04.002

Abstract

Background: Global right ventricular (RV) function is determined by the interplay of different motion components related to the myofiber architecture, and the relative importance of these components is still not thoroughly characterized. The aims of this study were to quantify the relative contributions of longitudinal, radial, and anteroposterior motion components to global RV function and to examine their determining factors in a large cohort of healthy volunteers using three-dimensional echocardiography.

Methods: Three hundred healthy adults with a balanced age range and an equal sex distribution were investigated at two centers. A three-dimensional mesh model of the right ventricle was generated, and its motion was decomposed along the three anatomically relevant axes. Multiplicative relative contributions were measured by dividing the ejection fraction (EF) values generated by shortening in the longitudinal, radial, and anteroposterior directions by global RV EF (longitudinal EF index [LEFi], radial EF index [REFi], and anteroposterior EF index, respectively). The circumferential contribution was defined as shortening in the radial and anteroposterior directions, omitting only longitudinal shortening.

Results: Circumferential EF index was markedly higher compared with LEFi (79 ± 7% vs 47 ± 9%, P < .001). LEFi (47 ± 9%) and anteroposterior EF index (49 ± 7%) were found to be similar in the pooled population, whereas REFi (44 ± 10%) was lower (P < .001). In younger individuals (20-39 years of age), the relative contribution of longitudinal shortening was significantly higher compared with the radial component; however, in the older age groups, LEFi and REFi were comparable. Age, body surface area, heart rate, and RV end-diastolic volume were independent predictors of LEFi and REFi, but all with opposite effects on the two motion directions.

Conclusions: In contrast to the traditional viewpoint, the contributions of the radial and anteroposterior motion directions may be of comparable significance with that of longitudinal shortening in determining global RV function. Standard parameters referring only to longitudinal shortening of the right ventricle may be inadequate to characterize RV function thoroughly.

Keywords: 3D echocardiography; Myocardial deformation; Right ventricle.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Echocardiography, Three-Dimensional*
Healthy Volunteers
Heart Ventricles / diagnostic imaging
Humans
Stroke Volume
Ventricular Dysfunction, Right*
Ventricular Function, Right