Three-Dimensional Echocardiographic Evaluation of Longitudinal and Non-Longitudinal Components of Right Ventricular Contraction Results from the World Alliance of Societies of Echocardiography Study

Eur Heart J Cardiovasc Imaging. 2023 Aug 21:jead213. doi: 10.1093/ehjci/jead213. Online ahead of print.


Aims: Right ventricular (RV) functional assessment is mainly limited to its longitudinal contraction. Dedicated 3-dimensional echocardiography (3DE) software enabled the separate assessment of the non-longitudinal components of RV ejection fraction (EF). The aims of this study were 1) to establish normal values for RV 3D-derived longitudinal, radial, and anteroposterior EF (LEF, REF, AEF respectively) and their relative contributions to global RV EF, 2) to calculate 3D RV strain normal values and, 3) to determine sex, age and race related differences in these parameters in a large group of normal subjects (WASE study).

Methods and results: 3DE RV wide-angle datasets from 1043 prospectively enrolled healthy adult subjects, were analyzed to generate a 3D mesh model of the RV cavity (TomTec). Dedicated software (ReVISION) was used to analyze RV motion along the three main anatomical planes. The EF values corresponding to each plane were identified as LEF, REF, and AEF. Relative contributions were determined by dividing each EF component by the global RVEF. RV strain analysis included longitudinal, circumferential, and global area strains (GLS, GCS and GAS, respectively). Results were categorized by sex, age (18-40, 41-65 and >65 years) and race. Absolute REF, AEF, LEF and global RVEF were higher in women than in men (p < .001). With aging, both sexes exhibited a decline in all components of longitudinal shortening (p < .001), which was partially compensated in elderly women by an increase in radial contraction. Black subjects showed lower RV EF and GAS values compared to White and Asian subjects of the same sex (p < .001) and Black men showed significantly higher RV radial but lower longitudinal contributions to global RVEF compared to Asian and White men.

Conclusions: 3DE evaluation of the non-longitudinal components of RV contraction provides additional information regarding RV physiology, including sex, age and race - related differences in RV contraction patterns that may prove useful in disease states involving the right ventricle.

Keywords: non-longitudinal; right ventricle; three-dimensional echocardiography.