Echocardiography in the Assessment of the Right Ventricle - Research Paper Example

? Echocardiography in the Assessment of the Right Ventricle Echocardiography in the Assessment of the Right Ventricle Echocardiography is an established procedure known to be essential in the diagnosis of heart ailments with special emphasis on the right ventricle due to mortality and morbidity associated to its malfunction. It is a widely available, inexpensive, and well validated tool that allows for comprehensive evaluation of the right ventricle's size and function. With improvements in ultrasound techniques and methods, there are many qualitative and quantitative indicators that, when used in conjunction with noninvasive pulmonary hemodynamics can provide better diagnostic and prognostic information needed by clinicians. And as echocardiography modalities improve, enhanced assessment of the right ventricle will lead to a better understanding of the pathophysiology of right heart failure and enhanced ability to follow responses to therapy. It has been found out that right ventricular function is an important predictor of morbidity and mortality in patients with heart failure and pulmonary hypertension (Karas & Kizer 2012, p 144). Before, prognostic assessment for heart failure was focused on the left ventricle considering this chamber as the primary locus of disease. Now, investigators have focused research on the Right ventricle size and function. RV dysfunction has been shown to be a major predictor of outcome following myocardial infarction, as well as a key prognostic indicator in patients with chronic heart failure. Accurate assessment of RV size and function is an essential component to comprehensive evaluation of the patient with heart failure and/or pulmonary vascular disease (Karas & Kizer 2012, p. 144). And echocardiography remains the primary tool in RV evaluation for it is noninvasive, portable, inexpensive, and widely available. As therapeutic interventions continue to expand for heart failure and pulmonary hypertension, echocardiography serves as an important tool for screening patients at risk and tracking response to treatment (Karas & Kizer 2012, p. 145) In lieu with using echocardiography in determining right ventricular function, the American Society of Echocardiography recommends standard acoustic windows, as well as RV focused views, in the apical 4-chamber, 5-chamber and coronary-sinus views to better visualize the right ventricle anterior, lateral, and inferior walls (Karas & Kizer 2012, p. 145). By the viewing the different portions of the right heart thru echocardiography disease patterns such as heart failure and pulmonary hypertension can be evaluated and tracked for prognosis. Echocardiography as a diagnostic assessment of the right heart The right atrium serves three main functions in right ventricle filling: a reservoir for systemic venous return when the tricuspid valve is closed, a passive conduit in early diastole and an active conduit during atrial contraction in late diastole. Right Atrium dimensions have been reported to predict adverse outcome in the setting of primary pulmonary hypertension. Accurate estimation of Right Atrial pressure is important in obtaining reliable noninvasive measurement of pulmonary pressures (Karas & Kizer 2012, p. 146). On the other hand, the Right Ventricle dilates in response to chronic volume overload, pressure overload, and Right Ventricle systolic failure, and Right Ventricular size has been shown to be a predictor of survival in patients with chronic pulmonary disease and acute pulmonary embolism. Thus the evaluation of normal pressures and measures of the right ventricle is necessary. It also includes assessment of the Right Ventricle outflow tract, the proximal diameter of which is obtained in the parasternal long-axis view. Increased proximal right ventricle outflow tract diameter has been documented to be a manifestation of arrhythmogenic right ventricular cardio myopathy (Karas & Kizer 2012, p. 146). By the technology brought upon today more innovations and improvements are going with echocardiography. For instance, 3D echocardiographic right ventricle volumes are comparable to those done by the more expensive magnetic resonance imaging (MRI) and are more accurate than 2D echocardiographic volumes. Thus, 3D imaging has the potential to greatly enhance further echocardiographic assessment of right ventricle structure and function as well as the whole heart for better assessment of prognoses purposes (Karas & Kizer 2012, p. 146). Moreover, Two-dimensional and Doppler echocardiography can be used to noninvasively determine pulmonary pressures and resistance. Though right heart catheterization remains the gold standard for the diagnosis of pulmonary hypertension, nevertheless, echocardiography is an important screening modality that plays an important role in following patients' response to therapy (Karas & Kizer 2012, p. 148). Furthermore, determining right ventricular systolic function, by the use of echocardiography, is an essential prognostic factor in a variety of cardiac and pulmonary diseases. As well as determining elevated Pulmonary Vascular Resistance, one of the parameters used for diagnosis and prognosis of patients with pulmonary hypertension, has also been associated with increased mortality, heart failure hospitalizations and adverse cardiovascular events in patients with coronary artery disease (Karas & Kizer 2012, p. 150). Using echocardiography, Right Ventricular diastolic function can be recognized. Right Ventricular diastolic dysfunction is important to recognize since its presence has been shown in small studies to be a predictor of morbidity and mortality in patients with chronic heart failure and pulmonary hypertension (Karas & Kizer 2012, p. 153). Aside from determining right heart measures and functions, echocardiography can also determine complex congenital heart disease and isolated intracardiac shunts which are causes of structural and functional abnormalities of the cardiac chambers especially the right heart. Depending on the size, an atrial septal defect (ASD) can cause a large left-to-right shunt leading to right heart volume overload, right heart chamber enlargement, and flow-related pulmonary hypertension. Structural and hemodynamic consequences can also be seen with ventricular septal defects (VSD) and patent ductus arteriosus (PDA), lesions associated with high-pressure left-to-right shunts. Echocardiography plays a central role in the diagnosis of these structural abnormalities, as well as in their long-term medical and surgical management. Routine evaluation of patients with congenital anomalies such as ASD or VSD includes a comprehensive echocardiographic evaluation of Right Atrial and ventricular sizes, systolic function, and pulmonary hemodynamics (Karas & Kizer 2012, p. 155). Assessment of Right Ventricular size and function is an important part of the evaluation patients with heart failure and pulmonary hypertension. Numerous studies have demonstrated the prognostic significance of Right Ventricle function through echocardiography that provides the ability to evaluate its features and functions qualitatively. More importantly echocardiographic evaluation of the Right Ventricle through a variety of techniques and further technological progress has improved the overall assessment and allowed more precise decisions for earlier disease detection, diagnosis, improved therapeutic intervention, treatment and patient outcome (Karas & Kizer 2012, p. 157). References: Karas M. & Kizer J. (2012) Echocardiographic assessment of the right ventricle and associated hemodynamics. Progress in cardiovascular Diseases, pp. 144-160 Read More