RIGHT VENTRICULAR SPECKLE TRACKING STRAIN HAS A CLOSER CORRELATION WITH RIGHT VENTRICULAR EJECTION FRACTION THAN OTHER ECHOCARDIOGRAPHIC INDICES OF RIGHT VENTRICULAR FUNCTION: A COMPARISON WITH CARDIAC MAGNETIC RESONANCE IMAGING 1,2 Rae F Duncan, 1 Adam J Nelson, 1 Ben K Dundon, 2 Julie Schuster, 1 Matthew I. Worthley, 1 Angelo Carbone, 1 Kerry Williams, 2 Robin Taylor, 2 Azfar Zaman, 1 Stephen G. Worthley. 1 Cardiovascular Research Centre, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia 5000, Australia 2 Cardiology, The Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
Disclosures: No authors have any relationships to disclose
BACKGROUND Accurate quantification of RV function is important for diagnostic and prognostic reasons. The superior spatial resolution of cardiac magnetic resonance (CMR) makes it the reference standard for RVEF calculation The complex geometry of the RV means 2D-echo (2DE) calculation of RVEF is inaccurate. Several non-volumetric 2DE indices of RV function have been developed It remains unclear which of these indices correlates best with CMR-derived RVEF and is the most reproducible.
STUDY AIM To perform a head-to-head comparison of eight 2DE non-volumetric indices of global RV function, indexed against CMR RVEF as the reference standard, in patients exhibiting a broad spectrum of RV function.
Methods: Patient Selection 60 patients (RVEF range: 24-73%) were recruited. Inclusion Criteria Sinus rhythm No CI to CMR Exclusion Criteria Atrial fibrillation CI to CMR Poor endocardial wall definition Severe TV annular calcification TV prosthesis/tv surgical ring
Methods: Study Design Study subjects underwent CMR (1.5T Siemens Sonata) & 2DE (GE Vivid 7) sequentially within two hours of each other to ensure similar cardiac loading conditions. CMR: RVEF was calculated in the standard manner. Echo: Standard 2D imaging, M-Mode, 2D strain, spectral Doppler & tissue Doppler (TDE) traces recorded for all patients. Eight 2DE indices of RV function were measured and then correlated against CMR-RVEF (using bivariate correlation), and compared against each other (using regression analysis).
Methods: CMR Imaging Protocol Calculating RVEF by CMR
Methods: Echo Imaging Protocols Speckle tracking strain: RV global strain (RVGS)
Methods: Echo Imaging Protocols Speckle tracking strain: RV free wall strain (RVFWS)
Methods: Echo Imaging Protocols Tricuspid annular plane systolic excursion by M-Mode (M-Mode TAPSE)
Methods: Echo Imaging Protocols Tricuspid annular peak systolic myocardial tissue velocity by pulsed-wave tissue Doppler (RV PWTDE Sm)
Methods: Echo Imaging Protocols Tricuspid annular peak systolic tissue velocity by colour tissue velocity imaging (RV CTDE Sm)
Methods: Echo Imaging Protocols Myocardial acceleration during isovolumic contraction of the right ventricle - Isovolumic acceleration (IVA). IVA = IVV/AT
Methods: Echo Imaging Protocols Tricuspid annular plane systolic excursion by colour tissue Doppler (TDE TAPSE).
Methods: Echo Imaging Protocols RV Myocardial Performance Index (RV MPI) Spectral Doppler patterns of tricuspid inflow and pulmonary outflow were recorded RV MPI = (a-b)/b <=> (IVCT+IVRT)/RVET
Results:Patient Characteristics (N=50)
Results: Correlations with CMR (1/2) RVfwS RVGS MM TAPSE CTDE Sm
Results: Correlations with CMR (2/2) PWTDE Sm TDE TAPSE MPI IVA
Results:Receiver-operator characteristics (1/2) RVfwS RVGS MM-TAPSE Cut-off 25.50% ( 22.5%) Cut-off 19.15% Cut-off 1.6cm Sensitivity = 90% (80%) Sensitivity = 79% Sensitivity = 37% Specificity = 55% (80%) Specificity = 87% Specificity = 94%
Results:Receiver-operator characteristics (2/2) CTDE Sm PWTDE Sm TDE TAPSE Cut-off <8.5cm/s Cut-off <10cm/s Cut-off 1.8cm Sensitivity = 73% Sensitivity = 53% Sensitivity = 79% Specificity = 65% Specificity = 67% Specificity = 65%.
Results: Regression, Reproducibility. Acquisition & Analysis times (1/3) RV FREE WALL STRAIN: 1. was accurate: RVfwS had a stronger correlation with CMR-RVEF than all other RV echo indices. 2. was reproducible: 3. was clinically applicable:
Results: Regression, Reproducibility, Acquisition & Analysis times (2/3) 2ND: RVGS 1. Regression analysis: 3RD: MM TAPSE 1. Regression analysis: 2. Reproducibility: 2. Reproducibility: 3. Clinical application: 3. Clinical application:
Results: Regression, Reproducibility, Acquisition & Analysis times (3/3) Upon exclusion of RVfwS, RVGS and M-Mode TAPSE, no remaining echocardiographic index of RV systolic function exhibited a superior correlation over the other indices, when compared to CMR-RVEF.
Conclusions RVFwS had strongest correlation to CMR-derived RVEF. RVfwS is reproducible. RVfwS is sensitive & specific for detecting RV systolic dysfunction. RVfwS is quick and easy to use and has the potential to be used widely in clinical practice.
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Results:Correlation of RV indices with visual assessment of RV function Comparison of CMR-RVEF and eight echo indices of RV function with visual assessment of RV systolic function. Each category of RV dysfunction is compared to the category above (i.e. Mild RV dysfunction is compared to normal RV function; moderatesevere RV dysfunction is compared to mild RV dysfunction).
Results: Reproducibility
Study limitations & future work The normative cut-off values derived by ROC analysis in this study were for RV strain quantified using GE speckle tracking software. It is unclear if the same normative values can be applied to 2D strain analysed using software from other manufacturers and this warrants further investigation. The patient numbers in this pilot study are small, and the results of our research now need to be validated in a larger prospective study.