Echocardiographic quantification of regional right ventricular systolic function

Abstract

In this thesis we addressed the currently available imaging modalities to evaluate RV function and morphology, the role echocardiographic deformation imaging could have for this assessment, and explored its technical traits. Quantifcation of regional RV function is currently lacking, while it is of clinical relevance in order to establish the risk of a patients for ventricular arrhythmias. We have shown that defornation imaging is a feasable tool to acomplish this end. The questions related to the physiological right and left ventricular (LV) remodeling in the athletes’ heart were addressed in Part 2, where the functional and morphological adaptations in response to long term endurance training were studied. The RV shows marked dialation with a moderate reduction in regional, but not global function. LV function remains preserved as well. Diastolic parameters in both ventricles showed no differences between atheltes and non-athletes. Finally, the role of echocardiographic deformation imaging in pathological RV remodeling was studied in Part 3. The clinical applicability of this technique in the evaluation and diagnostic process of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) was explored with respect to the detection of subtle functional abnormalities in both the RV and the LV. The main findings were that deformation imaging is the single best test to detect functional abnormalities in the RV, and even detects subtle abnormalties in asymptomatic mutation carriers. Furtheremore, LV abnormalties (a prognostic infavorable sign) were also detected in a large number of patients, while this was not seen by routine evaluation.