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New Directions in Right Ventricular Assessment Using 3-Dimensional Echocardiography

Educational Objective
To improve understanding of right ventricular structure and function and the roles of 2-dimensional and 3-dimensional echocardiography approaches to evaluating the right ventricle.
1 Credit CME

Importance  Before the introduction of 3-dimensional echocardiography, estimations of right ventricular (RV) size and function by echocardiography were limited to regional approximations of global function. This review describes the novel application of 3-dimensional echocardiography in the assessment of RV size and function, in juxtaposition with what is currently available using 2-dimensional echocardiography.

Observations  Two-dimensional echocardiographic evaluation of RV size and function includes measures of systolic basal longitudinal excursion (tricuspid annular plane systolic excursion and peak systolic velocity), fractional area change, and free-wall strain, all of which are measured from a single tomographic imaging plane: the RV-focused view. Given this limitation, clinical situations in which more accurate assessment of the RV or close patient follow-up were required were resolved with the use of cardiovascular magnetic resonance, computed tomography, and other modalities to obtain global measures of size and function (ie, volume and ejection fraction). With 3-dimensional echocardiography, both volume and ejection fraction assessments of the RV are possible with an accuracy and reproducibility close to that of cardiovascular magnetic resonance imaging. Further, 3-dimensional RV data sets can be cropped, sliced, and rotated to assess device leads, tricuspid valve leaflets, and RV wall–motion abnormalities. The 3-dimensional RV data set opens the horizon to endless possibilities for further exploration of novel parameters, including 3-dimensional RV shape and 3-dimensional RV deformation analysis.

Conclusions and Relevance  The use of 3-dimensional echocardiography overcomes many of the limitations associated with conventional 2-dimensional echocardiography and has the potential to provide the detailed information required for the complex clinical decision-making that requires accurate, quantitative information about the RV.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 29, 2019.

Corresponding Author: Roberto M. Lang, MD, Section of Cardiology, Department of Medicine, The University of Chicago, 5758 S Maryland Ave, MC 9067, DCAM 5509, Chicago, IL 60637 (

Published Online: July 24, 2019. doi:10.1001/jamacardio.2019.2424

Author Contributions: Drs Addetia and Lang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Addetia, Badano, Lang.

Acquisition, analysis, or interpretation of data: Addetia, Muraru.

Drafting of the manuscript: Addetia, Muraru, Lang.

Critical revision of the manuscript for important intellectual content: Addetia, Badano, Lang.

Administrative, technical, or material support: Addetia, Lang.

Conflict of Interest Disclosures: Dr Muraru reported nonfinancial support from GE Healthcare during the conduct of the study and personal fees from GE Healthcare outside the submitted work. Dr Lang reported grants and other support from Philips Imaging Systems outside the submitted work. Dr Badano has received equipment grants from GE Vingmed and TomTec Imaging Systems and has received speaker honoraria from GE Vingmed outside the submitted work. No other disclosures were reported.

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