|
PLAX
|
2D
|
RV:LV Diastolic Ratio
• Qualitative
• Identify pericardial effusion as a marker of adverse
prognosis
|
RV:LV
ratio cutoff
>0.5:1
• Significance: Diagnostic
• An assessment of RV enlargement
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Click to enlarge
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A4CH
|
2D
|
RV Minor/Major Axis Dimensions (RVd)
• Quantitative
RV Diastolic and Systolic Area (RVAd/s)
• Quantitative - calculate Fractional Area Change1
|
• See BSE Guidelines: Chamber Quantification
• Significance: Diagnostic
• An assessment of RV size and function
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Click to enlarge
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A4CH
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M-mode
|
Tricuspid
Systolic Annular Plane Excursion
(TAPSE)
• M-mode cursor
across lateral tricuspid
annulus
• Select a fast
sweep speed
• Measure total
excursion of the tricuspid annulus
|
TAPSE cutoff <1.6
cm
• See BSE Guidelines:
Chamber Quantification
• Significance:
Diagnostic
• A
measure of longitudinal RV
systolic
function2
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Click to enlarge
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PSAX
|
2D
M-mode
|
Inferior Vena Cava Diameter
(IVC)
• At end diastole and end-expiration
• Perpendicular to the IVC long axis
• Approx1.0 - 2.0 cm from the RA junction
• Assess % reduction in diameter with sniffing
|
See BSE Guidelines: Chamber Quantification
• Significance: Diagnostic & Prognostic
• Indicator of RV filling pressure
• Consider assessing hepatic vein flow to supplement
accuracy3
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Click to enlarge
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A4C
PSAX
|
CW
|
Peak tricuspid regurgitant velocity (TR Vmax)
|
TR Vmax
cutoff
>2.6 m/s
>2.8 m/s if obese
>2.9 m/s if >60 yrs
• Significance: Diagnostic4
• An indicator of pulmonary pressure in the absence of pulmonary
stenosis
• Consider agitated saline/air/blood contrast if incomplete
envelope 5
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Click to enlarge
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PSAX
|
PW
|
RV outflow tract acceleration time
(AT)
Held end-expiration
Onset of flow to peak velocity
|
RVOT AT cutoff <105 ms
• Significance: Diagnostic 6
• Surrogate measure of PA pressure
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Click to enlarge
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A4CH
|
PW TDI
|
Isovolumetric relaxation time (IVRT)
• Sample volume at basal lateral RV myocardium
• Held end-expiration
• Offset of S' wave to onset E' wave
|
RV IVRT cutoff >75 ms
• Significance: Diagnostic. A value below 40ms has a high
negative predictive value for PHT 7
• A measure of RV dysfunction
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Click to enlarge
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PSAX
|
2D
|
Eccemticity Index (EI)
EI = D2/D1
Where: D1 = Minor axis dimension perpendicular to septum
D2 = Minor axis dimension perdendicular to D1
|
EI cutoff >1.0
• Significance: Prognostic 8
• EI end systole an expression pressure overload
• EI end diastole an expression volume overload
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Click to enlarge
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A4CH
|
2D
|
RA Volume (RAV)
Where: RAV=0.85(A2)/L
|
RAVI male cutoff >33 m/m2
RAVI female cutoff >27 ml/m2
• Significance: Prognostic 9
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Click to enlarge
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A4CH
|
PW TDI
|
RV S' Wave Velocity
• Sample volume at basal lateral RV myocardium
|
S' wave velocity cutoff : <12 cm/s
• Significance: Diagnostic 10
• Expression of RV longitudinal systolic function
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Click to enlarge
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A4CH
|
PW TDI
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RV MPI MPI= a-b/b
Where:
a = A' offset to E' onset
b = S' onset to S' offset
|
• RV MPI cut off: >0.32
• Significance: Prognostic 11
• Expression of RV systolic and diastolic
performance
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Click to enlarge
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