Il ventricolo destro: Il ruolo dell'ecocardiografia Doppler nella pratica clinica [The right ventricle: role of Doppler echocardiography in clinical practice]

Abstract To date, right ventricular function can be clinically assessed by Doppler echocardiography. Monodimensional and two-dimensional echocardiography provide information about right ventricular dimensions, wall thickness and tricuspid annular plane systolic excursion, which is an accurate estimate of longitudinal systolic function. Additional insights into right ventricular systolic function are given by Doppler interrogation of right ventricular outflow, measuring the duration of systolic time intervals. The Doppler recordings of the tricuspid inflow and hepatic venous flow allow the assessment of right ventricular diastolic properties. Also the new ultrasound technologies are clinically useful. The myocardial velocities and time intervals, detectable by pulsed tissue Doppler at the level of the tricuspid annulus, are markers of systolic and diastolic longitudinal motion of the right ventricle. The off-line strain rate imaging permits quantification of right ventricular myocardial contractility and may be particularly useful for the assessment of congenital cardiomyopathies. The right ventricular filling pressure and pulmonary arterial pressure may be derived by the combined analysis of the grade of tricuspid regurgitation and the respiratory reactivity of the inferior vena cava. The systolic time intervals, measured at the level of the right ventricular outflow, represent estimates of changes in pulmonary vascular resistance. The prognostic value of Doppler echocardiographic measurements of right ventricular function is demonstrated in various pathologies. This evaluation also provides additional value for the risk stratification of patients with chronic heart failure.