The evaluation of right ventricular kinesis by two-dimensional transthoracic echocardiography represents a difficult task. This technique can visualize the right ventricle in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. In this study, we investigated the potential of 'panoramic' transesophageal echocardiography for evaluating ventricular global and regional kinesis. In 53 controls and in 17 patients with previous inferior myocardial infarction and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the right ventricle were obtained in 81.4% of subjects by conventional (90°) sector in 100% of subjects through a wide-angle (270°) sector. Images of the right ventricle in short-axis view at medium level were acquired and evaluated in 91.4% of cases, but at basal and apical levels only in 65.7% and 37.1%, respectively. The low percentage of successful detection and evaluation of the right ventricle at apical level can be explained by the prominent motion and trabeculation of the apex. Global systolic area changes in controls attained similar values at apical and medium levels (56% and 55%, respectively), but were significantly lower (48%, p < 0.05) at basal level. In patients with previous inferior myocardial infarction and inferoposterior asynergy, global systolic area changes were significantly (p < 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. The regional kinesis of the right ventricle was assessed as segmental systolic area changes in 12 different segments, by both fixed and float system of center of cavity. In controls, the fixed system underestimated the kinesis of inferior and septal segments and overestimated the kinesis of anterolateral segments, due to a leftward translation and inferior rotation of the right ventricle during systole. The float system showed an almost concentric kinesis of the right ventricle, with segmental systolic area changes ranging between 52% and 66%. In patients with right ventricular asynergy, the fixed system confirmed the 'eyeball' analysis, while the float system tended to mask the asynergy and showed a more uniform kinesis, with diffuse decrement in systolic area changes throughout all segments. Further evaluation, also by biplane and omniplane probes, may help to overcome the limitations of the present method for a comprehensive analysis of right ventricular kinesis. As compared to the transthoracic approach, transesophageal echocardiography, however, already allows to improve the echocardiographic assessment of right ventricular kinesis and appears to be a promising tool, and potentially a reference technique, for the investigation of right ventricular kinesis during stress.
Transesophageal echocardiography for the investigation of right ventricular kinesis: Preliminary experience in patients with normal right ventricle or previous inferior myocardial infarction | [L'ECOCARDIOGRAFIA TRANSESOFAGEA PER LO STUDIO DELLA CINESI DEL VENTRICOLO DESTRO NORMALE E DOPO INFARTO MIOCARDICO INFERIORE: PROBLEMI ATTUALI E PROSPETTIVE]
PALOMBO, CARLO;
1995-01-01
Abstract
The evaluation of right ventricular kinesis by two-dimensional transthoracic echocardiography represents a difficult task. This technique can visualize the right ventricle in several projections, but the image quality and the variability of imaging views usually do not allow quantitative analysis. In this study, we investigated the potential of 'panoramic' transesophageal echocardiography for evaluating ventricular global and regional kinesis. In 53 controls and in 17 patients with previous inferior myocardial infarction and asynergy involving the inferior wall of both ventricles. Good-quality images of at least one horizontal section of the right ventricle were obtained in 81.4% of subjects by conventional (90°) sector in 100% of subjects through a wide-angle (270°) sector. Images of the right ventricle in short-axis view at medium level were acquired and evaluated in 91.4% of cases, but at basal and apical levels only in 65.7% and 37.1%, respectively. The low percentage of successful detection and evaluation of the right ventricle at apical level can be explained by the prominent motion and trabeculation of the apex. Global systolic area changes in controls attained similar values at apical and medium levels (56% and 55%, respectively), but were significantly lower (48%, p < 0.05) at basal level. In patients with previous inferior myocardial infarction and inferoposterior asynergy, global systolic area changes were significantly (p < 0.01) lower at medium and basal levels (32% and 27%, respectively) compared with controls. The regional kinesis of the right ventricle was assessed as segmental systolic area changes in 12 different segments, by both fixed and float system of center of cavity. In controls, the fixed system underestimated the kinesis of inferior and septal segments and overestimated the kinesis of anterolateral segments, due to a leftward translation and inferior rotation of the right ventricle during systole. The float system showed an almost concentric kinesis of the right ventricle, with segmental systolic area changes ranging between 52% and 66%. In patients with right ventricular asynergy, the fixed system confirmed the 'eyeball' analysis, while the float system tended to mask the asynergy and showed a more uniform kinesis, with diffuse decrement in systolic area changes throughout all segments. Further evaluation, also by biplane and omniplane probes, may help to overcome the limitations of the present method for a comprehensive analysis of right ventricular kinesis. As compared to the transthoracic approach, transesophageal echocardiography, however, already allows to improve the echocardiographic assessment of right ventricular kinesis and appears to be a promising tool, and potentially a reference technique, for the investigation of right ventricular kinesis during stress.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
