Three-dimensional echocardiographic evaluation of longitudinal and non-longitudinal components of right ventricular contraction: results from the World Alliance of Societies of Echocardiography study
Authors: Cotella Juan I , Kovacs Attila , Addetia Karima , Fabian Alexandra , Asch Federico M , Lang Roberto M ,   WASE Investigators, Prado Aldo D , Filipini Eduardo , Ronderos Ricardo E , Kwon Agatha , Hoschke-Edwards Samantha , Scalia Gregory M , Afonso Tania Regina , Rodridugues Ana Clara Tude , Thampinathan Babitha , Sooriyakanthan Maala , Tsang Wendy , Zhang Mei , Wang Yingbin , Zhang Yu , Zhu Tiangang , Wang Zhilong , Yin Lixue , Li Shuang , Alagesan R , Balasubramanian S , Ananth R V A , Amuthan Vivekanandan , Bansal Manish , Kasliwal Ravi R , Alizadehasl Azin , Sadeghpour Anita , Badano Luigi , Muraru Denisa , Bossone Eduardo , Vece Davide Di , Citro Rodolfo , Bellino Michele , Nakao Tomoko , Kawata Takayuki , Hirokawa Megumi , Sawada Naoko , Daimon Masao , Nabeshima Yousuke , Takeuchi Masaki , Yun Hye Rim , Park Seung Woo , Hwang Ji-won , Fajardo Pedro Gutierrez , Ogunyankin Kofo O , Tucay Edwin S , Monaghan Mark J , Kirkpatrick James N , Miyoshi Tatsuya 
Published: August 2023

Abstract

Aims
Right ventricular (RV) functional assessment is mainly limited to its longitudinal contraction. Dedicated three-dimensional echocardiography (3DE) software enabled the separate assessment of the non-longitudinal components of RV ejection fraction (EF). The aims of this study were (i) to establish normal values for RV 3D-derived longitudinal, radial, and anteroposterior EF (LEF, REF, and AEF, respectively) and their relative contributions to global RVEF, (ii) to calculate 3D RV strain normal values, and (iii) to determine sex-, age-, and race-related differences in these parameters in a large group of normal subjects (WASE study).

Methods and results
3DE RV wide-angle datasets from 1043 prospectively enrolled healthy adult subjects were analysed to generate a 3D mesh model of the RV cavity (TomTec). Dedicated software (ReVISION) was used to analyse RV motion along the three main anatomical planes. The EF values corresponding to each plane were identified as LEF, REF, and AEF. Relative contributions were determined by dividing each EF component by the global RVEF. RV strain analysis included longitudinal, circumferential, and global area strains (GLS, GCS, and GAS, respectively). Results were categorized by sex, age (18–40, 41–65, and &gt;65 years), and race. Absolute REF, AEF, LEF, and global RVEF were higher in women than in men (P &lt; 0.001). With aging, both sexes exhibited a decline in all components of longitudinal shortening (P &lt; 0.001), which was partially compensated in elderly women by an increase in radial contraction. Black subjects showed lower RVEF and GAS values compared with white and Asian subjects of the same sex (P &lt; 0.001), and black men showed significantly higher RV radial but lower longitudinal contributions to global RVEF compared with Asian and white men.

Conclusion
3DE evaluation of the non-longitudinal components of RV contraction provides additional information regarding RV physiology, including sex-, age-, and race-related differences in RV contraction patterns that may prove useful in disease states involving the right ventricle.