Abstract 17811: Right Ventricular Longitudinal Rotation is Predictive of Tricuspid Annular Plane Systolic Excursion in Patients with Right Ventricular Dilation

Abstract

Introduction: Assessment of right ventricular (RV) function plays an important role in patients with cardiopulmonary disease and current guidelines recommend the use of tricuspid annular plane systolic excursion (TAPSE) to assess RV longitudinal function. While we have previously described a form of longitudinal rotation in the setting of a dilated left ventricle, rocking of the heart is also noticed in the presence of RV dilation where the magnitude and significance of this phenomenon or its potential physiologic predictors have yet to be described.

Hypothesis: We assessed the hypothesis that longitudinal RV rotation is an independent predictor of TAPSE. We also investigated relationships between longitudinal RV rotation and potential predictors such as RV size, RV function, estimated RV systolic pressure (RVSP), QRS duration and the presence of a pericardial effusion.

Methods: We assessed a series of 143 consecutive patients with RV dilation by echocardiography. Patients with LV dilation and LBBB were excluded. Standard RV parameters were determined using established guidelines. Longitudinal RV rotation and RV strain measurements were performed with velocity vector imaging.

Results: Mean longitudinal RV rotation measured -1.8±3.0 degrees. By convention, negative values imply clockwise motion. In a multiple linear regression model, TAPSE could be predicted from a combination of RV Rotation and RV Strain (see Figure). No relationship was found between longitudinal RV rotation and RV function, QRS duration or estimated RVSP. A mild association was noted between longitudinal RV rotation and RV size (R=0.25,p=0.003) and the presence of a pericardial effusion (R=0.19,p=0.02).

Conclusion: In conclusion, longitudinal RV rotation is an independent predictor of TAPSE. Awareness of this previously undescribed motion should be considered in the interpretation of TAPSE as a marker of RV function in patients with RV dilation.