New ASE guidelines offer clarity for right ventricular assessment

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Estimation of right ventricular systolic pressure by Doppler echocardiography
Image source: Cardiophile MD

The American Society of Echocardiography (ASE) has published new guidelines to improve the existing norms of the right heart in the July issue of the Journal of the American Society of Echocardiography. The recommended procedures will establish a more uniform method of evaluating the size and function of the right ventricle, said the society.

Currently, systematic assessment of right heart function is not uniformly carried out, partially due to the enormous attention given to the evaluation of the left heart, a lack of familiarity with ultrasound techniques that can be used in imaging the right heart and a paucity of ultrasound studies providing normal reference values of right heart size and function, according to ASE.

"The right ventricle plays an important role in the morbidity and mortality of patients presenting with signs and symptoms of cardiopulmonary disease," said Lawrence Rudski, MD, director of non-invasive laboratories at the Jewish General Hospital in Montreal. "Yet, to date, primarily the left ventricle has been studied, while the right heart is often neglected. These guidelines will help bring clarity to ultrasound techniques that can be used in imaging the right heart."

The guidelines state that to obtain an optimal view of the right heart, multiple echocardiographic views are necessary. Each view adds information, allowing for a better insight of the structure and the function of the right heart. Clinicians are encouraged to use various parameters to evaluate RV systolic function and to evaluate right heart and pulmonary hemodynamic parameters. To help determine normal and abnormal function, it is often recommended to combine several measurements.

The guidelines also recommend that reporting results be based both on qualitative and quantitative parameters and must include measures of the RV size, right atrial size, and of RV systolic function. In addition, evaluation of RV diastolic function may be included in the report.

A gradual shift to more quantitative approaches for the assessment of RV size and function will help standardize assessment of the right ventricle across laboratories and allow clinicians to incorporate better assessment of the right heart into an echocardiographic evaluation, noted ASE.

The guidelines document provides upper and lower cut-off values, based on meta-analyses, of a range of relevant right heart parameters. Many of the recommended values differ from those published in previous recommendations for chamber quantification; and proposed values are not indexed to body surface area or height so patients at either end of the extremes may be misclassified, noted ASE.

"The application of the values included in the guidelines will enhance the value of echocardiography in recognizing RV dysfunction in clinical practice, in improving disease detection and in patient follow-up," summarized Rudski.

The full guidelines are available at