Right Ventricular Strain by Echocardiography: Current Clinical Applications and Future Directions for Mechanics Assessment of the Forgotten Ventricle

Figure 1. Steps for image acquisition and analysis of RVLS. Panel (A): Obtain an optimized RV-focused view from the apical window with all RV free wall segments within the sector. Panel (B): Define points for the region of interest (ROI). Panel (C): Review segments and adjust ROI to ensure appropriate tracing of RV myocardial segments.

Figure 2. Different RV strain acquisition software packages. Panel (A) demonstrates RV strain acquisition using GE Software, with the septal segments blanked out (X Marks) to remove from RVLS analysis. Panel (B) demonstrates RV free wall strain visualization using Phillips Software.

Figure 3. Potential ROI errors in RV strain assessment. Panel (A) demonstrates an appropriate RV free wall tracing with a correct strain measurement in the normal range (RVLS: −25.3%). Panel (B) shows the effect of setting the ROI too narrowly, resulting in an overestimation of the true RVLS value (−30.6%). Panel (C) shows an ROI tracing set too far outward, including the pericardium, with a resulting underestimation of the true RVLS value in the mildly impaired range (−23.4%).

Figure 4. Summary of clinical applications of RV strain.

Figure 5. Example of strain analysis in a case of pulmonary hypertension (PH). Panel (A) shows an RV-focused view of a dilated RV with a lack of coaptation of the tricuspid valve but with a visual appearance of normal RV systolic function. Panel (B) demonstrates a continuous wave Doppler signal of severe tricuspid regurgitation, with RVSP of 51 mmHg. Panel (C) demonstrates RV strain analysis with impaired RVLS of −16.1%, which carries incremental prognostic significance in this patient with PH.