Der rechte Ventrikel – welche bildgebende Modalität ist sinnvoll?

Abstract

For a long time the right ventricle was hardly noticed in the pathophysiology of cardiovascular diseases. The advancement in echocardiography and the increasing availability of magnetic resonance imaging (MRI) amended the understanding of the RV and led to a decisive improvement of diagnosis and treatment of cardiovascular diseases such as congenital heart disease or pulmonary hypertension. The use of radionuclide-based techniques or computed tomography (CT) can be helpful in certain settings. In most cases, the use of a multimodal approach will yield in the best treatment for patients with RV involvement.

Kernaussagen

• Die echokardiografische Untersuchung des RV ist die Basisdiagnostik. Sie ist breit verfügbar, kostengünstig und zeichnet sich durch eine hohe räumliche und zeitliche Auflösung aus.

• Bei Patienten mit schlechtem Schallfenster und bei bestimmten Fragestellungen bietet die kardiale MRT eine hervorragende Ergänzung zur Echokardiografie.

• Insbesondere bei Patienten mit angeborenen Herzfehlern eignet sich die MRT zur Therapieplanung und zur Erfolgskontrolle nach chirurgischer oder interventioneller Therapie.

• Mithilfe der Late-Gadolinium-Enhancement-MR-Bildgebung können myokardiale Nekrosen und Narben oder eine Fibrose visualisiert werden; eine Quantifizierung mittels T1-Mapping ist für den RV zum jetzigen Zeitpunkt nicht ausreichend validiert.

• Die kardiale Multidetektor-CT und radionuklidbasierte Techniken sind in der nicht invasiven Bildgebung des rechten Ventrikels von untergeordneter Bedeutung und nur bei bestimmten Fragestellungen indiziert.

• Die Weiterentwicklung von Hybridtechniken wird das Verständnis des RV in der Pathophysiologie kardiovaskulärer Erkrankungen weiter verbessern.

• Ein multimodaler Ansatz ist der Schlüssel für eine optimale Beurteilung der RV-Anatomie und RV-Funktion.

• Literatur

• 1 Goor DA, Lillehei CW. Congenital malformations of the heart. In: Goor DALC, ed. Congenital Malformations of the Heart: Embryology, Anatomy, and Operative Considerations. 1st. ed. New York: Grune & Stratton; 1975: 1-37
• 2 Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart 2006; 92: 12-13
• 3 Sanz J, Conroy J, Narula J. Imaging of the right ventricle. Cardiol Clin 2012; 30: 189-203
• 4 Haber I, Metaxas DN, Geva T et al. Three-dimensional systolic kinematics of the right ventricle. Am J Physiol Heart Circ Physiol 2005; 289: H1826-H1833
• 5 Haddad F, Hunt SA, Rosenthal DN et al. Right Ventricular Function in Cardiovascular Disease, Part I: Anatomy, Physiology, Aging, and Functional Assessment of the Right Ventricle. Circulation 2008; 117: 1436-1448
• 6 Curtiss E, Reddy PS, O'Toole JD et al. Alterations of right ventricular systolic time intervals by chronic pressure and volume overloading. Circulation 1976; 53: 997-1003
• 7 Sheehan F, Redington A. The right ventricle: anatomy, physiology and clinical imaging. Heart 2008; 94: 1510-1515
• 8 Le Tourneau T, Piriou N, Donal E et al. Imaging and modern assessment of the right ventricle. Minerva Cardioangiol 2011; 59: 349-373
• 9 Rudski LG, Lai WW, Afilalo J et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23: 685-713
• 10 Roy PM, Colombet I, Durieux P et al. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ 2005; 331: 259
• 11 Anavekar NS, Gerson D, Skali H et al. Two-dimensional assessment of right ventricular function: an echocardiographic-MRI correlative study. Echocardiography 2007; 24: 452-456
• 12 Anavekar NS, Skali H, Bourgoun M et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol 2008; 101: 607-612
• 13 Tei C, Nishimura RA, Seward JB et al. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 1997; 10: 169-178
• 14 Niemann PS, Pinho L, Balbach T et al. Anatomically oriented right ventricular volume measurements with dynamic three-dimensional echocardiography validated by 3-Tesla magnetic resonance imaging. J Am Coll Cardiol 2007; 50: 1668-1676
• 15 van der Zwaan HB, Helbing WA, Boersma E et al. Usefulness of real-time three-dimensional echocardiography to identify right ventricular dysfunction in patients with congenital heart disease. Am J Cardiol 2010; 106: 843-850
• 16 Eyskens B, Brown SC, Claus P et al. The influence of pulmonary regurgitation on regional right ventricular function in children after surgical repair of tetralogy of Fallot. Eur J Echocardiogr 2010; 11: 341-345
• 17 Puwanant S, Park M, Popović ZB et al. Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension. Circulation 2010; 121: 259-266
• 18 Coats L, Khambadkone S, Derrick G et al. Physiological consequences of percutaneous pulmonary valve implantation: the different behaviour of volume- and pressure-overloaded ventricles. Eur Heart J 2007; 28: 1886-1893
• 19 Hendel RC, Patel MR, Kramer CM et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006; 48: 1475-1497
• 20 Greil GF, Boettger T, Germann S et al. Quantitative assessment of ventricular function using three-dimensional SSFP magnetic resonance angiography. J Magn Reson Imaging 2007; 26: 288-295
• 21 Valsangiacomo Buechel ER, Mertens LL. Imaging the right heart: the use of integrated multimodality imaging. Eur Heart J 2012; 33: 949-960
• 22 Buechel EV, Kaiser T, Jackson C et al. Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11 Doi:
• 23 Maceira AM, Prasad SK, Khan M et al. Reference right ventricular systolic and diastolic function normalized to age, gender and body surface area from steady-state free precession cardiovascular magnetic resonance. Eur Heart J 2006; 27: 2879-2888
• 24 Fratz S, Schuhbaeck A, Buchner C et al. Comparison of accuracy of axial slices versus short-axis slices for measuring ventricular volumes by cardiac magnetic resonance in patients with corrected tetralogy of fallot. Am J Cardiol 2009; 103: 1764-1769
• 25 Greil GF, Beerbaum P, Razavi R et al. Imaging the right ventricle: non-invasive imaging. Heart 2008; 94: 803-808
• 26 Youssef A, Ibrahim el SH, Korosoglou G et al. Strain-encoding cardiovascular magnetic resonance for assessment of right-ventricular regional function. J Cardiovasc Magn Reson 2008; 10
• 27 Schuster A, Kutty S, Padiyath A et al. Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress. J Cardiovasc Magn Reson 2011; 13
• 28 Beerbaum P, Körperich H, Barth P et al. Noninvasive quantification of left-to-right shunt in pediatric patients: phase-contrast cine magnetic resonance imaging compared with invasive oximetry. Circulation 2001; 103: 2476-2482
• 29 Wagner A, Mahrholdt H, Holly TA et al. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 2003; 361: 374-379
• 30 White SK, Sado DM, Fontana M et al. T1 mapping for myocardial extracellular volume measurement by CMR: bolus only versus primed infusion technique. JACC Cardiovasc Imaging 2013; 6: 955-962
• 31 Ellims AH, Shaw JA, Stub D et al. Diffuse myocardial fibrosis evaluated by post-contrast t1 mapping correlates with left ventricular stiffness. J Am Coll Cardiol 2014; 63: 1112-1118
• 32 Plumhans C, Mühlenbruch G, Rapaee A et al. Assessment of global right ventricular function on 64-MDCT compared with MRI. Am J Roentgenol 2008; 190: 1358-1361
• 33 Gaemperli O, Bengel FM, Kaufmann PA. Cardiac hybrid imaging. Eur Heart J 2011; 32: 2100-2108
• 34 Lurz P, Muthurangu V, Schuler PK et al. Impact of reduction in right ventricular pressure and/or volume overload by percutaneous pulmonary valve implantation on biventricular response to exercise: an exercise stress real-time CMR study. Eur Heart J 2012; 33: 2434-2441
• 35 Lurz P, Nordmeyer J, Muthurangu V et al. Comparison of bare metal stenting and percutaneous pulmonary valve implantation for treatment of right ventricular outflow tract obstruction: use of an x-ray/magnetic resonance hybrid laboratory for acute physiological assessment. Circulation 2009; 119: 2995-3001
• 36 Lurz P, Puranik R, Nordmeyer J et al. Improvement in left ventricular filling properties after relief of right ventricle to pulmonary artery conduit obstruction: contribution of septal motion and interventricular mechanical delay. Eur Heart J 2009; 30: 2266-2274
• 37 Schievano S, Coats L, Migliavacca F et al. Variations in right ventricular outflow tract morphology following repair of congenital heart disease: implications for percutaneous pulmonary valve implantation. J Cardiovasc Magn Reson 2007; 9: 687-695
• 38 Oosterhof T, Mulder BJ, Vliegen HW et al. Corrected tetralogy of Fallot: delayed enhancement in right ventricular outflow tract. Radiology 2005; 237: 868-871
• 39 Marcus F, McKenna WJ, Sherrill D et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J 2010; 31: 806-814
• 40 Pandya B, Quail MA, Steeden JA et al. Real-time magnetic resonance assessment of septal curvature accurately tracks acute hemodynamic changes in pediatric pulmonary hypertension. Circ Cardiovasc Imaging 2014; 7: 706-713
• 41 Benza R, Biederman R, Murali S et al. Role of cardiac magnetic resonance imaging in the management of patients with pulmonary arterial hypertension. J Am Coll Cardiol 2008; 52: 1683-1692
• 42 Douma RA, Kamphuisen PW, Büller HR. Acute pulmonary embolism. Part 1: epidemiology and diagnosis. Nat Rev Cardiol 2010; 7: 585-596
• 43 Andersen HR, Falk E, Nielsen D. Right ventricular infarction: frequency, size and topography in coronary heart disease: a prospective study comprising 107 consecutive autopsies from a coronary care unit. J Am Coll Cardiol 1987; 10: 1223-1232
• 44 Mehta SR, Eikelboom JW, Natarajan MK et al. Impact of right ventricular involvement on mortality and morbidity in patients with inferior myocardial infarction. J Am Coll Cardiol 2001; 37: 37-43
• 45 Lopez-Sendon J, Garcia-Fernandez MA, Coma-Canella I et al. Segmental right ventricular function after acute myocardial infarction: two-dimensional echocardiographic study in 63 patients. Am J Cardiol 1983; 51: 390-396
• 46 Grothoff M, Elpert C, Hoffmann J et al. Right ventricular injury in ST-elevation myocardial infarction: risk stratification by visualization of wall motion, edema, and delayed-enhancement cardiac magnetic resonance. Circ Cardiovasc Imaging 2012; 5: 60-68