From the Guidelines
The right ventricle is functioning normally based on the provided parameters, including wall thickness, chamber size, and systolic function, as evidenced by a TAPSE of 2.6 cm, which is above the threshold for normal systolic function 1. The wall thickness being normal indicates that there is no significant hypertrophy or thinning, which could suggest pathology such as pulmonary hypertension or right ventricular dysfunction.
- The chamber size, with a right ventricular internal diameter (RVID) at mid-cavity measuring 2.5 cm, falls within the normal range, typically considered as less than 3.3 cm, indicating no dilation or constriction that would suggest right ventricular failure or other conditions affecting the right heart.
- Systolic function, measured by Tricuspid Annular Plane Systolic Excursion (TAPSE), is an important indicator of right ventricular longitudinal function, showing how well the right ventricle contracts. A TAPSE value of 2.6 cm exceeds the normal threshold, which, according to the guidelines, is considered reduced if less than 16 mm 1, but in clinical practice, values above 1.7 cm are generally considered normal, indicating that the right ventricle is contracting effectively. These findings collectively suggest that the right ventricle has appropriate structure and contractile ability, indicating adequate right-sided cardiac function without signs of right ventricular failure, pulmonary hypertension, or other pathology affecting the right heart, as outlined in the guidelines for the diagnosis and treatment of acute and chronic heart failure 1.
From the Research
Right Ventricle Characteristics
- The right ventricle (RV) is responsible for accepting venous blood and propelling it to the lungs where it is oxygenated and its CO2 eliminated 2.
- The normal RV is anatomically and functionally different from the left ventricle, which precludes direct extrapolation of our knowledge of left-sided physiopathology to the right heart 3.
- RV adaptation is largely determined by the level of exposure to hemodynamic overload (both preload and afterload) as well as its intrinsic contractile function 3.
Right Ventricle Function Assessment
- Right ventricular function is acknowledged as an important prognostic element in cardiovascular pathologies 4.
- Assessing right ventricular performance still remains a challenge for the daily practice due to its complex structure and low impedance system 4.
- The aims of assessing RV function include describing the main characteristics of RV anatomy, function, and failure, and presenting the standard and novel tools that can be employed to investigate them 4.
Treatment and Prognosis
- β-blockers improve the prognosis of patients with cardiac failure due to left ventricular systolic dysfunction, and also show promise in patients with dysfunctional systemic right ventricle 5.
- In patients with cardiac failure due to systemic right ventricular dysfunction, β-blockers improve New York Heart Association class, quality of life, and systemic right ventricular ejection fraction assessed by radionuclide ventriculography 5.
- Treatment of RV failure rests on the relief of excessive loading, and measurements of RV systolic function but also of diastolic function predict outcome in any cause pulmonary hypertension and heart failure with or without preserved left ventricular ejection fraction 6.
Pathophysiology
- The contribution of the RV to cardiac output is negligible in normal resting conditions when pressures in the pulmonary circulation are low, but the RV becomes relevant in healthy subjects during exercise and definitely so in patients with increased pulmonary artery pressures both at rest and during exercise 6.
- Pathobiological changes in the overloaded RV include a combination of myocardial fibre hypertrophy, fibrosis and capillary rarefaction, a titin phosphorylation-related displacement of myofibril tension-length relationships to higher pressures, a metabolic shift from mitochondrial free fatty acid oxidation to cytoplasmic glycolysis, toxic lipid accumulation, and activation of apoptotic and inflammatory signalling pathways 6.