合田 亜希子, 真野 敏昭, 増山 理

Akiko GODA, Toshiaki MANO, Tohru MASUYAMA

兵庫医科大学内科循環器内科

Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine

キーワード :

Right ventricular（RV）dysfunction is one of the predictors of cardiopulmonary disease. The role of RV function is important not only in pulmonary arterial hypertension（PAH）and also in patients with left ventricular（LV）dysfunction. Echocardiography is the most common modality in clinical practice for the evaluation of cardiac function. However, RV function and the morphology are not necessarily measured in a routine fashion. Right ventricular fractional area change（FAC）, tricuspid annulus plane systolic excursion（TAPSE）, and systolic peak velocity at tricuspid annulus（S’）are used as indices of RV function. Recently, strain analysis of cardiac tissues has been developed to assess regional and global cardiac performance. Two dimensional（2D）RV free wall strain（longitudinal strain）may be measured in the four chamber view, and it is reported that RV free wall strain is a useful predictor in patients with pulmonary hypertension1. Right ventricular free wall strain might be used as an estimate of the systolic function of RV.
Right ventricular deterioration is seen both in the function and in the morphology. High afterload for RV causes hypertrophy and enlargement in RV as a part of adaptation process. It is hard to recognize the turning point of adaptive remodeling and maladaptive remodeling. The potential of RV volume measured by three dimensional echocardiography as an index to distinguish adaptive and maladaptive remodeling is reported recently2. It is difficult to evaluate RV morphology by 2D echocardiography because of the complex geometry. However, we should pay attention to RV morphology as well as the function.
Enlarged RV pushes the septum and result in reduction of the LV volume because they share the common space in pericardial sac. Therefore, there is an interaction between RV and LV. However, it has not been discussed sufficiently.
We would like to discuss in this session about the importance of RV evaluation and interaction between RV and LV.
1.Fine NM, Chen L, Bastiansen PM, Frantz RP, Pellikka PA, Oh JK, et al. Outcome prediction by quantitative right ventricular function assessment in 575 subjects evaluated for pulmonary hypertension. Circ Cardiovasc Imaging 2013;6:711-721.
2.Ryo K, Goda A, Onishi T, Delgado-Montero A, Tayal B, Champion HC, et al. Characterization of right ventricular remodeling in pulmonary hypertension associated with patient outcomes by 3-dimensional wall motion tracking echocardiography. Circ Cardiovasc Imaging 2015;8.