Acute Right Ventricular Dysfunction in Intensive Care Unit

Table 2

Cut-off values of RV structural and functional parameters and RV afterload assessment.

RV structural parameters	RV functional parameters	RV afterload assessment
Basal RV diameter > 42 mm	RV fractional area change ≥ 35%	AccT < 100 msec
RV mid-diameter > 33 mm	MPI^§ > 0.43 (pulsed Doppler); >0.54 (tissue Doppler)	Shape of doppler RV outflow tract envelope:
RV EDD/LV EDD > 0.9	TAPSE < 16 mm	(i) No notch
RV/LV EDA > 0.6	S wave° < 10 cm/s	(ii) Late notch
LV eccentricity index > 1	Peak RV free wall 2D strain >−20%	(iii) Midsystolic notch
McConnell’s sign
RV wall thickness > 5 mm

AccT: acceleration time of RV outflow tract flow; EDD: end-diastolic diameter; EDA: end-diastolic area; LV: left ventricle; RV: right ventricle; MPI: myocardial performance index (the ratio of the sum of isovolumic contraction plus relaxation time and ejection time intervals); S wave: peak velocity of systolic excursion at the lateral tricuspid annulus; TAPSE: tricuspid annular plane systolic excursion. The presence and position of the systolic notching are related to the pulmonary dynamic afterload severity and RV dysfunction in patients referred for PH [31]. The presence of midsystolic notch is associated with the worst hemodynamic profile. TTE: apical four-chamber; TEE: mid esophageal four-chamber; TTE: parasternal midpapillary short axis; TEE: transgastric midpapillary short axis; °TTE: apical four-chamber; TEE: deep transgastric RV; RV-focused four-chamber view. M-mode imaging at the lateral tricuspid valve plane.