From the Departments of Cardiology (T.G., A.J.P., E.C.C., S.D.C.) and
Radiology (T.C.), Children's Hospital, and the Departments of Pediatrics
and Radiology, Harvard Medical School, Boston, Mass.
Correspondence to Tal Geva, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail geva_t{at}a1.tch.harvard.edu
Background—Accurate quantitative
evaluation of right ventricular (RV) function has been
limited by its complex structural geometry. Although embryological and
anatomic observations suggest that the RV is composed of 2 distinct
components, the RV sinus and infundibulum, most studies on RV
dimensions and function viewed it as a single chamber. This study was
designed to determine the volumes, relative contribution to global
systolic function, and temporal course of contraction and
relaxation of the RV sinus and infundibulum.
Methods and Results—Thirty-one individuals without heart disease
(aged 1 month to 17 years, 16 boys and 15 girls) participated in this
study. Instantaneous area over time, its derivatives, and the temporal
course of contraction and relaxation were studied by acoustic
quantification echocardiography and
phonocardiography in 20 individuals. Global and regional RV volumes and
ejection fraction were determined by cine MRI in 11 individuals. The RV
sinus made up 81±6% of the combined RV end-diastolic
volume and 87±4% of the combined stroke volume. The infundibulum
accounted for the remaining 19±6% and 13±4%, respectively
(P<0.0001). Compared with the infundibulum, the extent
of RV sinus fiber shortening was significantly greater: for ejection
fraction (56±11% versus 38±13%, P<0.001),
fractional area change (42±14% versus 28±9%,
P<0.0001), and dA/dt (27±17% versus 13±6%,
P<0.0001). Analysis of temporal course of
contraction and relaxation (expressed as percentage of the cardiac
cycle to adjust for differences in heart rate) showed that the
infundibulum follows the RV sinus: onset of contraction 53%±14 versus
19±11% of systole, time to peak systole 115±16% versus 97±19%
(P
Conclusions—The results of this study demonstrate significant
regional differences between the sinus and infundibulum components of
the RV with regard to contribution to stroke volume, extent of fiber
shortening, and sequence of mechanical activation. These data from
normal individuals can be used in future research on RV function in
pathological conditions.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Evaluation of Regional Differences in Right Ventricular Systolic Function by Acoustic Quantification Echocardiography and Cine Magnetic Resonance Imaging
0.01), indicating a peristalsis-like pattern of
contraction and relaxation.
Key Words: ventricles • magnetic resonance imaging • echocardiography
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