Right ventricular function in Ebstein disease: Comparative value of three-dimensional echocardiography and myocardial imaging echocardiography

Background: The aim of the present study was to assess right ventricular function in Ebstein’s patients (pts) using three-dimensional echocardiography (3DE), Tissue Doppler Imaging (TDI) and Speckle Tracking Imaging (STI) to better understand the relationship between anatomic derangement and functional severity. Methods: We studied 13 pts aged 16-67 years and 13 age- and gender-matched controls with no signs of heart disease (CTR). Standard 2D and Doppler parameters were assessed. 3DE was performed as a full-volume scan of the LV and RV from the apical position using a system equipped with a real-time X3 transducer (Vivid 9 ultrasound system, GE, Horten, Norway). RV and LV annular peak systolic and diastolic velocities were measured by TDI. RV and LV peak systolic strain, peak systolic strain rate, and early and late diastolic strain rate were obtained in the basal, mid and apical segments in apical 4-chamber view both by TDI and STI. All measurements were taken from an acceptable tracing and determined using offline analysis programs (EchoPAC, version 9.0, GE Ultrasound). Results: Peak systolic strain and systolic and diastolic strain rate at apical and mid level were lower in pts than in CTR (p<0.001). No correlation was found between E/A ratio, deceleration time, and anatomic derangement. A significant relationship was shown between apical peak systolic strain and the ratio of proximal to distal right ventricle (r=-0.72, p<0.005) and between apical peak systolic strain and apical displacement of septal/posterior leaflet (r=-0.61, p<0.05). A significant relationship was also obtained between mean peak systolic strain at RV free wall (RVFW) site and 3DE-RVEF (r=0.81, p<0.001) and mean peak systolic strain rate at RVFW site and 3DE-RVEF (r=0.84, p<0.001). Conclusion: Our data show that 3DE and myocardial imaging echocardiography (TDI, STI) have potential clinical value in the management of patients with Ebstein disease and may enable morphological and functional assessment of this complex heart disease.