The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance

Background: Assessment of right ventricular (RV) function remains challenging because of complex RV chamber geometry and a paucity of easily derived and objective functional methods. Methods: Visual 2-dimensional echocardiographic estimates of RV ejection fraction (EF), tricuspid annular plane systolic excursion, Doppler tissue imaging, and myocardial performance index (MPI) were compared with biplanar Simpson's rule RV EF in 101 consecutive patients. Data were analyzed using simple linear regression and receiver operating characteristic curves. Results: RV EF was significantly correlated with tricuspid annular plane systolic excursion (r = 0.48, P <.0001), Doppler tissue imaging peak systolic velocity (r = 0.45, P <.0001), and MPI (r = -0.38, P =.006). Using a Simpson's RV EF < 50%, the sensitiv-ity, specificity, and positive and negative predictive values of tricuspid annular plane systolic excursion < 1.5 cm were 59%, 94%, 71%, and 89%; of Doppler tissue imaging peak systolic velocity < 10 cm/s were 59%, 92%, 67%, and 89%; and of MPI < 0.40 were 100%, 35%, 29%, and 100%, respectively. The area under the receiver operating characteristic curves was similar for the 3 indices. Conclusions: Measurements of tricuspid annular motion are easy to obtain, correlate with Simpson's RV EF, and have a high specificity and negative predictive value for detecting abnormal RV systolic function; and the MPI, although not specific, has high sensitivity and negative predictive value for detecting abnormal RV systolic function.