rv dilatation vs hypertrophy | Dr.S.Venkatesan MD

Posts Tagged ‘rv dilatation vs hypertrophy’

Trying to answer two casual queries on RV dysfunction

Posted in Uncategorized, tagged lv function impact on rv function, rv dilatation vs hypertrophy, rv dysfunction, tapse limitations, transverse vs longitudinal rv function on August 3, 2024|

1.What is the response of RV to pressure overload ?

A. Dilatation

B. Hypertrophy

C Both occur together

D. Hypertrophy is the Initial response, followed by dilatation

Answer :

Since we believe RV’s behavior is generally opposite to that of LV , many would tick, dilatation as the first response. This may be correct when there is acute raise in RV after load, as in PE. However, It is surprising even in chronic pulmonary hypertension , the degree of RVH is not constant and homogenous .This is because , different parts of RV chamber has different wall thickness .Further, the pressure distribution from PA to RV is uneven. The co-existing TR confounds the loading conditions. It is not yet clear, how the RV would respond to raised PA pressure. In the bed side, we are seeing both flight(dilate) ot fight (RVH) reactions from RV (more often the former than the later) It is possible RV behavior is be pre-programed and built into the genes of the contractile proteins.

It is worthwhile to note, RVH is constant feature in non pulmonary hypertension related “after-load” conditions as in valvular or sub valvular PS. This is more to do failure of regression of RV mass early after birth, rather than the actual effect of high after load. Another point is purely technical. RVH is measured in RV free wall, in subcostal view in diastole and inspiratory phase.(upper limit is 4mm) Many of us could miss RVH in routine echocardiography unless specifically looked for.

2.Which is the first echocardiographic parameter to get impaired when RV fails ?

A. RV FAC (Fractional area change)

B.TAPSE

C. RV Ejection fraction

D.RV longitudinal strain

E. RV S‘

Answer : I am not very sure about the right answer , but TAPSE is last to get Impaired .(Still, we celebrate it like anything is a different story) Many believe transverse functional Indices like FAC is impaired early. and is less influenzed by the spurious spill over of Left ventricular contractile force in transannular plane (Which augments longitudinal functional Index like TAPSE),

The following illustration (From Ref 2 ) summarizes all RV functional parameter in a succinct fashion. Fellows must be familiar with at-least half of them.( RIMP is less practical and error prone can be ignored)