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Right Ventricular Ejection Fraction
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Author: Steve Leung

Date: 11/1/2017

Indications and Purpose of the Scan

  • In patients with suspected right ventricular pathology such as significant valvular heart disease, left to right shunts, complex congenital heart disease, or arrhythmogenic right ventricular dysplasia, CMR is a highly reproducible method of assessing the right ventricular volume and ejection fraction.

Description 

  • Images already used to calculate left ventricular volumes and ejection fraction can be used for right ventricular volume and ejection fraction calculation without any additional time.  Additional views can be obtained to evaluate the right ventricular free wall motion. 

Why CMR (Specific Advantages)

  • The right ventricle is a difficult cardiac structure to image with traditional cardiac modalities such as transthoracic echocardiography.
  • With CMR, the right ventricle can be easily visualized, and highly reproducible volumetric and systolic function assessment can be performed, even in patients with congenital heart disease.1, 2
  • A variety of cardiac pathology that can affect the right ventricle can be easily identified with cardiac MRI. Primary pathology that can affect the right ventricle include:  Arrhythmogenic right ventricular dysplasia, Uhl's anomaly, Ebstein's anomaly.  Right ventricular infarct, thrombus, sarcoidosis can also be easily identified with cardiac MRI.  In patients with tetralogy of Fallot and other complex congenital heart disease, left-to-right shunts (e.g. atrial septal defects, anomalous pulmonary venous return), pulmonary hypertension, severe tricuspid or pulmonic valvular regurgitation, the effect on the right ventricle can be reliably measured and follow over time.3-5

Evidence

1.  Mooij CF, de Wit CJ, Graham DA, Powell AJ, Geva T.  Reproducibility of MRI measurements of right ventricular size and function in patients with normal and dilated ventricles.  J Magn Reson Imaging. 2008 Jul;28(1):67-73.

a.    20 normal volunteers, 20 patients with ASD and 20 patients with Tetralogy of Fallot underwent CMR.  Right ventricular volume and ejection fraction were obtained from short axis cine, and were measured by 2 independent readers and had high inter- (ICC: 0.94-0.99) and intra-observer (ICC = 0.96-0.99) reprodcubitility

 

2.  Clarke CJ, Gurka MJ, Norton PT, Kramer CM, Hoyer AW. Assessment of the accuracy and reproducibility of RV volume measurements by CMR in congenital heart disease.  JACC Cardiovasc Imaging. 2012 Jan;5(1):28-37

b.    50 patients with congenital heart disease underwent CMR. Right ventricular volume and ejection fraction were obtained based on both short axis cines and axial cines, and were measured 3 times.  There was high inter- and intra-observer reproducibility with both methods.

 

Contraindications

  • Contraindications to MRI.  Arrhythmias, patient’s inability to hold their breath can limit the accuracy of the measurements. 

Appropriateness3

  • Evaluation of Ventricular and Valvular Function Procedures may include LV/RV mass and volumes: Assessment of complex congenital heart disease including anomalies of coronary circulation, great vessels, and cardiac chambers and valves:  A (9)
  • Evaluation for arrhythmogenic right ventricular cardiomyopathy (ARVC), patients presenting with syncope or ventricular arrhythmia:   A (9)

More Information

References

  1. Mooij CF, de Wit CJ, Graham DA, Powell AJ, Geva T.  Reproducibility of MRI measurements of right ventricular size and function in patients with normal and dilated ventricles.  J Magn Reson Imaging. 2008 Jul;28(1):67-73.
  2.  Clarke CJ, Gurka MJ, Norton PT, Kramer CM, Hoyer AW. Assessment of the accuracy and reproducibility of RV volume measurements by CMR in congenital heart disease.  JACC Cardiovasc Imaging. 2012 Jan;5(1):28-37
  3.  Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006 Oct 3;48(7):1475-97.
  4.  Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP Jr, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD.  ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008 Dec 2;118(23):e714-833
  5.  Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DM, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W.  Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J. 2010 Apr;31(7):806-14.
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