Assessment of Right Ventricular Performance by 4D Echocardiography and 2D Speckle Tracking in Patients with Inferior Defect Detected by SPECT Imaging

Early detection of subtle right ventricular dysfunction has a good prognostic value and redirects the treatment strategy plans. Our aim is to assess the right ventricular performance by 2D speckle tracking and 4D echocardiography in patients with inferior hypo-perfusion defects detected by SPECT imaging. A hospital based cross sectional study included 40 individuals, positive for inferior wall hypo-perfusion defect by SPECT MPI imaging. The study group individuals underwent full history taking, clinical examination, conventional echocardiography, tissue Doppler imaging (TDI), 2D-speckle tracking, and 4D-echocardiography of the RV. 16 patients (40%) of our study population showed decreased average global RV longitudinal strain (-14.92±1.81) and decreased 4D RV function (EF%) 34.32 ± 7.65. TAPSE was decreased in the impaired group (14 ± 2.28) compared to (20.96 ± 2.64) in the preserved group. Qualitative analysis of the perfusion scan showed mild increase in the lung heart ratio among the impaired group (0.34 ± 0.69) compared to the preserved group (0.3 ± 0.04), with increased RV uptake among 7 cases from the impaired group as compared to only 2 cases from the preserved group. 68.8% of the RV impaired study group had MPI hypo-perfusion defects in inferior, infero-septal, and infero-apical regions compared to only (12.5%) of the preserved group. The impaired group showed totally scared defects (37.5%) compared to only (12.5%) of the preserved group. Our finding highlights that speckle tracking and 4D echocardiography enable more accurate assessment of the RV morphology and functions. Furthermore, SPECT imaging could be a good guide for the culprit stenosed artery.