International Journal of Cardiology 172 (2014) e30

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International Journal of Cardiology

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Letter to the Editor

The forgotten valvulopathy and the forgotten ventricle?

María Martín a,⁎, Cecilia Corros a, Ana García-Campos a, María Luisa Rodríguez a, Santiago Colunga a,José Rozado a, Vicente Barriales a, Jesús de la Hera a, Elena Santamarta b

a Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spainb Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain

⁎ Corresponding author at: Cardiology Department,Universitario Central de Asturias, Avda Julián Clavería s/nTel.: +34 98510800.

E-mail address: mmartinf7@hotmail.com (M. Martín)

0167-5273/$ – see front matter © 2014 Elsevier Ireland Lhttp://dx.doi.org/10.1016/j.ijcard.2013.12.089

a r t i c l e i n f o

Article history:

Received 27 September 2013Accepted 21 December 2013Available online 4 January 2014

Keywords:Tricuspid regurgitationRight ventricle functionCardiac MR

systolic velocity at the tricuspid annulus or pulsed or tissue Dopplermyocardial performance index. However, none of these methods is asuseful as Cardiac MR in the evaluation of the RV both in terms of ana-tomical delineation, function quantification and tissue characterization[2]. What is more, recent studies have shown low correlation with theechocardiographic method [3].

Usefulness of Cardiac MR goes beyond the only assessment of RVfunction, which is crucial not only in tricuspid regurgitation but alsoduring the follow-up of congenital heart diseases; it seems to be a

Dear Editor

We have read with great interest and admiration the fantastic man-uscript entitled “Functional tricuspid regurgitation: An underestimatedissue”whichwill be published in your journal. DiMauro et al. havewrit-ten a complete review about the “forgotten valvulopathy” [1]. As it is re-ferred by the authors, although severe tricuspid regurgitation can bewell tolerated during years, it has a poor prognosis. The prolonged over-load burden over right ventricle (RV) may result in its progressive dila-tation and irreversible dysfunction. For this reason, it is fundamental toevaluate right ventricular size and function accurately. About this mat-ter, both 2D echocardiography and real-time-three-dimensional-echo-cardiography, although useful for the evaluation of tricuspid anatomyand function, have important limitations in the right ventricle assess-ment. Cardiovascular magnetic resonance (Cardiac MR) has emergedas “the standard of reference” for RV morphology and function. It hasthe capability of providing an accurate and reproducible assessment offunction and tissue characterization [2].

Traditionally, 2D echocardiography has been the method of choicefor evaluating RV function by means of TAPSE (tricuspid annular plane

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systolic excursion), RV fractional area change, tissue Doppler peak

good method for non invasive assessment and monitoring of patientswith pulmonary arterial hypertension [4]. Other frequent well-recognized indications are the evaluation of cardiomyopathies likearrytmoghenic RV dysplasia or ischaemic heart disease with involve-ment of the RV.

For all these reasons, and in conclusion, we think that Cardiac MRplays a crucial role in the complete evaluation of RV morphology andfunction, especially in patients with severe tricuspid regurgitation be-fore surgery.

References

[1] Di Mauro M, Bezante GP, Di Baldassarre A, et al. Italian Study Group on ValvularHeart Disease (Italian Society of Cardiology). Functional tricuspid regurgitation:an underestimated issue. Int J Cardiol 2013;168:707–15.

[2] Galea N, Carbone I, Cannata D, et al. Right ventricular cardiovascular magnetic reso-nance imaging: normal anatomy and spectrum of pathological findings. Insights Im-aging 2013 Apr;4(2):213–23.

[3] Souto Bayarri M, Masip Capdevila L, Remuiñan Pereira C, et al. Cardiac magnetic res-onance analysis of right ventricular function: comparison of quantification in theshort-axis and 4-chamber planes. Radiologia 2013 Apr 23, http://dx.doi.org/10.1016/j.rx.2013.02.004 (S0033-8338(13)00067-2).

[4] Vonk-Noordegraaf A, Souza R. Cardiac magnetic resonance imaging: what can it addto our knowledge of the right ventricle in pulmonary arterial hypertension? Am JCardiol 2012 Sep 15;110(6 Suppl.):25S–31S.