Right ventricle

The contractile function of the RV is difficult to measure in clinical practice due to its complex anatomy. Historically, little attention has been paid to this particular chamber, because its roll was wrongly assumed to be passive. Only in the last three decades it has been shown that the function of the RV plays an important role in the survival of many cardiac conditions. Therefore, echocardiographic evaluation of the right ventricular anatomy and function has increasingly gained interest.

RV size

Parameter Mean ± SDNormal range
RV basal diameter (mm)33 ± 425 – 41
RV mid diameter (mm)27 ± 419 – 35
RV longitudinal diameter (mm)71 ± 659 – 83
RVOT PLAX diameter (mm)25 ± 2.520 – 30
RVOT proximal diameter (mm)28 ± 3.521 – 35
RVOT distal diameter (mm)22 ± 2.517 – 27
RV Wall thickeness3 ± 11 – 5
Area by gender
RVOT EDA (cm²) MALE17 ± 3.510 – 24
RVOT EDA (cm²) FEMALE14 ± 38 – 20
RV EDA BSA (cm/m²) MALE8.8 ± 1.95 – 12.6
RV EDA BSA (cm/m²) FEMALE8.0 ± 1.754.5 – 11.5
RV ESA (cm/m²) MALE9 ± 33 – 15
RV ESA (cm/m²) FEMALE7 ± 23 – 11
RV ESA BSA (cm/m²) MALE4.7 ± 1.352.0 – 7.4
RV ESA BSA (cm/m²) FEMALE4.0 ± 1.21.6 – 6.4
Volume by gender
RV EDV BSA (mL /m²) MALE61 ± 1335 – 87
RV EDV BSA (mL /m²) FEMALE53 ± 10.532 – 74
RV ESV BSA (mL /m²) MALE27 ± 8.510 – 44
RV ESV BSA (mL/m²) FEMALE22 ± 78 – 36
EDA, end-diastolic area ; ESA, end-systolic area; EDA, end-diastolic volume ; ESA, end-systolic volume

RV function

ParameterAbnormality threshold
TAPSE (mm)<17
PW Doppler S wave (cm/s)<9.5
Color Doppler S wave (cm/s)<6.0
RV FAC (%)<35
RV Freewall strain* (%)> -20
RV 3D EF (%)<45
PW Doppler MPI>0.43
Tissue Doppler MPI>0.54
DecT (ms)<119 or >242
E/A<0.8 or >2.0
é (cm/s)<7.8

RV strain

VariableLRVMean (95% CI)URV
2D peak strain rate at the base (s)0.70 (0.50-0.90)1.62 (1.50-1.74)2.54 (2.34-2.74)
2D peak strain rate at the mid cavity (s)0.85 (0.66-1.04)1.54 (1.46-1.62)2.23 (2.04-2.42)
2D peak strain rate at the apex (s)0.86 (0.46-1.25)1.62 (1.46-1.79)2.39 (1.99-2.78)
2D peak strain at base (%)18 (14-22)28 (25-32)39 (35-43)
2D peak strain at mid cavity (%)20 (15-24)29 (25-33)38 (34-43)
2D peak strain at the apex (%)19 (15-22)29 (26-32)39 (36-43)
Doppler peak strain rate at the base (s)1.00 (0.63-1.38)1.83 (1.50-2.15)2.66 (2.28-3.03)
Doppler peak strain rate at mid cavity (s)0.98 (0.68-1.28)1.88 (1.73-2.03)2.79 (2.49-3.09)
Doppler peak strain rate apex (s)1.14 (0.60-1.69)2.04 (1.57-2.51)2.93 (2.39-3.48)
Doppler peak strain at the base (%)13 (09-17)29 (27-31)45 (41-49)
Doppler peak strain mid cavity (%)13 (9-18)31 (29-32)48 (44-52)
Doppler peak strain apex (%)17 (12-21)30 (27-34)44 (39-48)
CI, Confidence interval; LRV, lower reference value; URV, upper reference value .
Reference limits cannot be recommended, because of very wide confidence intervals both around the mean values and around the reference limits. Strain and strain rate remain research tools in experienced labs until their limita- tions can be overcome.

Tricuspid Annular Plane Systolic Excursion (TAPSE)

TAPSE is a method to measure the distance from the systolic excursion of the RV annulus in longitudinal direction to the apex, in a standard apical 4-chamber view. TAPSE represents the longitudinal function of the RV. The amplitude of movement of the RV base towards the apical direction in systole represents the RV systolic function. This assumes that the displacement of the basal and adjacent segments represents the entire function of the RV. This assumption, however, is not valid in a number of diseases, especially when RV regional wall motion abnormalities exist. TAPSE is obtained by placing an M-mode cursor through the tricuspid valve annulus in the apical 4chamber view. Hence, the distance can be measured from the longitudinal movement of the annulus from base to peak during the cardiac cycle. In validated studies TAPSE correlates strongly with radio-nuclear angiography, with a low interobserver variability. It is also validated with biplane Simpson RVEF and RV FAC.

Good RV function
Decreased RV function


JASE 2010 Jul;23(7):685-713
JASE 2015 Jan;28(1):1-39.e14