An abnormal right ventricular apical angle is indicative of global right ventricular impairment

The presence of right ventricular (RV) dysfunction is an adverse prognostic indicator but current echocardiographic methods have some limitations. RV apical angles in systole and diastole were correlated with known parameters of RV function in patients without pulmonary hypertension (Group 1) and in patients with pulmonary hypertension (Group 2). RV apical angles were significantly smaller in both systole (22 +/- 7 degrees) and diastole (33 +/- 6 degrees) in Group 1 patients when compared to Group 2 (54 +/- 18 degrees, p < 0.0001 and 59 +/- 17 degrees, p < 0.0001, respectively). RV apical angles, both in systole and diastole, were strongly correlated with RV end-systolic area (R = 0.89, p < 0.0001) and end-diastolic area (R = 0.81, p < 0.0001), respectively. Similarly, the apical systolic and diastolic angle correlated well with decreased tricuspid annular plane systolic excursion (TAPSE, R = -0.76 and R = -0.73, p < 0.001) as well as with decreased RV fractional area change (R = -0.81 and R = -0.77, p < 0.001). Therefore, we conclude that this new measurement of RV apical angle is simple and useful to quantify RV apical structural and functional abnormalities that are well correlated with global RV impairment in patients with chronic pulmonary hypertension.