Evaluation of Right and Left Ventricular Function in Ebstein Anomaly Using RVGLS and LVGLS: A Narrative Literature Review

Authors

  • Matthew Risdian Pratama Sembiring Medical Programme, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Achmad Lefi Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Dian Paramita Kartikasari Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

DOI:

https://doi.org/10.37012/jik.v17i2.3133

Keywords:

Ebstein anomaly, RVGLS, LVGLS, Left ventricular dysfunction, Right ventricular dysfunction.

Abstract

Ebstein anomaly is a rare congenital heart defect characterized by tricuspid valve malformation, atrialization of the RV, and hemodynamic disturbances that may affect both ventricles. Assessing ventricular function in this condition is essential because it is closely related to disease progression, clinical symptoms, and long term prognosis. Conventional parameters such as TAPSE, RVFAC, and LVEF are commonly used but have limitations. Speckle Tracking Echocardiography (STE), through Right Ventricular Global Longitudinal Strain (RVGLS) and Left Ventricular Global Longitudinal Strain (LVGLS), provides higher sensitivity for detecting ventricular dysfunction. This narrative literature review evaluates the role of RVGLS and LVGLS in patients with Ebstein anomaly. Evidence shows that RVGLS is more accurate in identifying RV dysfunction compared with TAPSE and RVFAC, and possesses strong prognostic value for mortality. LVGLS can detect LV dysfunction at a subclinical stage even when LVEF remains preserved, reflecting involvement of longitudinal myocardial fibers due to ventricular interdependence and secondary remodeling. After tricuspid valve surgery, both RVGLS and LVGLS remain sensitive indicators of changes in ventricular performance. Overall, RVGLS and LVGLS demonstrate superiority over conventional systolic parameters and are recommended as primary tools for evaluating biventricular function in patients with Ebstein anomaly

Author Biographies

Matthew Risdian Pratama Sembiring, Medical Programme, Faculty of Medicine, Universitas Airlangga, Surabaya

Medical Programme, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Achmad Lefi, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Dian Paramita Kartikasari, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya

Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

References

Egbe, A. C., Miranda, W. R., Dearani, J. A., & Connolly, H. M. (2021a). Hemodynamics and Clinical Implications of Occult Left Ventricular Dysfunction in Adults Undergoing Ebstein Anomaly Repair. Circulation: Cardiovascular Imaging, 14(2), E011739. https://doi.org/10.1161/CIRCIMAGING.120.011739

Egbe, A. C., Miranda, W. R., Dearani, J., & Connolly, H. M. (2021b). Left Ventricular Global Longitudinal Strain Is Superior to Ejection Fraction for Prognostication in Ebstein Anomaly. In JACC: Cardiovascular Imaging (Vol. 14, Issue 8, pp. 1668–1669). Elsevier Inc. https://doi.org/10.1016/j.jcmg.2021.01.036

Egbe, A. C., Miranda, W. R., Jain, C. C., Andi, K., Abozied, O., Younis, A. K., Kandlakunta, S., Salama, A. A., Stephens, E. H., & Connolly, H. M. (2023). Prognostic Performance of Right Ventricular Global Longitudinal Strain Measurements in Patients With Ebstein Anomaly. Journal of the American College of Cardiology, 82(6), 503–513. https://doi.org/10.1016/j.jacc.2023.05.045

Fratz, S., Janello, C., Müller, D., Seligmann, M., Meierhofer, C., Schuster, T., Schreiber, C., Martinoff, S., Hess, J., Kühn, A., Vogt, M., & Stern, H. (2013). The functional right ventricle and tricuspid regurgitation in Ebstein’s anomaly. International Journal of Cardiology, 167(1), 258–261. https://doi.org/10.1016/j.ijcard.2011.12.081

Holst, K. A., Connolly, H. M., & Dearani, J. A. (2019). Ebstein’s Anomaly. Methodist DeBakey Cardiovascular Journal, 15(2), 138. https://doi.org/10.14797/mdcj-15-2-138

Jost, C. H. A., Connolly, H. M., Dearani, J. A., Edwards, W. D., & Danielson, G. K. (2007). Ebstein’s anomaly. Circulation, 115(2), 277–285. https://doi.org/10.1161/CIRCULATIONAHA.106.619338

Meng, H., Wan, L.-Y., Qu, R., Liu, Q.-Q., Li, M.-Z., Li, Y.-D., Pan, S.-W., Li, S.-J., Wang, Q., Yan, J., & Yang, K.-M. (2024). Biventricular function after Ebstein anomaly repair from a single-center echocardiography study. Hellenic Journal of Cardiology. https://doi.org/10.1016/j.hjc.2024.05.019

Mihos, C. G., Liu, J. E., Anderson, K. M., Pernetz, M. A., O’Driscoll, J. M., Aurigemma, G. P., Ujueta, F., Wessly, P., Banchs, J., Marwick, T. H., Muraru, D., Qamruddin, S., & Sitges, M. (2025). Speckle-Tracking Strain Echocardiography for the Assessment of Left Ventricular Structure and Function: A Scientific Statement from the American Heart Association. Circulation, 152(10), e96–e109. https://doi.org/10.1161/CIR.0000000000001354

Prota, C., Di Salvo, G., Sabatino, J., Josen, M., Paredes, J., Sirico, D., Pernia, M. U., Hoschtitzky, A., Michielon, G., Citro, R., Fraisse, A., & Ghez, O. (2019). Prognostic value of echocardiographic parameters in pediatric patients with Ebstein’s anomaly. International Journal of Cardiology, 278, 76–83. https://doi.org/10.1016/j.ijcard.2018.10.046

Ricci, P., Ostenfeld, E., Flick, C., West, C., Babu-Narayan, S., Nihoyannopoulos, P., & Li, W. (2020). Assessment of biventricular function using advanced echocardiography in patients with Ebstein’s anomaly pre and post-tricuspid valve surgery. European Heart Journal, 41(Supplement_2). https://doi.org/10.1093/ehjci/ehaa946.0147

Singh, D. P., Hussain, K., Horenstein, M. S., & Mahajan, K. (2025). Ebstein Anomaly and Malformation.

Downloads

Published

2025-11-12

How to Cite

Sembiring, M. R. P., Lefi, A., & Kartikasari, D. P. (2025). Evaluation of Right and Left Ventricular Function in Ebstein Anomaly Using RVGLS and LVGLS: A Narrative Literature Review. Jurnal Ilmiah Kesehatan, 17(2), 210–217. https://doi.org/10.37012/jik.v17i2.3133

Citation Check