Forgotten No More—The Role of Right Ventricular Dysfunction in Heart Failure with Reduced Ejection Fraction: An Echocardiographic Perspective

Abstract

During the last decade, studies have raised awareness of the crucial role that the right ventricle plays in various clinical settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they show good correlation with the gold standard represented by cardiac magnetic resonance. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature.

Right Ventricular Longitudinal Strain in Patients with Heart Failure

“…The myocardium can be directly or indirectly damaged through the systemic pathway by these diseases, which usually lead to myocardial hypertrophy and myocardial fibrosis (MF), resulting in RV myocardial dysfunction [77]; In addition, neurohumoral activation in left-sided HF may have adverse influences on RV function. 4 Atrial fibrillation. Shortened ventricular filling time resulting from atrial fibrillation can give rise to the increased left atrial pressure load, which cause an increase in pulmonary vein and pulmonary capillary pressure, followed by an increase in pulmonary artery pressure and RV afterload [77].…”

“…Heart failure (HF) is a clinical syndrome with typical symptoms and signs caused by abnormal structure and function of heart [ 1 ]. HF is the end stage of various cardiovascular diseases with high prevalence, and it remains a serious public health problem [ 2 , 3 , 4 , 5 ]. Accurate identification of predictors of adverse outcomes of HF can help clinicians to detect high-risk patients early and provide timely intervention, which is of great clinical significance for improving long-term survival of patients.…”

“…In recent years, myocardial strain measured by speckle tracking echocardiography (STE) has become an established echocardiographic parameter for the diagnosis and prognostic assessments of patients with cardiovascular diseases [ 23 ]. RV strain obtained by STE, being able to detect RV subclinical dysfunction in the early stage, has been regarded as a more sensitive parameter for evaluating RV function and has important prognostic significance in patients with HF [ 4 , 16 , 24 , 25 , 26 , 27 ]. Therefore, RV strain suggested by the American Society of Echocardiography (ASE) has been quite useful in clinical practice as a complement to the routine echocardiography parameters, such as TAPSE or RVFAC [ 28 ].…”

My Approach To Echocardiographic Assessment In Pulmonary Hypertension

“…The clinical need for an accurate RV assessment and the technological advancement of software favored the study of numerous parameters in the search for an earlier diagnosis to delay the disease's natural course. 9 Cardiac resonance, the gold standard for functional analysis 1. Use several windows (apical four-chamber, short-axis, subcostal, or other modified positions) to obtain the best regurgitant jet envelope.…”

“…The low availability of software in devices and the few studies of its standardization among manufacturers are real limitations in daily practice. 9,11 The presence of pericardial effusion and measurements of right ventricular diameters and thickness are additional parameters useful in analyzing the severity of pulmonary hypertension and its hemodynamic repercussion on the right chambers (Table 5).…”