Multimodality Evaluation of the Right Ventricle: An Updated Review

Abstract

The assessment of the volumes, function, and mechanics of the right ventricle (RV) is very challenging because of the anatomical complexity of the RV. Because RV structure, function, and deformation are very important predictors of cardiovascular morbidity and mortality in patients with heart failure, pulmonary hypertension, congenital heart disease, or arrhythmogenic RV cardiomyopathy, it is of great importance to use an appropriate imaging modality that will provide all necessary information. In everyday clinical practice, 2-dimensional echocardiography (2DE) represents a method of first choice in RV evaluation. However, cardiac magnetic resonance (CMR) remained the gold standard for RV assessment. The development of new imaging tools, such as 3-dimensional echocardiography (3DE), provided reliable data, comparable with CMR, and opened a completely new era in RV imaging. So far, 3DE has shown good results in determination of RV volumes and systolic function, and there are indications that it will also provide valuable data about 3-dimensional RV mechanics, similar to CMR. Two-dimensional echocardiography-derived strain is currently widely used for the assessment of RV deformation, which has been proven to be a more significant predictor of functional capacity and survival than CMR-derived RV ejection fraction. The purpose of this review is to summarize currently available data about RV structure, function, and mechanics obtained by different imaging modalities, primarily 2DE and 3DE, and their comparison with CMR and cardiac computed tomography.

Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

“…Additionally, the authors have shown that RV GLS < −20% is the most sensitive and specific predictor of RV dysfunction . Investigations have revealed RV GLS as one of the most important predictors of cardiovascular and total morbidity and mortality in a large number of cardiovascular disorders . Figure represents the evaluation of RV longitudinal strain.…”

“…The development of cardiovascular medicine, particularly the improvement of cardiac imaging techniques, has revealed that the RV has a vital role in global cardiac function, cardiovascular and total morbidity, and mortality. Not only in diseases that predominantly involve pulmonary circulation, such as pulmonary hypertension and congenital heart diseases, but also in conditions that primarily affect the left ventricle (LV), such as heart failure and mitral and aortic valve disease …”

“…Cardiac magnetic resonance and cardiac computer tomography are more accurate and provide better insight, but their availability and cost still represent the major limitation to their usage in everyday clinical practice. The introduction of three‐dimensional echocardiography (3DE) and speckle tracking imaging has significantly changed the approach to the RV evaluation providing the information regarding RV size, shape, function, and mechanics …”

Multimodality Imaging of the Right Ventricle

“…While this method requires increased radiation exposure, it provides dynamic images throughout the cardiac cycle allowing for precise and reproducible quantification of RV volume and function. 39 While CMR is traditionally used more frequently for quantification of volumes and ejection fraction, CT can be used as an alternative modality when CMR is contraindicated or unavailable. 14 CT like CMR provides multiplanar imaging of the RV with excellent endocardial definition and high spatial resolution.…”

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

“…The importance of right ventricular (RV) structure and function has been underestimated in comparison with left ventricular remodeling for a long time. However, studies have shown that its structure and function is very important in patients with congenital heart disease and pulmonary hypertension, but afterward, the important role of RV remodeling has been proved in the patients with heart failure, heart transplantation, cardiomyopathies, and valvular heart disease . The influence of aortic stenosis (AS) and particularly of AS severity on RV remodeling is still debatable, and the data are scarce .…”