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Imaging the right ventricle—current state of the art

Nature Reviews Cardiology volume 7, pages 551–563 (2010)Cite this article

Subjects

Abstract

The right ventricle has long been the 'forgotten ventricle', as it is difficult to image owing to its complex morphology, its thin wall with coarse trabeculations, and its anterior position within the chest. Developments in cardiac magnetic resonance imaging (CMR) and echocardiography have provided new insights into right ventricular (RV) structure and function. RV performance seems to be an important determinant of clinical status and long-term outcome in patients with pulmonary hypertension, cardiomyopathies, and, especially, in patients with congenital heart disease. A variety of different parameters can be measured to assess RV function, but a lot of uncertainty remains on how to assess RV performance in daily clinical practice and which measurements to use in clinical decision-making. CMR is currently considered the reference technique for RV volumetry and calculation of ejection fraction. Various echocardiographic techniques can provide reliable information on RV dimensions and RV systolic and diastolic function that can be used in clinical follow-up. The introduction of newer echocardiographic techniques, such as three-dimensional echocardiography, tissue Doppler ultrasonography, and ultrasound strain imaging, challenge the leading role of CMR in RV functional assessment, but further validation and accumulation of data are required before these techniques can play a key part in clinical decision-making.

Key Points

  • The determination of right ventricular (RV) function is important in the assessment of the clinical status and outcome of patients with pulmonary hypertension, cardiomyopathies, or congenital heart disease

  • Cardiac magnetic resonance imaging (CMR) is the reference technique for RV volumetric measurements and calculation of ejection fraction, but good standardization of the technique is required

  • Three-dimensional echocardiography is a promising alternative to CMR, but requires further optimization and validation to be useful in clinical practice

  • RV tissue characterization by CMR can be used to identify fibrofatty tissue infiltration and fibrosis in the RV wall, but its role in clinical practice is still uncertain

  • Echocardiographic measurement of tricuspid annular motion, tricuspid annular tissue Doppler velocities, or longitudinal systolic strain in the RV free wall can be performed to monitor RV systolic function in routine clinical practice

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Figure 1: Tissue characterization by cardiac magnetic resonance imaging in the diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).
Figure 2: Assessment of dimensions and volume of the right ventricle (RV).
Figure 3: Assessment of right ventricular (RV) function by echocardiography.
Figure 4: Restrictive right ventricular physiology.

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  1. Division of Cardiology, The Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, ON, Canada

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L. L. Mertens and M. K. Friedberg contributed equally to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

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Mertens, L., Friedberg, M. Imaging the right ventricle—current state of the art. Nat Rev Cardiol 7, 551–563 (2010). https://doi.org/10.1038/nrcardio.2010.118

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