Evaluation of right ventricular function and pulmonary hypertension

Right ventricular (RV) function is an important component of overall heart function with prognostic value in predicting symptomatic limitation and outcome in patients with heart failure and pulmonary hypertension of different etiologies and, since long-term mechanical circulatory support by ventricular assist devices has become a well-established life-saving treatment for drug-refractory end-stage heart failure, assessment of RV size, geometry, and function has emerged as a crucial component of preoperative cardiac evaluation. However, measurement of RV systolic function and identification of RV dysfunction using conventional echocardiography remains one of the most challenging and technically difficult tasks in echocardiography. Speckle tracking echocardiography provides a non-Doppler, angle-independent, and objective quantification of RV myocardial deformation and has recently emerged as an imaging technique to accurately evaluate RV function. Data regarding feasibility, accuracy, and clinical applications of RV strain measurement are rapidly gathering, and there is evidence that RV free-wall longitudinal systolic strain using speckle-tracking echocardiography is reproducible, feasible, and a highly prognostic metric of RV function. This has been demonstrated for patients with heart failure, ischemic heart disease, pulmonary hypertension, infiltrative disease, and many other types of cardiovascular disease. In this chapter, will describe the fundamental concepts of RV strain analysis, its measurement, normal values, and emerging clinical applications.