Beyond right ventricular size and function: the importance of evaluating the right ventricle’s capacity for recovery

Abstract

Historically, the right ventricle (RV) has received less attention than the left probably because morbidity and mortality associated with left ventricular disease is clinically more apparent. Right heart disease, in contrast, tends to have a more prolonged and, in the early stages, often subclinical course. Furthermore, the left ventricle is easier to image, model and quantify, so that research has been successful at amassing a great deal of clinically useful information about the left heart while the right heart still remains, in many ways, a mystery. In this perspective, the authors sought to explore the topic of RV recovery potential that has important clinical implications in the evaluation and treatment of advanced right-sided valvular heart disease, congenital heart disease, pulmonary arterial disease and even lung disease which impacts the RV. We see a clear need for a better understanding of RV viability given our increasing appreciation that RV failure is a significant contributor to morbidity and mortality in many disease states and the fact that newer imaging modalities and innovative changes to older modalities make more comprehensive evaluation of the RV feasible.

Keywords::

• contractile reserve
• perfusion reserve
• right ventricle
• right ventricle recovery
• right ventricular dysfunction
• viability

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Right ventricular failure is associated with high morbidity and mortality yet mechanisms for right ventricular dysfunction and recovery are poorly understood.

• There are numerous scenarios involving the right heart in which it would be of incremental value to clinical decision-making if it were possible to gain some insight into the potential for right ventricular recovery.

• Multiple imaging modalities are available for right ventricular assessment in the current era.

• Future research must focus on how information obtained by the various imaging modalities can be used to predict the recoverability of the right ventricle.

Notes

ARDS: Acute respiratory distress syndrome; ARVC: Arrhythmogenic right ventricular cardiomyopathy; ASD: Atrial septal defect; VSD: Ventricular septal defect.