Skip to main content
SpringerLink
Log in

Multimodality Imaging of the Right Heart

  • Chapter
  • First Online:
Clinical Cases in Right Heart Failure

Part of the book series: Clinical Cases in Cardiology ((CCC))

  • 675 Accesses

Abstract

While historically neglected, the right ventricle has become recognized as being an important component of cardiac status. Pathophysiologic impact of various conditions on the right side of the heart can have profound implications on mortality, morbidity, and quality of life. Due to its complex shape, the right ventricle often requires multiple modalities, to view from various planes and angles, in order to assess its size, function, and tissue characterization. This, in turn can provide potential useful information, including prognosis, extent of disease, associated impact on the tricuspid valve and pulmonary circulation, and finally for patient selection and periprocedural planning of invasive treatment options.

David J. Hur, MD, FACC is an US Government employee.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713.

    Google Scholar 

  2. Koifman E, Didier R, Patel N, Jerusalem Z, Kiramijyan S, Ben-Dor I, et al. Impact of right ventricular function on outcome of severe aortic stenosis patients undergoing transcatheter aortic valve replacement. Am Heart J. 2017;184:141–7.

    Article  PubMed  Google Scholar 

  3. Hur DJ, Sugeng L. Non-invasive multimodality cardiovascular imaging of the right heart and pulmonary circulation in pulmonary hypertension. Front Cardiovasc Med. 2019;6:24.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.e14.

    Article  PubMed  Google Scholar 

  5. Genovese D, Mor-Avi V, Palermo C, Muraru D, Volpato V, Kruse E, et al. Comparison between four-chamber and right ventricular-focused views for the quantitative evaluation of right ventricular size and function. J Am Soc Echocardiogr. 2019;32(4):484–94.

    Article  PubMed  Google Scholar 

  6. Gleason WL, Braunwald E. Studies on the first derivative of the ventricular pressure pulse in man. J Clin Invest. 1962;41:80–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Anconina J, Danchin N, Selton-Suty C, Isaaz K, Juilliere Y, Buffet P, et al. Noninvasive estimation of right ventricular dP/dt in patients with tricuspid valve regurgitation. Am J Cardiol. 1993;71(16):1495–7.

    Article  CAS  PubMed  Google Scholar 

  8. Sade LE, Gulmez O, Eroglu S, Sezgin A, Muderrisoglu H. Noninvasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery. J Am Soc Echocardiogr. 2007;20(8):982–8.

    Article  PubMed  Google Scholar 

  9. Sundereswaran L, Nagueh SF, Vardan S, Middleton KJ, Zoghbi WA, Quinones MA, et al. Estimation of left and right ventricular filling pressures after heart transplantation by tissue Doppler imaging. Am J Cardiol. 1998;82(3):352–7.

    Article  CAS  PubMed  Google Scholar 

  10. Thenappan T, Shah SJ, Rich S, Tian L, Archer SL, Gomberg-Maitland M. Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation. Eur Respir J. 2010;35(5):1079–87.

    Article  CAS  PubMed  Google Scholar 

  11. Gan CT, Holverda S, Marcus JT, Paulus WJ, Marques KM, Bronzwaer JG, et al. Right ventricular diastolic dysfunction and the acute effects of sildenafil in pulmonary hypertension patients. Chest. 2007;132(1):11–7.

    Article  CAS  PubMed  Google Scholar 

  12. Dell’Italia LJ. The right ventricle: anatomy, physiology, and clinical importance. Curr Probl Cardiol. 1991;16(10):653–720.

    PubMed  Google Scholar 

  13. Kawel-Boehm N, Maceira A, Valsangiacomo-Buechel ER, Vogel-Claussen J, Turkbey EB, Williams R, et al. Normal values for cardiovascular magnetic resonance in adults and children. J Cardiovasc Magn Reson. 2015;17:29.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res. 2017;113(12):1474–85.

    Article  CAS  PubMed  Google Scholar 

  15. Buckberg G, Hoffman JI, Mahajan A, Saleh S, Coghlan C. Cardiac mechanics revisited: the relationship of cardiac architecture to ventricular function. Circulation. 2008;118(24):2571–87.

    Article  PubMed  Google Scholar 

  16. Kaminska M, Sobkowicz B, Sawicki R, Lewkowicz J, Tomaszuk-Kazberuk A, Glinska R, et al. Is real time contrast echocardiography useful for assessment of the right ventricular morphology, function, and perfusion? Echocardiography. 2015;32(7):1080–6.

    Article  PubMed  Google Scholar 

  17. Medvedofsky D, Mor-Avi V, Kruse E, Guile B, Ciszek B, Weinert L, et al. Quantification of right ventricular size and function from contrast-enhanced three-dimensional echocardiographic images. J Am Soc Echocardiogr. 2017;30(12):1193–202.

    Article  PubMed  Google Scholar 

  18. Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19(6):591–600.

    Article  PubMed  Google Scholar 

  19. Sanz-de la Garza M, Giraldeau G, Marin J, Imre Sarvari S, Guasch E, Gabrielli L, et al. Should the septum be included in the assessment of right ventricular longitudinal strain? An ultrasound two-dimensional speckle-tracking stress study. Int J Cardiovasc Imaging. 2019;35:1853–60.

    Article  PubMed  Google Scholar 

  20. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr. 2011;12(3):167–205.

    Article  PubMed  Google Scholar 

  21. Negishi K, Negishi T, Kurosawa K, Hristova K, Popescu BA, Vinereanu D, et al. Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovasc Imaging. 2015;8(4):489–92.

    Article  PubMed  Google Scholar 

  22. Verhaert D, Mullens W, Borowski A, Popovic ZB, Curtin RJ, Thomas JD, et al. Right ventricular response to intensive medical therapy in advanced decompensated heart failure. Circ Heart Fail. 2010;3(3):340–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Guendouz S, Rappeneau S, Nahum J, Dubois-Rande JL, Gueret P, Monin JL, et al. Prognostic significance and normal values of 2D strain to assess right ventricular systolic function in chronic heart failure. Circ J. 2012;76(1):127–36.

    Article  PubMed  Google Scholar 

  24. Houard L, Benaets MB, de Meester de Ravenstein C, Rousseau MF, Ahn SA, Amzulescu MS, et al. Additional prognostic value of 2D right ventricular speckle-tracking strain for prediction of survival in heart failure and reduced ejection fraction: a comparative study with cardiac magnetic resonance. JACC Cardiovasc Imaging. 2019;12(12):2373–85.

    Article  PubMed  Google Scholar 

  25. Antoni ML, Scherptong RW, Atary JZ, Boersma E, Holman ER, van der Wall EE, et al. Prognostic value of right ventricular function in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Circ Cardiovasc Imaging. 2010;3(3):264–71.

    Article  PubMed  Google Scholar 

  26. Ivey-Miranda JB, Almeida-Gutierrez E, Borrayo-Sanchez G, Antezana-Castro J, Contreras-Rodriguez A, Posada-Martinez EL, et al. Right ventricular longitudinal strain predicts acute kidney injury and short-term prognosis in patients with right ventricular myocardial infarction. Int J Cardiovasc Imaging. 2019;35(1):107–16.

    Article  PubMed  Google Scholar 

  27. Borges AC, Knebel F, Eddicks S, Panda A, Schattke S, Witt C, et al. Right ventricular function assessed by two-dimensional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy. Am J Cardiol. 2006;98(4):530–4.

    Article  CAS  PubMed  Google Scholar 

  28. Bartko PE, Wiedemann D, Schrutka L, Binder C, Santos-Gallego CG, Zuckermann A, et al. Impact of right ventricular performance in patients undergoing extracorporeal membrane oxygenation following cardiac surgery. J Am Heart Assoc. 2017;6(8):e005455.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ternacle J, Berry M, Cognet T, Kloeckner M, Damy T, Monin JL, et al. Prognostic value of right ventricular two-dimensional global strain in patients referred for cardiac surgery. J Am Soc Echocardiogr. 2013;26(7):721–6.

    Article  PubMed  Google Scholar 

  30. Peyrou J, Chauvel C, Pathak A, Simon M, Dehant P, Abergel E. Preoperative right ventricular dysfunction is a strong predictor of 3 years survival after cardiac surgery. Clin Res Cardiol. 2017;106(9):734–42.

    Article  PubMed  Google Scholar 

  31. Geva T, Powell AJ, Crawford EC, Chung T, Colan SD. Evaluation of regional differences in right ventricular systolic function by acoustic quantification echocardiography and cine magnetic resonance imaging. Circulation. 1998;98(4):339–45.

    Article  CAS  PubMed  Google Scholar 

  32. Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, et al. Multimodality comparison of quantitative volumetric analysis of the right ventricle. JACC Cardiovasc Imaging. 2010;3(1):10–8.

    Article  PubMed  Google Scholar 

  33. Nagata Y, Wu VC, Kado Y, Otani K, Lin FC, Otsuji Y, et al. Prognostic value of right ventricular ejection fraction assessed by transthoracic 3D echocardiography. Circ Cardiovasc Imaging. 2017;10(2):e005384.

    Article  PubMed  Google Scholar 

  34. Ryo K, Goda A, Onishi T, Delgado-Montero A, Tayal B, Champion HC, et al. Characterization of right ventricular remodeling in pulmonary hypertension associated with patient outcomes by 3-dimensional wall motion tracking echocardiography. Circ Cardiovasc Imaging. 2015;8(6):e003176.

    Article  PubMed  Google Scholar 

  35. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol. 2010;55(23):2614–62.

    Article  PubMed  Google Scholar 

  36. Pena E, Dennie C, Veinot J, Muniz SH. Pulmonary hypertension: how the radiologist can help. Radiographics. 2012;32(1):9–32.

    Article  PubMed  Google Scholar 

  37. Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008;117(11):1436–48.

    Article  PubMed  Google Scholar 

  38. Peacock AJ, Vonk Noordegraaf A. Cardiac magnetic resonance imaging in pulmonary arterial hypertension. Eur Respir Rev. 2013;22(130):526–34.

    Article  PubMed  Google Scholar 

  39. Marrone G, Mamone G, Luca A, Vitulo P, Bertani A, Pilato M, et al. The role of 1.5T cardiac MRI in the diagnosis, prognosis and management of pulmonary arterial hypertension. Int J Cardiovasc Imaging. 2010;26(6):665–81.

    Article  PubMed  Google Scholar 

  40. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803–69.

    Article  CAS  PubMed  Google Scholar 

  41. Freed BH, Collins JD, Francois CJ, Barker AJ, Cuttica MJ, Chesler NC, et al. MR and CT imaging for the evaluation of pulmonary hypertension. JACC Cardiovasc Imaging. 2016;9(6):715–32.

    Article  PubMed  PubMed Central  Google Scholar 

  42. McLure LE, Peacock AJ. Cardiac magnetic resonance imaging for the assessment of the heart and pulmonary circulation in pulmonary hypertension. Eur Respir J. 2009;33(6):1454–66.

    Article  CAS  PubMed  Google Scholar 

  43. Alunni JP, Degano B, Arnaud C, Tetu L, Blot-Souletie N, Didier A, et al. Cardiac MRI in pulmonary artery hypertension: correlations between morphological and functional parameters and invasive measurements. Eur Radiol. 2010;20(5):1149–59.

    Article  PubMed  Google Scholar 

  44. Aquaro GD, Pingitore A, Di Bella G, Piaggi P, Gaeta R, Grigoratos C, et al. Prognostic role of cardiac magnetic resonance in arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol. 2018;122(10):1745–53.

    Article  PubMed  Google Scholar 

  45. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(12):e81–e192.

    Article  PubMed  Google Scholar 

  46. Beurskens NEG, Hagdorn QAJ, Gorter TM, Berger RMF, Vermeulen KM, van Melle JP, et al. Risk of cardiac tachyarrhythmia in patients with repaired tetralogy of Fallot: a multicenter cardiac MRI based study. Int J Cardiovasc Imaging. 2019;35(1):143–51.

    Article  PubMed  Google Scholar 

  47. Meyer P, Filippatos GS, Ahmed MI, Iskandrian AE, Bittner V, Perry GJ, et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation. 2010;121(2):252–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gulati A, Ismail TF, Jabbour A, Alpendurada F, Guha K, Ismail NA, et al. The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy. Circulation. 2013;128(15):1623–33.

    Article  PubMed  Google Scholar 

  49. van Wolferen SA, Marcus JT, Westerhof N, Spreeuwenberg MD, Marques KM, Bronzwaer JG, et al. Right coronary artery flow impairment in patients with pulmonary hypertension. Eur Heart J. 2008;29(1):120–7.

    Article  PubMed  Google Scholar 

  50. Blyth KG, Groenning BA, Martin TN, Foster JE, Mark PB, Dargie HJ, et al. Contrast enhanced-cardiovascular magnetic resonance imaging in patients with pulmonary hypertension. Eur Heart J. 2005;26(19):1993–9.

    Article  PubMed  Google Scholar 

  51. McCann GP, Gan CT, Beek AM, Niessen HW, Vonk Noordegraaf A, van Rossum AC. Extent of MRI delayed enhancement of myocardial mass is related to right ventricular dysfunction in pulmonary artery hypertension. AJR Am J Roentgenol. 2007;188(2):349–55.

    Article  PubMed  Google Scholar 

  52. Swift AJ, Rajaram S, Capener D, Elliot C, Condliffe R, Wild JM, et al. LGE patterns in pulmonary hypertension do not impact overall mortality. JACC Cardiovasc Imaging. 2014;7(12):1209–17.

    Article  PubMed  Google Scholar 

  53. Yang D, Li X, Sun JY, Cheng W, Greiser A, Zhang TJ, et al. Cardiovascular magnetic resonance evidence of myocardial fibrosis and its clinical significance in adolescent and adult patients with Ebstein’s anomaly. J Cardiovasc Magn Reson. 2018;20(1):69.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Sun Z, Choo GH, Ng KH. Coronary CT angiography: current status and continuing challenges. Br J Radiol. 2012;85(1013):495–510.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Lewis MA, Pascoal A, Keevil SF, Lewis CA. Selecting a CT scanner for cardiac imaging: the heart of the matter. Br J Radiol. 2016;89(1065):20160376.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J. 2015;46(4):903–75.

    Article  CAS  PubMed  Google Scholar 

  57. Henneman MM, Schuijf JD, Jukema JW, Holman ER, Lamb HJ, de Roos A, et al. Assessment of global and regional left ventricular function and volumes with 64-slice MSCT: a comparison with 2D echocardiography. J Nucl Cardiol. 2006;13(4):480–7.

    Article  PubMed  Google Scholar 

  58. Greupner J, Zimmermann E, Grohmann A, Dubel HP, Althoff TF, Borges AC, et al. Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol. 2012;59(21):1897–907.

    Article  PubMed  Google Scholar 

  59. Abel E, Jankowski A, Pison C, Luc Bosson J, Bouvaist H, Ferretti GR. Pulmonary artery and right ventricle assessment in pulmonary hypertension: correlation between functional parameters of ECG-gated CT and right-side heart catheterization. Acta Radiol. 2012;53(7):720–7.

    Article  PubMed  Google Scholar 

  60. Ceriani E, Combescure C, Le Gal G, Nendaz M, Perneger T, Bounameaux H, et al. Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost. 2010;8(5):957–70.

    CAS  PubMed  Google Scholar 

  61. Mesquita SM, Castro CR, Ikari NM, Oliveira SA, Lopes AA. Likelihood of left main coronary artery compression based on pulmonary trunk diameter in patients with pulmonary hypertension. Am J Med. 2004;116(6):369–74.

    Article  PubMed  Google Scholar 

  62. Jia D, Zhou XM, Hou G. Estimation of right ventricular dysfunction by computed tomography pulmonary angiography: a valuable adjunct for evaluating the severity of acute pulmonary embolism. J Thromb Thrombolysis. 2017;43(2):271–8.

    Article  PubMed  Google Scholar 

  63. Khalique OK, Cavalcante JL, Shah D, Guta AC, Zhan Y, Piazza N, et al. Multimodality imaging of the tricuspid valve and right heart anatomy. JACC Cardiovasc Imaging. 2019;12(3):516–31.

    Article  PubMed  Google Scholar 

  64. Hahn RT, Thomas JD, Khalique OK, Cavalcante JL, Praz F, Zoghbi WA. Imaging assessment of tricuspid regurgitation severity. JACC Cardiovasc Imaging. 2019;12(3):469–90.

    Article  PubMed  Google Scholar 

  65. Rich JD, Ward RP. Right-ventricular function by nuclear cardiology. Curr Opin Cardiol. 2010;25(5):445–50.

    Article  PubMed  Google Scholar 

  66. Wong YY, Ruiter G, Lubberink M, Raijmakers PG, Knaapen P, Marcus JT, et al. Right ventricular failure in idiopathic pulmonary arterial hypertension is associated with inefficient myocardial oxygen utilization. Circ Heart Fail. 2011;4(6):700–6.

    Article  CAS  PubMed  Google Scholar 

  67. Wong YY, Raijmakers P, van Campen J, van der Laarse WJ, Knaapen P, Lubberink M, et al. 11C-Acetate clearance as an index of oxygen consumption of the right myocardium in idiopathic pulmonary arterial hypertension: a validation study using 15O-labeled tracers and PET. J Nucl Med. 2013;54(8):1258–62.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    Edith Liliana Posada-Martinez, Xochitl A. Ortiz-Leon, Lissa Sugeng & David J. Hur

Authors
  1. Edith Liliana Posada-Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xochitl A. Ortiz-Leon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lissa Sugeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David J. Hur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David J. Hur .

Editor information

Editors and Affiliations

  1. St. Elizabeth’s Medical Center, Boston, MA, USA

    Lana Tsao

  2. Maine Medical Center, Portland, ME, USA

    Maxwell E. Afari

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Posada-Martinez, E.L., Ortiz-Leon, X.A., Sugeng, L., Hur, D.J. (2020). Multimodality Imaging of the Right Heart. In: Tsao, L., Afari, M. (eds) Clinical Cases in Right Heart Failure. Clinical Cases in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-38662-7_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-38662-7_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-38661-0

  • Online ISBN: 978-3-030-38662-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation