Cardiovascular magnetic resonance imaging for the assessment of right heart involvement in cardiac and pulmonary disease.

In most patients with heart disease left ventricular dysfunction is the principle physiologic disorder leading to heart failure and is an important prognostic factor. Various imaging methods have been developed for the evaluation of left ventricular function and a substantial body of literature is available describing these methods. The right ventricle (RV) may be predominantly involved in certain cardiac or pulmonary pathological conditions such as arrhythmogenic right ventricular cardiomyopathy or pulmonary hypertension. Also in many congenital or acquired cardiac diseases primarily affecting the left ventricle (LV), right heart involvement has an important role in disease prognosis. The RV is difficult to evaluate using two-dimensional (2D) cross-sectional imaging modalities due to its complex shape and orientation. Cardiovascular magnetic resonance imaging (CMR) is a virtually three-dimensional (3D) tomographic technique which has entered the mainstream of clinical cardiovascular imaging over the last decade. Compared to other imaging methods CMR allows the accurate quantification of RV volumes, myocardial mass, and transvalvular flow with the added benefit of tissue characterisation and without the use of ionising radiation. The manuscript presents a review of the contemporary use of CMR for the evaluation of right heart involvement in various cardio-pulmonary diseases.