Right ventricular involvement in coronary artery disease: role of echocardiography for diagnosis and prognosis.

The right ventricle differs from the left ventricle in many anatomic and physiologic aspects. This disparity renders the right ventricle less vulnerable to ischemia and less susceptible to myocardial injury when right coronary artery occlusion occurs compared with the extent of left ventricular dysfunction during left coronary artery occlusion. Acute right ventricular (RV) myocardial infarction is usually caused by proximal right coronary artery occlusion and therefore is usually associated with inferior myocardial infarction. Conventional echocardiography along with Doppler tissue imaging has played a significant role in early diagnosis of RV myocardial infarction and has a role in prognostic stratification. Stress echocardiography is less validated and more technically demanding in detecting RV reversible dysfunction compared with left ventricular dysfunction. The threshold of RV ischemia during stress echocardiography is higher compared with left ventricular ischemia and usually affects the inferior RV wall. Further studies, particularly with the use of novel echocardiographic techniques such as speckle-tracking and three-dimensional echocardiography, may be required to better elucidate the role of the right ventricle in coronary artery disease.