Khalil I Bourji1, Paul M Hassoun. 1. aDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA bDivision of Rheumatology, Department of Medicine, University of Padua, Padua, Italy.
Abstract
PURPOSE OF REVIEW: This review highlights the right ventricular (RV) involvement in pulmonary hypertension from pathophysiologic changes to current imaging tools used to screen, diagnose and follow up RV function in patients with pulmonary hypertension. RECENT FINDINGS: Although right heart catheterization is the gold standard for the diagnosis of pulmonary hypertension, other diagnostic methods such as echocardiography, magnetic resonance and nuclear imaging are of great utility in the assessment of the RV in pulmonary hypertension. Apart from its conventional use as a screening tool for pulmonary hypertension, echocardiography allows assessment of RV size and function and has prognostic value. Among the novel applications of echocardiography, exercise echocardiography and measurements of RV strain might help unveil subclinical pulmonary hypertension, whereas three-dimensional echocardiography allows more accurate measures of RV morphology and function. Cardiac magnetic resonance imaging is currently the gold standard noninvasive imaging method to assess RV volume, mass and function and has prognostic value in the assessment of pulmonary hypertension. Finally, positron emission tomography is a promising tool in the metabolic assessment of the RV and pulmonary circulation. SUMMARY: RV assessment is essential in the overall evaluation of pulmonary hypertension. Despite the availability of several methods and measurements for this assessment, there is, however, no standard approach or broad consensus on their application.
PURPOSE OF REVIEW: This review highlights the right ventricular (RV) involvement in pulmonary hypertension from pathophysiologic changes to current imaging tools used to screen, diagnose and follow up RV function in patients with pulmonary hypertension. RECENT FINDINGS: Although right heart catheterization is the gold standard for the diagnosis of pulmonary hypertension, other diagnostic methods such as echocardiography, magnetic resonance and nuclear imaging are of great utility in the assessment of the RV in pulmonary hypertension. Apart from its conventional use as a screening tool for pulmonary hypertension, echocardiography allows assessment of RV size and function and has prognostic value. Among the novel applications of echocardiography, exercise echocardiography and measurements of RV strain might help unveil subclinical pulmonary hypertension, whereas three-dimensional echocardiography allows more accurate measures of RV morphology and function. Cardiac magnetic resonance imaging is currently the gold standard noninvasive imaging method to assess RV volume, mass and function and has prognostic value in the assessment of pulmonary hypertension. Finally, positron emission tomography is a promising tool in the metabolic assessment of the RV and pulmonary circulation. SUMMARY: RV assessment is essential in the overall evaluation of pulmonary hypertension. Despite the availability of several methods and measurements for this assessment, there is, however, no standard approach or broad consensus on their application.
Authors: George Hung; Valentina Mercurio; Steven Hsu; Stephen C Mathai; Ami A Shah; Monica Mukherjee Journal: Curr Rheumatol Rep Date: 2019-12-07 Impact factor: 4.592