Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary arterial pressure (mPAP) ≥25 millimeters of mercury (mmHg) via right heart (RH) catheterization (RHC), where increased afterload in the pulmonary arterial vasculature leads to alterations in RH structure and function. Mortality rates have remained high despite therapy, however non-invasive imaging holds the potential to expedite diagnosis and lead to earlier initiation of treatment, with the hope of improving prognosis. While historically the right ventricle (RV) had been considered a passive chamber with minimal role in the overall function of the heart, in recent years in the evaluation of PH and RH failure the anatomical and functional assessment of the RV has received increased attention regarding its performance and its relationship to other structures in the RH-pulmonary circulation. Today, the RV is the key determinant of patient survival. This review provides an overview and summary of non-invasive imaging methods to assess RV structure, function, flow, and tissue characterization in the setting of imaging's contribution to the diagnostic, severity stratification, prognostic risk, response of treatment management, and disease surveillance implications of PH's impact on RH dysfunction and clinical RH failure.
Highlights
Pulmonary hypertension (PH) is a progressive, potentially life-threatening condition resulting from a variety of causes, defined as an invasively measured resting mean pulmonary arterial pressure ≥25 millimeters of mercury (mmHg) [1]
Multimodality non-invasive imaging of the right heart (RH)-pulmonary artery (PA) plays a vital role in the evaluation and management of PH
Reliable, and relatively low-cost tool to initially appraise the heart in suspected PH; it can be used to evaluate for PH due to left heart (LH) disease, the most common cause of PH in the developed world
Summary
Pulmonary hypertension (PH) is a progressive, potentially life-threatening condition resulting from a variety of causes, defined as an invasively measured resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg [1]. The historical view that the right ventricle (RV) being a passive chamber with minimal role in the overall function of the heart has changed in recent years, in the evaluation of PH. This has given rise to increasing attention and focus on the RV regarding its performance and relationship to other structures in the RH-pulmonary circulation, including the PA, tricuspid valve (TV), and right atrium (RA). TTE has a leading role in the PH guidelines, recommended as a first-line non-invasive imaging test to be performed as part of the initial workup for suspected PH [26] It is safe, widely available, reproducible, and relatively inexpensive [27]. The following RAP values have been proposed [35]: IVC diameter
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