Multimodality Imaging of Right Heart Function: JACC Scientific Statement (JACC May 2023-2)-Article: Multimodality Imaging of Right Heart Function: JACC Scientific Statement (JACC May 2023-2)

Article: Multimodality Imaging of Right Heart Function: JACC Scientific Statement (JACC May 2023-2)

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The paper "Multimodality Imaging of Right Heart Function," published in the Journal of the American College of Cardiology, comprehensively reviews the importance of imaging techniques in assessing the size and function of the right ventricle (RV) in the heart. Proper understanding of RV anatomy and physiology is essential for appreciating the strengths and limitations of current imaging methods. The right ventricle’s ability to adapt to different stresses over time is disease-specific and impacts patient outcomes across various cardiovascular conditions like pulmonary hypertension, left heart failure, and valvular heart disease.<br /><br />The primary imaging methods discussed include echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR). Echocardiography is the most common and versatile tool, offering several measures like tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (TDI) velocities, and free wall strain (FWS). These measures, especially longitudinal function indicators such as TAPSE, are closely linked with patient prognosis. Despite their widespread use, these parameters are load-dependent, making comprehensive assessments challenging.<br /><br />Three-dimensional echocardiography and CMR provide more accurate evaluations of RV volumes and function but require advanced technology and expertise. CMR is deemed the gold standard for RV assessment, allowing for detailed evaluations of RV anatomy, function, and tissue characteristics. Novel techniques like T1 mapping and extracellular volume quantification have shown promise in detecting early RV fibrotic changes and predicting clinical outcomes.<br /><br />CT and nuclear imaging offer valuable adjuncts when echocardiographic or CMR data is insufficient, providing high accuracy for RV volumetric and functional assessments.<br /><br />The paper emphasizes a multimodal imaging approach to account for the RV's complex interactions with surrounding cardiac structures and variable response to physiological stresses. Future directions highlight artificial intelligence enhancements in imaging analysis to improve diagnostic accuracy and prognostication, potentially aiding early disease detection and management.

Keywords

Right ventricle

Multimodality imaging

Echocardiography

Cardiac computed tomography

Cardiac magnetic resonance

Pulmonary hypertension

TAPSE

RV function

AI in imaging

Cardiovascular conditions