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The Echocardiographic Evaluation of the Right Heart: Current and Future Advances

  • Echocardiography (JM Gardin and AH Waller, Section Editors)
  • Published:
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Abstract

Purpose of Review

To discuss physiologic and methodologic advances in the echocardiographic assessment of right heart (RH) function, including the emergence of artificial intelligence (AI) and point-of-care ultrasound.

Recent Findings

Recent studies have highlighted the prognostic value of right ventricular (RV) longitudinal strain, RV end-systolic dimensions, and right atrial (RA) size and function in pulmonary hypertension and heart failure. While RA pressure is a central marker of right heart diastolic function, the recent emphasis on venous excess imaging (VExUS) has provided granularity to the systemic consequences of RH failure. Several methodological advances are also changing the landscape of RH imaging including post-processing 3D software to delineate the non-longitudinal (radial, anteroposterior, and circumferential) components of RV function, as well as AI segmentation- and non-segmentation-based quantification. Together with recent guidelines and advances in AI technology, the field is shifting from specific RV functional metrics to integrated RH disease–specific phenotypes.

Summary

A modern echocardiographic evaluation of RH function should focus on the entire cardiopulmonary venous unit—from the venous to the pulmonary arterial system. Together, a multi-parametric approach, guided by physiology and AI algorithms, will help define novel integrated RH profiles for improved disease detection and monitoring.

Graphical Abstract: 

Advances in right heart echocardiography will incorporate a physiologic, multi-parametric approach that is augmented by deep learning to develop integrated right heart phenotypes. Ao Aorta, LV left ventricle, RA right atria, RV right ventricle, PA pulmonary artery

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Data Availability

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Christian O’Donnell

  2. Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Christian O’Donnell

  3. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Pablo Amador Sanchez, Bettia Celestin, Michael V. McConnell & Francois Haddad

  4. Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA

    Bettia Celestin, Michael V. McConnell & Francois Haddad

  5. Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA

    Bettia Celestin & Francois Haddad

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  4. Michael V. McConnell
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Contributions

C.O. and F.H. wrote the main text and prepared the final figures and tables. P.S. contributed to writing the POCUS and AI sections and Table 2. B.C. contributed to writing the phenotyping section and Fig. 1. M.V.M. contributed to AI sections and overall editing and idea generation. All authors reviewed the manuscript.

Corresponding author

Correspondence to Christian O’Donnell.

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Conflict of Interest

Michael V. McConnell reports former employee (until 2022) of Google Health, outside the submitted work. In addition, Dr. McConnell has a patent US 10219787 (Respiratory mode) issued and is a member of the ACC POCUS Innovation Work Group and the AHA Health Tech Advisory Group. Francois Haddad received research funding from Janssen on computational approaches to surrogate end-point in pulmonary hypertension and evaluating automation of right heart analysis in Pulmonary Hypertension using US2ai software. The other authors declare that they have no conflict of interest.

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O’Donnell, C., Sanchez, P.A., Celestin, B. et al. The Echocardiographic Evaluation of the Right Heart: Current and Future Advances. Curr Cardiol Rep 25, 1883–1896 (2023). https://doi.org/10.1007/s11886-023-02001-6

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