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Assessing right ventricular function: the role of echocardiography and complementary technologies
  1. G B Bleeker1,
  2. P Steendijk1,
  3. E R Holman1,
  4. C-M Yu3,
  5. O A Breithardt4,
  6. T A M Kaandorp5,
  7. M J Schalij1,
  8. E E van der Wall1,
  9. P Nihoyannopoulos6,
  10. J J Bax1
  1. 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
  3. 3Division of Cardiology, Prince of Wales Hospital, Shatin, NT, Hong Kong
  4. 4Department of Cardiology, Klinikum Mannheim, University of Heidelberg, Germany
  5. 5Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  6. 6Imperial College London, NHLI & Cardiothoracic Directorate, Hammersmith Hospital, London, UK
  1. Correspondence to:
    Dr Gabe B Bleeker
    Department of Cardiology, Leiden University Medical Center, Leiden, 2333ZA, The Netherlands; g.b.bleeker{at}

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The physiological importance of the right ventricle (RV) has been underestimated; the RV was considered mainly as a conduit whereas its contractile performance was thought to be haemodynamically unimportant.1 However, its essential contribution to normal cardiac pump function is well established with the primary RV functions being:

  • to maintain adequate pulmonary perfusion pressure under varying circulatory and loading conditions in order to deliver desaturated venous blood to the gas exchange membranes of the lungs

  • to maintain a low systemic venous pressure to prevent tissue and organ congestion.

RV function may be impaired either by primary right sided heart disease, or secondary to left sided cardiomyopathy or valvar heart disease.2 In addition, it should be considered that RV dysfunction may affect left ventricular (LV) function, not only by limiting LV preload, but also by adverse systolic and diastolic interaction via the intraventricular septum and the pericardium (ventricular interdependence). Moreover, RV function has been shown to be a major determinant of clinical outcome3–9 and consequently should be considered during clinical management and treatment.10 Thus, the need for diagnosis of RV dysfunction is evident. In practice, clinicians largely rely on non-invasive imaging methods for assessment of RV function. Two dimensional echocardiography is the mainstay for analysis of RV function, but recently alternative techniques have been proposed, including tissue Doppler imaging (TDI) techniques,11 three dimensional echocardiography,12 magnetic resonance imaging (MRI), and even invasive assessment of pressure–volume loops.13–17 An overview of these imaging modalities for assessment of RV function is provided in the current manuscript.


Due to its widespread availability, echocardiography is used as the first line imaging modality for assessment of RV size and RV function. The quantitative assessment of RV size and function is often difficult, because of the complex anatomy. Nevertheless, when used …

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  • Introduction
    N Masani P Nihoyannopoulos