Introduction
Heart failure (HF) remains a rising public health concern, with an
estimated prevalence of almost 38 million individuals worldwide [1,
2]. The total percentage of the population with HF is predicted to
rise to 2.97% in 2030 [3]. According to the presence or absence of
left ventricular (LV) dysfunction, HF can be classified into HF with
preserved, mid-range or reduced ejection fraction (EF) [4], the
latter being the most extensively studied.
Most of the research focused on the prognostic role of LV dysfunction
[5], while the occurrence and significance of right ventricular (RV)
dysfunction in HF with reduced EF is less clear. This happened mostly
due to the complex three-dimensional shape (3D) of the RV, which makes
its echocardiographic assessment challenging [6]; for this reason,
the RV used to be called for quite a while “the forgotten chamber”
[7]. However, during the last decade, RV dysfunction emerged as a
prognostic factor in HF and in pulmonary hypertension [8, 9], thus
raising awareness of the importance of accurately evaluating the RV
performance. Cardiac magnetic resonance (CMR) imaging remains the gold
standard for the assessment of RV size and function [10, 11], but
its cost, availability and contraindications make it feasible only in a
selected number of patients. By comparison, echocardiography is a
bedside, widely available tool, and novel echocardiographic techniques
such as myocardial strain imaging and 3D echocardiography have been
validated against (CMR) [12, 13], thus allowing an enhanced
assessment of RV morphology and function.
The aim of this review is to summarize the role of conventional and
novel echocardiographic parameters of RV function in patients with HF
and reduced EF, while focusing on the most recent evidence from
literature.