Multimodality Imaging to Understand Mechanisms of Right Ventricular Disease

Right ventricular (RV) disease is commonly encountered in patients with cardiovascular conditions and is associated with adverse prognosis. The principal pathogenic mechanisms giving rise to RV pathology include RV pressure overload, RV volume overload, and RV myocardial diseases. Noninvasive cardiac imaging is commonly used to detect the conditions associated with RV disease and ultimately guide therapeutic decisions. Transthoracic echocardiogram is usually the first-line test in patients with suspected RV disease and it provides relevant information on biventricular size and function, valvular abnormalities, and cardiac hemodynamics including pulmonary pressures. Cardiac magnetic resonance imaging is considered the reference standard noninvasive imaging test for quantifying ventricular size and function and cardiac shunts and has a secondary role for assessing valvular disease when echocardiography is nondiagnostic. Cardiac magnetic resonance imaging also provides insight into RV myocardial diseases such as inflammation, infarction, and infiltration. Nuclear cardiology and cardiac computed tomography imaging can also be used to inform on specific RV disease mechanisms originating from lung disease and pulmonary vasculature disorders. In this review, we discuss the role and utility of cardiac imaging in characterizing RV mechanisms of disease and provide a suggested framework for clinicians to appropriately utilize imaging in these clinical scenarios.