Beyond the right ventricle: assessment of the left ventricular function in pulmonary hypertension

Pulmonary hypertension (PH) is a pathological condition characterized by elevated pressure in the pulmonary artery, often accompanied by right ventricular (RV) dysfunction. Nevertheless, the significance of left ventricular (LV) function in PH is being increasingly acknowledged, especially in the context of ventricular interdependence and the interactions between the ventricles. This review comprehensively examines the anatomical, physiological, and pathophysiological foundations of LV function assessment in patients with PH while summarizing advancements in evaluating LV function within this context. Specifically, the evaluation of LV diastolic function, systolic function, alterations in interventricular septal morphology, and the presence of ventricular dyssynchrony play crucial roles in the comprehensive understanding of left ventricular dynamics and differentiating pre-capillary PH from post-capillary PH. Despite the availability of various assessment parameters, limitations, including the lack of standardized criteria and insufficient specificity, continue to prevail. Future research should concentrate on developing specific indicators, establishing unified assessment standards, and integrating multimodal imaging techniques to evaluate LV function comprehensively, aiming to enhance prognosis and optimize treatment strategies for PH patients.