Right Ventricular Myocardial Work by Echocardiography: A Scoping Review of Methodology, Validation, and Clinical...

Echocardiographic assessment of right ventricular (RV) function remains challenging because conventional functional and deformation indices are strongly influenced by loading conditions. Right ventricular myocardial work (RVMW), derived by integrating myocardial deformation with ventricular pressure, has emerged as a potential framework for contextualizing RV mechanics according to afterload. However, its methodology, validation, clinical applications, and readiness for routine use have not been comprehensively mapped.

A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported according to PRISMA-ScR. MEDLINE via PubMed was systematically searched from inception through August 14, 2026. The search was supplemented by targeted terminology-based searches, backward and forward citation tracking, reference-list screening, and searches using individual RVMW indices. Original human studies quantitatively evaluating echocardiography-derived RVMW were eligible. Data were charted regarding study characteristics, RVMW methodology, pressure source, work indices, validation strategy, clinical application, prognostic value, reproducibility, and methodological limitations.

Thirty-nine studies met the eligibility criteria. The evidence encompassed several related but methodologically distinct RVMW constructs: 27 studies primarily used conventional non-invasive subpulmonary RV pressure-strain-loop analysis, three regional myocardial-work approaches, two systemic-RV myocardial work, two invasive-pressure-integrated approaches, two single-ventricle/Fontan approaches, and three emerging three-dimensional or volume-integrated pressure-strain-volume/pressure-volume methods. These constructs differ in pressure source, ventricular geometry, and mathematical derivation and are not numerically interchangeable. The literature evolved from early physiological and proof-of-concept investigations toward invasive validation, reference-value assessment, disease-specific phenotyping, interventional studies, and preliminary prognostic applications. Pulmonary hypertension represented the most extensively investigated clinical domain, while applications expanded to heart failure, congenital and systemic-RV physiology, mechanical circulatory support, structural interventions, pediatric populations, and physiological adaptation. Substantial heterogeneity remained in strain definition, RV segmentation, pressure estimation, pressure-curve construction, and analytical methodology.

Echocardiography-derived RVMW is a promising integrative framework that contextualizes RV deformation according to prevailing pressure load and may provide complementary information beyond conventional RV functional indices. Current evidence is strongest in pulmonary hypertension, while applications across other cardiovascular and systemic conditions are expanding. Nevertheless, methodological heterogeneity, limited multicenter validation, absence of universally accepted reference values and disease-specific thresholds, and uncertain incremental clinical utility currently preclude routine implementation. Standardized RV-specific methodology and prospective studies demonstrating management-relevant incremental value are required before RVMW can become a routinely actionable echocardiographic measure.