Clinical Applications of Right Ventricular Strain by Two-Dimensional Speckle-Tracking Echocardiography

Assessment of right ventricular (RV) function by two-dimensional (2D) echocardiography remains challenging due to complex geometry, limited acoustic windows, and the angle dependency of conventional parameters. RV longitudinal strain, derived from 2D speckle-tracking echocardiography, has emerged as a quantitative, angle-independent marker of myocardial deformation, enabling earlier detection of dysfunction and providing incremental diagnostic and prognostic value beyond traditional indices in selected settings. RV free-wall longitudinal strain is most commonly used in clinical practice, with established reference values and growing applicability across a broad spectrum of cardiovascular and pulmonary diseases, including pulmonary hypertension, heart failure, ischemic heart disease, cardiomyopathies, and valvular heart disease. However, despite growing evidence supporting its clinical utility, its integration into routine decision-making remains limited. Important constraints persist, particularly inter-vendor variability and relatively high test-retest variability, which affect reproducibility and limit standardization. Emerging techniques, including three-dimensional strain, and artificial intelligence-based analysis, once sufficiently validated and standardized, hold potential to improve measurement accuracy and reproducibility.