Echocardiographic Evaluation of the Right Heart in Pulmonary Hypertension

Pulmonary hypertension (PH) is characterized by increased right ventricular (RV) afterload, which is accommodated early by dramatic increases in RV contractility to maintain right ventriculoarterial coupling. Related to its tissue biology, characteristics of RV contractility differ from those of the left ventricle (LV). As the RV undergoes adaptation in PH, echocardiographic signs emerge which can help identify PH and can be reassessed to noninvasively prognosticate outcomes in PH. Many of these indices can be calculated from standard echocardiographic views without significant modification to scanning procedures. This review will discuss contemporary diagnosis of PH, highlighting the role of echocardiography in this process. We will describe the differences between the LV and RV, including adaptations of the RV in PH, and how these factors impact echocardiographic assessment. We will conclude with a discussion of specific echocardiographic parameters and describe their role in diagnosis and reassessment. Routine assessment of the right heart improves noninvasive risk stratification in PH, may reduce delays in diagnosis, and ultimately may impact the significant and potentially modifiable disease burden in this patient population.