Introduction
Heart failure (HF) remains a rising public health concern, with an estimated prevalence of almost 38 million individuals worldwide [1, 2]. The total percentage of the population with HF is predicted to rise to 2.97% in 2030 [3]. According to the presence or absence of left ventricular (LV) dysfunction, HF can be classified into HF with preserved, mid-range or reduced ejection fraction (EF) [4], the latter being the most extensively studied.
Most of the research focused on the prognostic role of LV dysfunction [5], while the occurrence and significance of right ventricular (RV) dysfunction in HF with reduced EF is less clear. This happened mostly due to the complex three-dimensional shape (3D) of the RV, which makes its echocardiographic assessment challenging [6]; for this reason, the RV used to be called for quite a while “the forgotten chamber” [7]. However, during the last decade, RV dysfunction emerged as a prognostic factor in HF and in pulmonary hypertension [8, 9], thus raising awareness of the importance of accurately evaluating the RV performance. Cardiac magnetic resonance (CMR) imaging remains the gold standard for the assessment of RV size and function [10, 11], but its cost, availability and contraindications make it feasible only in a selected number of patients. By comparison, echocardiography is a bedside, widely available tool, and novel echocardiographic techniques such as myocardial strain imaging and 3D echocardiography have been validated against (CMR) [12, 13], thus allowing an enhanced assessment of RV morphology and function.
The aim of this review is to summarize the role of conventional and novel echocardiographic parameters of RV function in patients with HF and reduced EF, while focusing on the most recent evidence from literature.