Kovács Attila, Magunia Harry, Nicoara Alina, Oxborough David, Keller Marius, Augustine Daniel X, Thijssen Dick, van Dijk Arie, Denault Andre, Haddad Francois, Surkova Elena
Department of Experimental Cardiology and Surgical Techniques, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany.
Nat Rev Cardiol. 2025 Jun 25. doi: 10.1038/s41569-025-01180-9.
Given its crucial role in determining patient symptoms and outcomes in various cardiopulmonary diseases, the thorough and accurate assessment of right ventricular function is essential for both diagnosis and ongoing patient monitoring. In the era of precision medicine, a more detailed characterization of patients with cardiopulmonary diseases is needed, especially with the emergence of novel pharmacological and device-based therapies, such as transcatheter tricuspid valve intervention, gene therapy in patients with cardiomyopathy and anti-obesity interventions for patients with heart failure. Precise and reproducible quantification of right ventricular morphology and function are crucial for risk stratification, the selection of different therapies for the appropriate patients and the evaluation of treatment outcomes. As our understanding of right ventricular pathophysiology expands, the need for sensitive markers of functional deterioration, reliable prognostic indicators and more precise surrogates for clinical trials becomes increasingly important. In this Roadmap, we address current challenges in the standardization of image acquisition, analysis and interpretation across different modalities. We explore the factors limiting the clinical adoption of more advanced approaches and provide expert recommendations to overcome these barriers. Additionally, we outline potential next steps for incorporating parameters of right ventricular function as surrogate end points in multicentre clinical trials of new drugs or devices, and highlight new research opportunities, including the integration of artificial intelligence technologies. Finally, we issue a call for international collaboration on selected priority areas.
鉴于右心室功能在决定各种心肺疾病患者的症状和预后方面起着关键作用，对其进行全面、准确的评估对于诊断和持续的患者监测至关重要。在精准医学时代，需要对心肺疾病患者进行更详细的特征描述，特别是随着新型药物和基于器械的疗法的出现，如经导管三尖瓣介入治疗、心肌病患者的基因治疗以及心力衰竭患者的抗肥胖干预措施。精确且可重复地量化右心室形态和功能对于风险分层、为合适的患者选择不同的治疗方法以及评估治疗结果至关重要。随着我们对右心室病理生理学的理解不断扩展，对于功能恶化的敏感标志物、可靠的预后指标以及更精确的临床试验替代指标的需求变得越来越重要。在本路线图中，我们阐述了不同模式下图像采集、分析和解读标准化方面当前面临的挑战。我们探讨了限制更先进方法临床应用的因素，并提供专家建议以克服这些障碍。此外，我们概述了在新药或器械的多中心临床试验中纳入右心室功能参数作为替代终点的潜在下一步措施，并强调了新的研究机会，包括人工智能技术的整合。最后，我们呼吁在选定的优先领域开展国际合作。
