Noelck North J, Perry Heather A, Talley Phyllis L, Le D Elizabeth
Division of Cardiology, Portland Veterans Administration Health Care System, Portland, OR 97239, USA.
Knight Cardiovascular Institute, Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
J Clin Med. 2025 Aug 5;14(15):5505. doi: 10.3390/jcm14155505.
Historically, echocardiographic imaging of the right heart has been challenging because its abnormal geometry is not conducive to reproducible anatomical and functional assessment. With the development of advanced echocardiographic techniques, it is now possible to complete an integrated assessment of the right heart that has fewer assumptions, resulting in increased accuracy and precision. Echocardiography continues to be the first-line imaging modality for diagnostic analysis and the management of acute and chronic right heart failure because of its portability, versatility, and affordability compared to cardiac computed tomography, magnetic resonance imaging, nuclear scintigraphy, and positron emission tomography. Virtually all echocardiographic parameters have been well-validated and have demonstrated prognostic significance. The goal of this narrative review of the echocardiographic parameters of the right heart chambers and hemodynamic alterations associated with right ventricular dysfunction is to present information that must be acquired during each examination to deliver a comprehensive assessment of the right heart and to discuss their clinical significance in right heart failure. Using a literature search in the PubMed database from 1985 to 2025 and the Cochrane database, which included but was not limited to terminology that are descriptive of right heart anatomy and function, disease states involving acute and chronic right heart failure and pulmonary hypertension, and the application of conventional and advanced echocardiographic modalities that strive to elucidate the pathophysiology of right heart failure, we reviewed randomized control trials, observational retrospective and prospective cohort studies, societal guidelines, and systematic review articles. In addition to the conventional 2-dimensional echocardiography and color, spectral, and tissue Doppler measurements, a contemporary echocardiographic assessment of a patient with suspected or proven right heart failure must include 3-dimensional echocardiographic-derived measurements, speckle-tracking echocardiography strain analysis, and hemodynamics parameters to not only characterize the right heart anatomy but to also determine the underlying pathophysiology of right heart failure. Complete and point-of-care echocardiography is available in virtually all clinical settings for routine care, but this imaging tool is particularly indispensable in the emergency department, intensive care units, and operating room, where it can provide an immediate assessment of right ventricular function and associated hemodynamic changes to assist with real-time management decisions.
从历史上看，右心的超声心动图成像一直具有挑战性，因为其异常的几何形状不利于进行可重复的解剖和功能评估。随着先进超声心动图技术的发展，现在有可能完成对右心的综合评估，这种评估所需的假设更少，从而提高了准确性和精确性。由于与心脏计算机断层扫描、磁共振成像、核闪烁扫描和正电子发射断层扫描相比，超声心动图具有便携性、多功能性和可承受性，因此它仍然是诊断分析以及急性和慢性右心衰竭管理的一线成像方式。几乎所有超声心动图参数都经过了充分验证，并已显示出预后意义。这篇关于右心腔超声心动图参数以及与右心室功能障碍相关的血流动力学改变的叙述性综述的目的，是提供每次检查时必须获取的信息，以便对右心进行全面评估，并讨论它们在右心衰竭中的临床意义。通过在1985年至2025年的PubMed数据库和Cochrane数据库中进行文献检索，检索内容包括但不限于描述右心解剖和功能的术语、涉及急性和慢性右心衰竭及肺动脉高压的疾病状态，以及旨在阐明右心衰竭病理生理学的传统和先进超声心动图模式的应用，我们回顾了随机对照试验、观察性回顾性和前瞻性队列研究、社会指南以及系统评价文章。除了传统的二维超声心动图以及彩色、频谱和组织多普勒测量外，对疑似或确诊为右心衰竭患者的当代超声心动图评估必须包括三维超声心动图衍生测量、斑点追踪超声心动图应变分析和血流动力学参数，以便不仅能够描绘右心解剖结构，还能确定右心衰竭的潜在病理生理学。几乎在所有临床环境中都可进行完整的床旁超声心动图检查以用于常规护理，但这种成像工具在急诊科、重症监护病房和手术室中尤为不可或缺，在这些地方它可以立即评估右心室功能和相关的血流动力学变化，以协助做出实时管理决策。
