The role of the right ventricle in pulmonary arterial hypertension and imaging methods for non-invasive evaluation.

INTRODUCTION

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by the remodeling of pulmonary circulation, leading to increased pulmonary vascular resistance (PVR) and right ventricular (RV) overload. While the right heart may initially compensate, many patients ultimately face right heart failure and higher risk of mortality. Significant progress has been made in RV management, including advancements in molecular understanding, development of monitoring tools, and the exploration of new therapeutic pathways.

AREAS COVERED: A comprehensive literature search (January 2000-present) was conducted using PubMed and Embase. Search strategies focused on Pulmonary Arterial Hypertension and the Right Ventricle, incorporating specific concepts such as RV-pulmonary arterial (RV-PA) coupling and noninvasive assessment methods, including Echocardiography (2D and 3D) and Cardiac Magnetic Resonance (CMR).

EXPERT OPINION: The use of appropriate parameters to identify cardiac function deterioration is crucial for monitoring PAH patients. In this regard, imaging tests and new parameters have increasingly demonstrated added value when combined with traditional tools. This review highlights the central role of the RV in PAH pathophysiology and progression. We present and discuss noninvasive imaging methods for RV assessment, focusing on summarizing recent studies that support the use of noninvasive measures to evaluate RV-PA coupling and right systolic function.