How should we assess right ventricular function in 2008?

The right ventricle is neglected in clinical practice, both because it is difficult to assess and because there is a tack of awareness of the pivotal rote it plays in cardiac and pulmonary vascular diseases. Substantial progress is now being made and methods of assessing right ventricular function are beginning to be standardised and evaluated systematically in clinical studies. Clinicians need simple reproducible tests of right ventricular function to improve their management of pulmonary hypertension, carcinoid heart disease, congenital heart disease and left heart failure. Academics require robust methods of analysing the contribution of right ventricular myocardial failure to the clinical syndrome of cor-pulmonate and heart failure, so that the pathobiological processes can be resolved and optimal therapeutic approaches identified to support and improve right ventricular function in these conditions. While awaiting such developments we must recognise that current measures in clinical usage (right atrial area, right ventricular diameters, change in fractional area and right ventricular ejection times) give helpful if incomplete information, and should form part of standard echocardiographic assessment. Clinicians should also be aware of the progress in the fields of wall stress and strain rate imaging as these may welt be validated in the near future. MRI is already well recognised as the imaging technique of choice for right ventricular dysplasia and will certainty deliver to the clinician accurate assessment of right ventricular ejection fraction, mass and identification of areas of localised myocardial damage before long.