Pulmonary Hypertension

  • Julia Grapsa


The right ventricle (RV) has a complex anatomy: it is the most anteriorly positioned cardiac chamber, directly behind the sternum and it marks the inferior border of the heart. It is anatomically subdivided into three components: the inflow tract (sinus), which includes the tricuspid valve (TV), the outflow tract (infundibulum or conus) which represents the smooth outflow region, separated from the inflow tract by crista supraventricularis and the highly trabeculated apical portion.


Right heart Pulmonary hypertension Tricuspid regurgitation Pulmonary pressures 


  1. 1.
    McQuillan BM, Picard MH, Leavitt M, et al. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation. 2001;104:2797–802.CrossRefGoogle Scholar
  2. 2.
    Galie N, et al. The task force for the diagnosis and treatment of pulmonary hypertension for the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.CrossRefGoogle Scholar
  3. 3.
    Haddad F, Hunt SA, Rosenthal DN, et al. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008;117:1436–48.CrossRefGoogle Scholar
  4. 4.
    Haddad F, Doyle R, Murphy DJ, et al. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008;117:1717–31.CrossRefGoogle Scholar
  5. 5.
    Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006;92(Suppl 1):i2–13.CrossRefGoogle Scholar
  6. 6.
    Badano LP, Ginghina C, Easaw J, Muraru D, Grillo MT, Lancellotti P, Pinamonti B, Coghlan G, Marra MP, Popescu BA, De Vita S. Right ventricle in pulmonary arterial hypertension: haemodynamics, structural changes, imaging, and proposal of a study protocol aimed to assess remodelling and treatment effects. Eur J Echocardiogr. 2010;11(1):27–37.CrossRefGoogle Scholar
  7. 7.
    Cameli M, Khayyal M, Marino F, Augustine D, Forshaw T, Mondillo S, Stankovic I, Surkova E, Timeshova T, Vasco N, Badano L, Grapsa J. Club 35 EACVI web spotlight: comments on right ventricle assessment in the new echocardiography recommendations. Eur Heart J Cardiovasc Imaging. 2015;16(11):1185–6.CrossRefGoogle Scholar
  8. 8.
    Faletra FF, Muzzarelli S, Dequarti MC, Murzilli R, Bellu R, Ho SY. Imaging-based right-atrial anatomy by computed tomography, magnetic resonance imaging, and three-dimensional transoesophageal echocardiography: correlations with anatomic specimens. Eur Heart J Cardiovasc Imaging. 2013 Dec;14(12):1123–31.CrossRefGoogle Scholar
  9. 9.
    Garbi M, Habib G, Plein S, Neglia D, Kitsiou A, Donal E, Pinto F, Bax J, Achenbach S, Popescu BA, Edvardsen T, Badano LP, Stefanidis A, Bucciarelli-Ducci C, Derumeaux G, Luis Zamorano J, Lüscher TF, Maurer G, Lancellotti P. Appropriateness criteria for cardiovascular imaging use in clinical practice: a position statement of the ESC/EACVI taskforce. Eur Heart J Cardiovasc Imaging. 2014 May;15(5):477–82.CrossRefGoogle Scholar
  10. 10.
    Foale R, Nihoyannopoulos P, McKenna W, et al. Echocardiographic measurement of the normal adult right ventricle. Br Heart J. 1986;56:33–44.CrossRefGoogle Scholar
  11. 11.
    Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland. Heart. 2008;94(Suppl 1):i1–i41.Google Scholar
  12. 12.
    Consensus statement on the management of pulmonary hypertension in clinical practice in the UK and Ireland. Thorax. 2008;63(Suppl 2):ii1–ii41.Google Scholar
  13. 13.
    Yoshida K, Yoshikawa J, Shakudo M, et al. Color Doppler evaluation of valvular regurgitation in normal subjects. Circulation. 1988;78:840–7.CrossRefGoogle Scholar
  14. 14.
    Kitabatake A, Inoue M, Asao M, et al. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation. 1983;68:302–9.CrossRefGoogle Scholar
  15. 15.
    Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantifiation: a report from the American Society of Echocardiography’s Guidelines and standards committee and the chamber quantifiation writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.CrossRefGoogle Scholar
  16. 16.
    Maeba H, Nakatani S, Sugawara M, et al. Different time course of changes in tricuspid regurgitant pressure gradient and pulmonary artery flow acceleration after pulmonary thromboendarterectomy: implications for discordant recovery of pulmonary artery pressure and compliance. Circ J. 2007;71:1771–5.CrossRefGoogle Scholar
  17. 17.
    Forfi PR, Fisher MR, Mathai SC, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006;174:1034–41.CrossRefGoogle Scholar
  18. 18.
    Kaul S, Tei C, Hopkins JM, et al. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984;107:526–31.CrossRefGoogle Scholar
  19. 19.
    Howard LS, Grapsa J, Dawson D, Bellamy M, Chambers JB, Masani ND, Nihoyannopoulos P, Simon R Gibbs J. Echocardiographic assessment of pulmonary hypertension: standard operating procedure. Eur Respir Rev. 2012;21(125):239–48.CrossRefGoogle Scholar
  20. 20.
    Lee CY, Chang SM, Hsiao SH, et al. Right heart function and scleroderma: insights from tricuspid annular plane systolic excursion. Echocardiography. 2007;24:118–25.CrossRefGoogle Scholar
  21. 21.
    Olson JM, Samad BA, Alam M. Prognostic value of pulse-wave tissue Doppler parameters in patients with systolic heart failure. Am J Cardiol. 2008;102:722–5.CrossRefGoogle Scholar
  22. 22.
    Abbas A, Lester S, Moreno FC, et al. Noninvasive assessment of right atrial pressure using Doppler tissue imaging. J Am Soc Echocardiogr. 2004;17:1155–60.CrossRefGoogle Scholar
  23. 23.
    Santamore WP, Dell’Italia LJ. Ventricular interdependence: signifiant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis. 1998;40:289–308.CrossRefGoogle Scholar
  24. 24.
    Stein PD, Sabbah HN, Anbe DT, et al. Performance of the failing and nonfailing right ventricle of patients with pulmonary hypertension. Am J Cardiol. 1979;44:1050–5.CrossRefGoogle Scholar
  25. 25.
    Schnittger I, Gordon EP, Fitzgerald PJ, et al. Standardized intracardiac measurements of two dimensional echocardiography. J Am Coll Cardiol. 1983;2:934–8.CrossRefGoogle Scholar
  26. 26.
    Wang Y, Gutman JM, Heilbron D, et al. Atrial volume in a normal adult population by two-dimensional echocardiography. Chest. 1984;86:595–601.CrossRefGoogle Scholar
  27. 27.
    Dujardin KS, Tei C, yeo TC, et al. Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic-dilated cardiomyopathy. Am J Cardiol. 1998;82:1071–6.CrossRefGoogle Scholar
  28. 28.
    Tei C, Dujardin KS, Hodge DO, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr. 1996;9:838–47.CrossRefGoogle Scholar
  29. 29.
    Yeo TC, Dujardin KS, Tei C, et al. Value of a Doppler derived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension. Am J Cardiol. 1998;81:1157–61.CrossRefGoogle Scholar
  30. 30.
    Alam M, Wardell J, Andersson E, et al. Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects. J Am Soc Echocardiogr. 1999;12:618–28.CrossRefGoogle Scholar
  31. 31.
    Feneley M, Gavaghan T. Paradoxical and pseudoparadoxical interventricular septal motion in patients with right ventricular volume overload. Circulation. 1986;74:230–8.CrossRefGoogle Scholar
  32. 32.
    Ryan T, Petrovic O, Dillon JC, et al. An echocardiographic index for separation of right ventricular volume and pressure overload. J Am Coll Cardiol. 1985;5:918–27.CrossRefGoogle Scholar
  33. 33.
    Hammarstrom E, Wranne B, Pinto FJ, et al. Tricuspid annular motion. J Am Soc Echocardiogr. 1991;4:131–9.CrossRefGoogle Scholar
  34. 34.
    Lopez-Candales A, Dohi K, Rajagopalan N, et al. Defining normal variables of right ventricular size and function in pulmonary hypertension: an echocardiographic study. Postgrad Med J. 2008;84:40–5.CrossRefGoogle Scholar
  35. 35.
    Anavekar NS, Skali H, Bourgoun M, et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO study). Am J Cardiol. 2008;101:607–12.CrossRefGoogle Scholar
  36. 36.
    Tadic M. Multimodality evaluation of the right ventricle: an updated review. Clin Cardiol. 2015;38(12):770–6.CrossRefGoogle Scholar
  37. 37.
    Ryo K, Goda A, Onishi T, Delgado-Montero A, Tayal B, Champion HC, Simon MA, Mathier MA, Gladwin MT, Gorcsan J 3rd. Characterization of right ventricular remodeling in pulmonary hypertension associated with patient outcomes by 3-dimensional wall motion tracking echocardiography. Circ Cardiovasc Imaging. 2015;8(6)Google Scholar
  38. 38.
    Blanchard DG, DeMaria AN. Right ventricular 3-dimensional strain in pulmonary hypertension: the quest to see the future. J Am Coll Cardiol. 2014;64(1):52–3.CrossRefGoogle Scholar
  39. 39.
    Smith BC, Dobson G, Dawson D, Charalampopoulos A, Grapsa J, Nihoyannopoulos P. Three-dimensional speckle tracking of the right ventricle: toward optimal quantification of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol. 2014;64(1):41–51.CrossRefGoogle Scholar
  40. 40.
    Wang J, Prakasa K, Bomma C, et al. Comparison of novel echocardiographic parameters of right ventricular function with ejection fraction by cardiac magnetic resonance. J Am Soc Echocardiogr. 2007;20:1058–64.CrossRefGoogle Scholar
  41. 41.
    Grapsa J, Gibbs JS, Dawson D, Watson G, Patni R, Athanasiou T, Punjabi PP, Howard LS, Nihoyannopoulos P. Morphologic and functional remodeling of the right ventricle in pulmonary hypertension by real time three dimensional echocardiography. Am J Cardiol. 2012;109(6):906–13.CrossRefGoogle Scholar
  42. 42.
    Grapsa J, O’Regan DP, Pavlopoulos H, Durighel G, Dawson D, Nihoyannopoulos P. Right ventricular remodelling in pulmonary arterial hypertension with three-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. Eur J Echocardiogr. 2010 Jan;11(1):64–73.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Julia Grapsa
    • 1
  1. 1.Imperial College of LondonLondonUK

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