Echocardiographic Grading of Right Ventricular Afterload in Left Heart Disease: Relation to Right Ventricular Function, Pulsatile and Resistant Load, and Outcome

Although right ventricle (RV) dysfunction drives clinical worsening in pulmonary hypertension (PH), information about RV function has not been well integrated in PH risk assessment. The gold standard for assessing RV function and ventriculo-arterial coupling is the construction of multi-beat pressure–volume (PV) loops.

Increased pulmonary artery systolic pressure (PASP) with downstream consequences on the right ventricle (RV) is the shared hallmark of the various forms of pulmonary hypertension (PH). The underlying pathophysiology of elevated PASP varies greatly between PH classification groups.

The hemodynamic definitions of pulmonary hypertension consider resistive loading (pulmonary vascular resistance [PVR]), but there are increasing evidence that pulsatile loading (pulmonary artery compliance [PAC]) has functional and prognostic importance.

The right ventricular stroke work index (RVSWI) reflects the active work of the right ventricle (RV), but its clinical usefulness is not yet fully known in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).