Assessment of right ventricular function

The right ventricle has traditionally received less consideration than the left ventricle. In recent years this interest has increased with the recognition of the critical role of right ventricular performance in determining the clinical outcome and decision-making in patients with both clinical heart failure and congenital heart disease. In this issue of Heart, Missant et al 1 ( see online only article on p e15 ) propose a non-invasive method for assessment of RV contractility that is less load-dependent than currently used techniques and that correlates with invasive pressure–volume assessment of RV function. The right ventricle is a structurally and functionally complex chamber, with a shape less amenable to geometric simplification for the purpose of volume estimation than the left ventricle, and a heavily trabeculated endocardial surface. In addition, its substernal position makes echocardiographic assessment of its size and function difficult. When assessing RV function, it is necessary to bear in mind that the ventricular septum is an important architectural component of the right ventricle, and myocardial fibre orientation in both the free wall and the septum plays a major role in determining ejection. The RV free wall predominantly contains transverse fibres, whereas the septum contains oblique fibres.2 The oblique orientation of fibres in the LV free wall and septum allows the wringing or twisting required to eject blood into high systemic vascular resistance, whereas the compressive force generated by transverse fibres in the RV free wall is sufficient to eject blood in …