Right Ventricular Reserve: A Scoping Review

Background Right ventricular reserve (RVR) describes the ability of the RV to augment cardiac output via contractile or diastolic reserve under stress, providing valuable insight into latent RV dysfunction across diverse cardiorespiratory diseases. Despite emerging data, RVR lacks standardized measurement protocols and clinical definitions. Objective To systematically describe and assess RVR assessment and clinical implications across multiple conditions. Methods and Results We conducted a scoping review of studies evaluating RVR via invasive or noninvasive modalities during exercise or pharmacological stress in adult populations. Data extracted included methodology, definitions, RV parameters, and clinical implications. We included 62 studies reporting on 4024 patients, covering healthy individuals, athletes, pulmonary hypertension, structural heart disease, left ventricular assist device recipients, and other conditions (eg, amyloidosis and chronic obstructive pulmonary disease). RVR was assessed via stress echocardiography, invasive pressure–volume loops, and cardiac magnetic resonance imaging. Healthy populations exhibited robust RVR, whereas patients with pulmonary hypertension, heart failure, left ventricular assist devices, and cardiomyopathies consistently showed impaired RVR, correlating with exercise intolerance and adverse clinical outcomes. Conclusions RVR is a significant marker of right heart adaptability across conditions. Heterogeneity in definitions, testing modalities, and imaging techniques limit clinical applicability and generalizability. Standardized methods and prospective validation are needed.