Right Ventricular Contractile Reserve: A Scoping Review

Background Right ventricular contractile reserve (RVCR) describes the ability of the RV to augment contractility under stress, providing valuable insight into latent RV dysfunction across diverse cardiorespiratory diseases. Despite emerging data, RVCR lacks standardized measurement protocols and clinical definitions. Objective To systematically describe and assess RVCR assessment and clinical implications across multiple conditions. Methods We conducted a scoping review of studies evaluating RVCR via invasive or non-invasive modalities during exercise or pharmacologic stress in adult populations. Data extracted included methodology, definitions, RV parameters, and clinical implications. Results We included 62 studies reporting on 4,024 patients, covering healthy individuals, athletes, pulmonary hypertension (PH), structural heart disease, left ventricular assist device (LVAD) recipients, and other conditions (e.g. amyloidosis and COPD). RVCR was assessed via stress echocardiography, invasive pressure-volume (PV) loops, and cardiac MRI. Healthy populations exhibited robust RVCR, whereas patients with PH, heart failure, LVADs, and cardiomyopathies consistently showed impaired RVCR, correlating with exercise intolerance and adverse clinical outcomes. Conclusion RVCR is a significant marker of right-heart adaptability across conditions. Heterogeneity in definitions, testing modalities, and imaging techniques limits clinical applicability and generalizability. Standardized methods and prospective validation are needed.