Right Ventricular Strain Imaging: Present and Future

Abstract

Right ventricular function has historically received less attention than left ventricular function. Yet, emerging evidence highlights its crucial prognostic role in various cardiovascular diseases, including acute myocardial infarction, pulmonary hypertension, pulmonary embolism, and congenital heart disease. Advances in echocardiography, particularly two-dimensional speckle-tracking echocardiography, have enabled quantitative assessment of right ventricular global longitudinal strain and right ventricular free-wall longitudinal strain, providing greater sensitivity for detecting subclinical right ventricular dysfunction than conventional indices, such as tricuspid annular plane systolic excursion or fractional area change. This review will provide methodology, normal reference values, and clinical applications of right ventricular global longitudinal strain, specifically for the Indian context. It incorporates recent Indian studies across acute myocardial infarction, valvular heart disease, cardiac surgery, heart failure with preserved ejection fraction, and diabetes mellitus. International data provide a comparative context, revealing significant gaps in population-specific normative data for India. Technical challenges, including vendor variability, load dependency, and imaging quality limitations, are discussed alongside emerging technologies such as 3D speckle-tracking, artificial intelligence integration, and telemedicine applications. The review concludes with recommendations for establishing India-specific reference ranges, developing comprehensive training programs, and conducting large-scale prospective outcome studies to facilitate routine clinical integration of right ventricular strain imaging across India’s diverse healthcare landscape.