The Non-invasive Assessment of the Pulmonary Circulation-Right Ventricular Functional Unit: Diagnostic and Prognostic Implications

Federica Giardino; Philipp Douschan; Stefania Paolillo; Christian Basile; Filippo Cademartiri; Francesca Musella; Antonio Cittadini; Alberto Maria Marra

doi:10.1016/j.hfc.2024.08.004

The Non-invasive Assessment of the Pulmonary Circulation-Right Ventricular Functional Unit: Diagnostic and Prognostic Implications

Heart Fail Clin. 2025 Jan;21(1):63-78. doi: 10.1016/j.hfc.2024.08.004. Epub 2024 Oct 15.

Authors

Federica Giardino¹, Philipp Douschan², Stefania Paolillo³, Christian Basile⁴, Filippo Cademartiri⁵, Francesca Musella⁶, Antonio Cittadini⁷, Alberto Maria Marra⁸

Affiliations

¹ Cardiovascular Pathophysiology and Therapeutics (CardioPath) Program, University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy; Division of Internal Medicine and Metabolism and Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Bld.18, 1st Floor, Naples 80131, Italy.
² Division of Pulmonology, Medical University of Graz, Auenbruggerplatz 15, Graz A-8036, Austria; Division of Pulmonology and Ludwig Boltzmann Institute for Lung Vascular Research, Medical University of Graz, Graz, Austria; Universities of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig-University, Giessen, Germany.
³ Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, Building. 2, Naples 80131, Italy.
⁴ Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini 5, Building. 2, Naples 80131, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, K2 Medicin, Solna, K2 Kardio Lund L Savarese G, Solnavägen 1, Solna, Stockholm 171 77, Sweden.
⁵ Department of Imaging, Fondazione Monasterio/CNR, Via Giuseppe Moruzzi 1, Pisa 56124, Italy.
⁶ Division of Cardiology, Department of Medicine, Karolinska Institutet, K2 Medicin, Solna, K2 Kardio Lund L Savarese G, Solnavägen 1, Solna, Stockholm 171 77, Sweden; Cardiology Department, Santa Maria delle Grazie Hospital, Via Domitiana, Pozzuoli, Naples 80078, Italy.
⁷ Division of Internal Medicine and Metabolism and Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Bld.18, 1st Floor, Naples 80131, Italy; Department of Internal Medicine and Clinical Complexity, University of Naples Federico II, Via S. Pansini 5, Building.18, 1st Floor, Naples 80131, Italy.
⁸ Division of Internal Medicine and Metabolism and Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Bld.18, 1st Floor, Naples 80131, Italy. Electronic address: albertomaria.marra@unina.it.

PMID: 39550081
DOI: 10.1016/j.hfc.2024.08.004

Abstract

The pulmonary circulation and the right ventricle play a pivotal role in the global hemodynamics of human beings, so much so that their close interaction is encapsulated in the concept of a "morpho-functional unit". In this review we aim to pinpoint the strengths and weaknesses of various noninvasive established techniques. The goal is to detect early morphologic and/or functional changes in the pulmonary circulation and right ventricular unit, which is crucial for tailoring treatments and prognostic assessments. The scope of this review includes resting and stress echocardiography, cardiopulmonary exercise testing, computed tomography, and cardiac magnetic resonance in characterizing the pulmonary circulation-right ventricular unit both morphologically and functionally.

Keywords: Cardiopulmonary interactions; Non-invasive test; Pulmonary hypertension; Right ventricular dysfunction.

Publication types

Review

MeSH terms

Echocardiography / methods
Exercise Test / methods
Heart Ventricles* / diagnostic imaging
Heart Ventricles* / physiopathology
Humans
Prognosis
Pulmonary Circulation* / physiology
Tomography, X-Ray Computed / methods
Ventricular Function, Right* / physiology