Redefining the role of cardiovascular imaging in patients with pulmonary arterial hypertension

While pulmonary arterial hypertension is a disease primarily affecting the pulmonary vasculature, the right ventricle plays an integral part in the disease process. Although widely used, two-dimensional echocardiography is limited in visualizing the right ventricle and, therefore, assessment of its structure and function has been largely subjective or invasive. Advanced imaging modalities such as real-time three-dimensional echocardiography and cardiovascular magnetic resonance overcome many challenges of two-dimensional echocardiography and have provided further insight into the pathophysiology of pulmonary arterial hypertension. Indices of right ventricular function obtained from these noninvasive techniques are being assessed for their prognostic capabilities as well as their ability to monitor response to pulmonary arterial hypertension-specific therapies. Future research is needed to compare the accuracy, reproducibility, and prognostic value of each of these parameters to definitively establish the role of cardiovascular imaging in the management of patients with pulmonary arterial hypertension.