Experts to explore imaging modalities for the often-overlooked right heart

The heart’s right ventricle is different structurally and functionally from the left ventricle. However, the latter tends to get much more attention from medical specialists than the former, said Navitha Ramesh, MD, MBBS, FCCP, ICU Medical Director for the University of Pittsburgh Medical Center.

“Sometimes, the right heart is called ‘the forgotten ventricle,’ so our goal is to bring more attention to this important structure,” said Dr. Ramesh, who will chair the CHEST 2025 session Pulmonary Vascular and Right Heart Imaging, Sunday, October 19, at 1:30 pm in McCormick Place, Lakeside Center, Room 353C.

Recognizing the importance of the right ventricle is crucial for care teams because right ventricle failure can lead to left ventricle failure, which subsequently causes the entire body to shut down.

“Echocardiographers and sonography technicians are trained to look at the left heart; they’re not necessarily trained to look at the right heart,” Dr. Ramesh said. “It’s important to make a note for them when there’s concern about a right heart problem so they can explore the area in more detail.”

Assessment of the right heart and pulmonary circulation can be challenging due to the complex geometry of the right ventricle, comorbid pulmonary airways and parenchymal disease, and the overlap of hemodynamic abnormalities with left heart failure. To gain a clearer picture, there are several imaging modalities available to care teams.

Dr. Ramesh will begin by presenting on transthoracic echocardiogram imaging, a relatively standard technique to capture still or moving images of the heart. According to Dr. Ramesh, this technique, while widely accessible, can be challenging to apply among certain patient populations.

“The patient body habitus does play a role, so some of the imaging views are difficult in patients who have obesity, especially among female patients,” she explained.

For additional imaging insights, a CT or PET CT scan would be a recommended next step, although Dr. Ramesh noted that these techniques carry the risk of radiation exposure. If additional testing is required, clinicians should refer patients for scanning with high-resolution CT, MRI, or nuclear imaging machines. Pulmonary experts Sandeep Sahay, MD, FCCP; Belinda Rivera-Lebron, MD, MSCE, FCCP; and Katie Fitton, DO, FCCP, will discuss the pros and cons of each of these different modalities during the session.

“The drawback of these newer imaging modalities is that your access to them depends on where you work,” Dr. Ramesh said. “They’re typically available only at tertiary care centers or large universities with extensive research funding.”

The session will also cover expanding applications of artificial intelligence (AI) for analysis of right heart imaging, which include risk detection for pulmonary embolisms (PE). Clinicians can work in conjunction with AI as a tool to diagnose patients when the imaging windows are particularly challenging, Dr. Ramesh said. The AI technology would primarily assist providers in determining PE severity when patients fall in the gray area between a mild and severe case, she said.

“Some AI modalities are being used to project how the patient will progress based on their current vital signs and blood work, which helps the physician determine whether they need to monitor them in the ICU or telemetry floor,” Dr. Ramesh said. “It takes us a step beyond what we already know by anticipating what’s going to happen to the patient.”