Maria Concetta Pastore
Simona Sperlongano
Paolo Calabrò
Matteo Cameli- 1Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- 2Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
Editorial on the Research Topic
The right heart: a key target for cardiovascular medicine
After being neglected for decades, the evaluation of the right ventricle (RV) has gained increasing interest among clinicians and researchers due to the strong evidence proving its importance for prognosis (1) in different clinical conditions, such as heart failure, valvular heart disease, and pulmonary hypertension (2–5). Although the RV is not the primary affected chamber in many pathological conditions, its involvement may be considered a marker of disease severity and transition to a poor prognosis (6). Moreover, new interventional techniques focused on the right heart and valves have been developed with significant improvement in quality of life (7).
This article Research Topic aimed at increasing scientific awareness of the right heart, highlighting the pivotal role of all its structures, which often must be considered not only as “collateral” but also as the main target for diagnostics, risk stratification, and therapy.
Research focusing on RV structural and functional impairment has led to the identification of new parameters to optimize the evaluation of this chamber, since its evaluation with common imaging modalities is sometimes limited (8). One of the emerging imaging modalities for the assessment of RV structure and function is 3D echocardiography (9), which offers a more comprehensive quantification of RV dimensions, with volumes comparable to cardiac magnetic resonance. This modality is gaining feasibility in parallel to the development of new automatic tools for the calculation of 3D parameters. Memis et al. achieved good results in the reproducibility of 3D echocardiography among expert and non-expert operators after a brief training to evaluate RV in patients with decompensated heart failure, which remains one of the main fields of application of RV assessment.
However, 3D echocardiography can sometimes be challenging in patients with pulmonary illness or who are poorly cooperative. Speckle tracking echocardiography (10–14) has been studied extensively and validated in multicenter studies to standardize acquisition and reference values (15). It offers a quick tool and sensitive parameters for RV function estimation, allowing for early diagnosis of subtle RV impairment and accurate prognostic assessment, particularly in primary and secondary pulmonary hypertension. Kaddoussi et al. showed how free-wall RV strain was useful in detecting subtle myocardial involvement in chronic obstructive pulmonary disease, despite normal basic echocardiographic parameters and left ventricular strain. The authors also found that RV strain was associated with a higher risk of hospitalization for acute exacerbation during the one-year follow-up (55% vs. 25% in patients with impaired vs. normal RV strain; p = 0.024). For these patients, the main target is to detect early signs of cor pulmonale in order to provide early therapy.
The same applies to patients with chronic thromboembolic pulmonary hypertension, a rare but severe cause of pulmonary hypertension (classified as “group 4”), which puts patients at high risk for decompensation and fatal events. Simeone et al., in two articles published in this Research Topic, provided an overview of the diagnostic algorithm and therapeutic strategies available for these patients, focusing on multidisciplinary evaluation and collaboration to optimize and personalize the treatment for this population.
Conversely, some authors claim that the use of imaging may be preceded by biomarkers for diagnosis. Cai et al. conducted research on rats undergoing surgical pulmonary artery banding with consequent RV remodeling to search for differentially expressed microRNAs (miRNAs), which were then validated in a cohort of 100 patients with either adaptive RV pressure overload (20), maladaptive RV pressure overload (20), left heart failure (20), or left ventricular hypertrophy (19) along with 21 controls. The authors identified circulating miRNA-486 as a marker of RV maladaptation in PH patients. This marker was not significantly different from B-type natriuretic peptide (BNP). It was also associated with the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio and BNP.
As previously mentioned, the RV plays a fundamental role in prognostic assessment in different clinical conditions, including cardiac surgery and left heart disease, since the pre-existence of RV dysfunction (16) or the development of considerable postoperative RV dysfunction is associated with a poor prognosis in patients undergoing cardiac surgery and may influence treatment choices. In fact, the scientific community is moving toward the research of reliable prognostic markers in these patients. Watanabe et al. proposed using QRS duration, as measured by a bipolar pacing catheter in the RV, as a perioperative monitoring parameter for RV function in patients undergoing robotic mitral valve surgery. The authors observed a prolongation of this parameter during robotic mitral valve repair, an association with right ventricular fractional area change (RVFAC), and they found that prolonged postoperative QRSRV duration was the only significant parameter associated with a longer stay in the intensive care unit after surgery.
Finally, primary or acquired isolated right heart disease should not be overlooked, as it can have fatal consequences, albeit rarely. In particular, one of the main causes of cyanotic disease includes RV structure involvement, as depicted in the case report of Cui et al. on an infant with cyanosis and severe tricuspid regurgitation after high-altitude exposure due to spontaneous chordae tendineae rupture and tricuspid valve prolapse. The infant was initially misdiagnosed, but the case was promptly solved with cardiac surgery.
The field of diagnostic and therapeutic research on the right heart is continuously growing. It is hoped that this Research Topic will shed light on the importance of evaluating the right heart, provide new practical information for the management of these patients, and stimulate future research in this area.
Author contributions
MP: Writing – original draft, Writing – review & editing. SS: Writing – original draft, Writing – review & editing. PC: Writing – review & editing. MC: Writing – review & editing.
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References
1. Zhou X, Ferrara F, Contaldi C, Bossone E. Right ventricular size and function in chronic heart failure: not to be forgotten. Heart Fail Clin. (2019) 15(2):205–17. doi: 10.1016/j.hfc.2018.12.015
2. Cameli M, Pastore MC, Mandoli GE, Nistor D, Lisi E, Tok ÖÖ, et al. Prognosis and risk stratification of patients with advanced heart failure (from PROBE). Am J Cardiol. (2019) 124(1):55–62. doi: 10.1016/j.amjcard.2019.03.041
3. Filippetti L, Voilliot D, Bellino M, Citro R, Go YY, Lancellotti P. The right heart-pulmonary circulation unit and left heart valve disease. Heart Fail Clin. (2018) 14(3):431–42. doi: 10.1016/j.hfc.2018.03.009
4. Mandoli GE, De Carli G, Pastore MC, Cameli P, Contorni F, D'Alessandro M, et al. Right cardiac involvement in lung diseases: a multimodality approach from diagnosis to prognostication. J Intern Med. (2021) 289(4):440–9. doi: 10.1111/joim.13179
5. Di Mauro M, Scrofani R, Antona C, Nicolò F, Cappabianca G, Beghi C, et al. Right ventricular assessment can improve prognostic value of Euroscore II. J Card Surg. (2020) 35(7):1548–55. doi: 10.1111/jocs.14672
6. Mandoli GE, Pastore MC, Benfari G, Setti M, Nistor D, D'Ascenzi F, et al. New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure. ESC Heart Fail. (2022) 9(1):476–85. doi: 10.1002/ehf2.13722
7. Tang GHL, Hahn RT, Whisenant BK, Hamid N, Naik H, Makkar RR, et al. Tricuspid transcatheter edge-to-edge repair for severe tricuspid regurgitation: 1-year outcomes from the TRILUMINATE randomized cohort. J Am Coll Cardiol. (2025) 85(3):235–46. doi: 10.1016/j.jacc.2024.10.086
8. Badano LP, Addetia K, Pontone G, Torlasco C, Lang RM, Parati G, et al. Advanced imaging of right ventricular anatomy and function. Heart. (2020) 106(19):1469–76. doi: 10.1136/heartjnl-2019-315178
9. Addetia K, Muraru D, Badano LP, Lang RM. New directions in right ventricular assessment using 3-dimensional echocardiography. JAMA Cardiol. (2019) 4(9):936–44. doi: 10.1001/jamacardio.2019.2424
10. Lejeune S, Roy C, Ciocea V, Slimani A, de Meester C, Amzulescu M, et al. Right ventricular global longitudinal strain and outcomes in heart failure with preserved ejection fraction. J Am Soc Echocardiogr. (2020) 33(8):973–984.e2. doi: 10.1016/j.echo.2020.02.016
11. Lundorff IJ, Sengeløv M, Pedersen S, Modin D, Bruun NE, Fritz-Hansen T, et al. Prognostic value of right ventricular echocardiographic measures in patients with heart failure with reduced ejection fraction. J Clin Ultrasound. (2021) 49(9):903–13. doi: 10.1002/jcu.23050
12. Lisi M, Cameli M, Righini FM, Malandrino A, Tacchini D, Focardi M, et al. RV longitudinal deformation correlates with myocardial fibrosis in patients with End-stage heart failure. JACC Cardiovasc Imaging. (2015) 8(5):514–22. doi: 10.1016/j.jcmg.2014.12.026
13. Motoki H, Borowski AG, Shrestha K, Hu B, Kusunose K, Troughton RW, et al. Right ventricular global longitudinal strain provides prognostic value incremental to left ventricular ejection fraction in patients with heart failure. J Am Soc Echocardiogr. (2014) 27(7):726–32. doi: 10.1016/j.echo.2014.02.007
14. Aymami M, Amsallem M, Adams J, Sallam K, Moneghetti K, Wheeler M, et al. The incremental value of right ventricular size and strain in the risk assessment of right heart failure post - left ventricular assist device implantation. J Card Fail. (2018) 24(12):823–32. doi: 10.1016/j.cardfail.2018.10.012
15. Badano LP, Kolias TJ, Muraru D, Abraham TP, Aurigemma G, Edvardsen T, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/industry task force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. (2018) 19(6):591–600. doi: 10.1093/ehjci/jey042
Keywords: right heart, right ventricle (RV), heart failure, pulmonary hypertension, diagnosis, prognosis
Citation: Pastore MC, Sperlongano S, Calabrò P and Cameli M (2025) Editorial: The right heart: a key target for cardiovascular medicine. Front. Cardiovasc. Med. 12:1713152. doi: 10.3389/fcvm.2025.1713152
Received: 25 September 2025; Accepted: 6 October 2025;
Published: 24 October 2025.
Edited and Reviewed by: Pietro Enea Lazzerini, University of Siena, Italy
Copyright: © 2025 Pastore, Sperlongano, Calabrò and Cameli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Maria Concetta Pastore, bWFyaWFjb25jZS5wYXN0b3JlQHVuaXNpLml0