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Review
. 2021 Mar;26(2):263-275.
doi: 10.1007/s10741-020-10014-4.

Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings

Giulia Elena Mandoli  1 , Carlotta Sciaccaluga  2 , Francesco Bandera  3 , Paolo Cameli  4 , Roberta Esposito  5 , Antonello D'Andrea  6 , Vincenzo Evola  7 , Regina Sorrentino  5 , Alessandro Malagoli  8 , Nicolò Sisti  2 , Dan Nistor  9 , Ciro Santoro  5 , Elena Bargagli  4 , Sergio Mondillo  2 , Maurizio Galderisi  5 , Matteo Cameli  2 ; Working group of Echocardiography of Italian Society of Cardiology (SIC)
Affiliations
Review

Cor pulmonale: the role of traditional and advanced echocardiography in the acute and chronic settings

Giulia Elena Mandoli et al. Heart Fail Rev. 2021 Mar.

Abstract

Cor pulmonale is the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process. Depending on the speed of onset of the pathological condition and subsequent effects on the right ventricle, it is possible to distinguish the acute cor pulmonale from the chronic type of disease. Echocardiography plays a central role in the diagnostic and therapeutic work-up of these patients, because of its non-invasive nature and wide accessibility, providing its greatest usefulness in the acute setting. It also represents a valuable tool for tracking right ventricular function in patients with cor pulmonale, assessing its stability, deterioration, or improvement during follow-up. In fact, not only it provides parameters with prognostic value, but also it can be used to assess the efficacy of treatment. This review attempts to provide the current standards of an echocardiographic evaluation in both acute and chronic cor pulmonale, focusing also on the findings present in the most common pathologies causing this condition.

Keywords: Cor pulmonale; Echocardiography; Pulmonary hypertension; Right heart failure; Right ventricular dysfunction.

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Figures

Fig. 1.
Fig. 1.
Echocardiographic assessment of the right ventricle. This figure shows the main four 2D-echocardiographic views that should be assessed for a thorough evaluation of the right ventricle (RV): parasternal long axis view (PLAX), short axis view (SAX), apical 4-chamber view, and subcostal view. CH, chambers; LA, left atrium; LV, left ventricle; PLAX, parasternal long-axis view; PV, pulmonary valve; RA, right atrium; RV, right ventricle; RVIT, right ventricular inflow tract; RVOT, right ventricular outflow tract; SAX, short axis; TV, tricuspid valve
Fig. 2.
Fig. 2.
Right ventricular assessment by 3D-echocardiography. This picture shows a 3D-echocardiographic reconstruction of the right ventricle (RV). The software provides a motion picture of the RV as well as the volume-time curve and RV measures, such as RV end-diastolic volume (EDV), RV end-systolic volume (ESV), RV stroke volume (SV), and RV ejection fraction (EF)
Fig. 3.
Fig. 3.
Main causes of chronic cor pulmonale. This figure shows the three most common disorders and their relative mechanisms, which are responsible for the development of chronic cor pulmonale: chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (PF), and chronic thromboembolic disease. PH, pulmonary hypertension; PE, pulmonary embolism
Fig. 4.
Fig. 4.
Morphological and functional difference between a healthy right ventricle and an impaired RV by 3D-echocardiography. The image on the left shows a healthy right ventricle (RV) that has a preserved triangular morphology, whereas the image on the right side shows a failing RV, with a markedly altered morphology and an impaired function, as indicated by the echocardiographic parameters listed in the picture. EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume; RVLS, right ventricular longitudinal strain; SV, stroke volume
Fig. 5.
Fig. 5.
Relevant echocardiographic parameters found in acute pulmonary embolism. This figure shows the most common findings that can be found in the setting of acute pulmonary embolism. (a) Ratio between right ventricular (RV) and left ventricular (LV) basal diameters, often enough > 1, meaning a RV dilatation. (b) Right atrio-ventricular gradient, rarely above 60 mm Hg in the acute setting. (c) Tricuspid annular plane systolic excursion (TAPSE), which in acute setting is not necessarily reduced compared with controls.(d) Reduced RV longitudinal strain
Fig. 6.
Fig. 6.
Relevant echocardiographic parameters found in chronic cor pulmonale. This figure shows the most common findings that can be found in the setting of chronic cor pulmonale. (a) Ratio between right ventricular (RV) and left ventricular (LV) basal diameters, often enough > 1, meaning a RV dilatation. (b) High right atrio-ventricular gradient, typical of chronic pulmonary hypertension. (c) Reduced tricuspid annular plane systolic excursion (TAPSE), reflecting a reduced RV longitudinal function. (d) Reduced RV longitudinal strain
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