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. 2021 Sep 30;14(10):e012774. doi: 10.1161/CIRCIMAGING.121.012774

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© 2021 The Authors.

Circulation: Cardiovascular Imaging is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

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Figure 1. — Functional adaptation of the right ventricle (RV) to the different degrees of left ventricular (LV) systolic dysfunction in patients with left-sided heart disease: representative cases. Three-dimensional schematic representation of the 3 major components contributing to total RV pump function: (i) longitudinal shortening along the long-axis (red) contributing to RV longitudinal ejection fraction component (LEF), (ii) inward (radial) motion of the RV free wall (orange) contributing to radial ejection fraction component (REF), and (iii) short-axis shortening in the anteroposterior direction (purple) contributing to anteroposterior ejection fraction component (AEF). Green mesh represents RV end-diastolic and the blue surface the RV end-systolic volume. In the case of preserved LV ejection fraction (LVEF), the 3 components show a balanced relative contribution. RV shortening along the longitudinal and anteroposterior directions continuously decreases with LVEF. However, shortening in the radial direction shows a compensatory increase in mild and moderate LV dysfunction, maintaining RVEF. In severe LV dysfunction, all motion components drop significantly, resulting in severe RV dysfunction.