Purpose of review: The assessment of ventricular systolic performance is one of the most critical roles of echocardiography, often impacting the diagnosis, management, and prognosis of patients with suspected cardiovascular disease.
Recent findings: Historically, the echocardiographic assessment of diseases affecting the right ventricle has lagged behind that of the left ventricle, despite knowledge demonstrating that diseases affecting the right heart have been shown to have the same clinical consequences as those affecting the left heart.
Summary: This up-to-date review of right ventricular imaging by two-dimensional and three-dimensional echocardiography will emphasize the clinical situations for which assessment of right ventricular systolic function is particularly important, and review the systematic assessment of right ventricular regional wall motion in terms of coronary anatomy. Technical and scanning tips designed to optimize the visualization of the right heart with echocardiography with case examples will be presented. Qualitative and quantitative two-dimensional methods for assessing right heart function that are both well established and evolving will be summarized and the case for considering more routine use of ultrasound contrast agents to enhance right ventricular endocardial border definition will be made. The current state of three-dimensional imaging of the right ventricle will be highlighted along with the challenges for making this powerful tool more widespread.