New noninvasive imaging techniques for pulmonary hypertension (PH)

 Speckle tracking-derived RV   strain and strain rateRV longitudinal peak systolic strain of ≥ −19% is significantly associated with all-cause mortality [72]
 RV automated systolic indexSemi-automated and reproducible [73]
 Three-dimensional echoExcellent correlation with CMRI, but can underestimate LV volumes [74]; real-time three-dimensional echo could be a time-saving and low-cost alternative to MRI [75]
 RV strainSystolic strain and strain rate are predictors of right-sided heart failure, clinical deterioration and mortality in patients with PAH [76]
 Contrast-enhanced CMRILGE at the right ventricle insertion point is a marker for advanced disease in PH and is related to clinical worsening [55]
 Wall sheer stressBeing investigated [77]
 Exercise CMRIRV stroke volume does not increase on exercise in patients with PAH (unlike healthy individuals) [78], indicating that these patients need to raise their heart rate to cope with exercise
 Fast SENC imagingA through-plane CMRI tagging technique that allows direct measurement of regional function by using a free-breathing single-heartbeat real-time image acquisition [79]
 Myocardial T1 mappingEnables quantification of myocardial extracellular volume; may be useful for detecting the early stages of chronic PH, prior to the onset of macroscopic fibrosis [80]
 Right ventricle 18F-FDGHigher uptake is associated with greater severity or clinical worsening of PH [81–83]
 Same-day scanning with   13N-NH3 and 18F-FDGFeasible for quantifying RV blood flow and metabolism in patients with idiopathic PAH [84]
  • Echo: echocardiography; RV: right ventricular; CMRI: cardiac magnetic resonance imaging; SENC: strain-encoded; PET: positron emission tomography; FDG: fluorodeoxyglucose; LV: left ventricular; MRI: magnetic resonance imaging; PAH: pulmonary arterial hypertension; LGE: late gadolinium enhancement.