A Narrative Review of Right Heart Dysfunction in Pulmonary Embolism: Current Insights and Clinical Perspectives

Pulmonary embolism (PE) often presents with non-specific symptoms that make the diagnosis challenging, but the identification of right heart strain (RHS) can help determine the disease severity. Therefore, timely identification and diagnosis of RHS in patients with pulmonary embolisms is critical for accurate risk categorization and appropriate management. The review mainly concentrates on acute pulmonary embolism and right‑heart strain assessment, risk stratification, and management using European Society of Cardiology (ESC) 2019 guidelines developed in collaboration with the European Respiratory Society (ERS). Right‑heart strain is diagnosed by imaging signs such as right‑ventricular dilation, interventricular septal flattening, McConnell’s sign, TAPSE < 16 mm, or an RV/LV ratio > 1 on CTPA, together with elevated biomarkers (NT‑proBNP, troponin I, and MPV). These biochemical markers are chosen because they rise with right‑ventricular overload or injury. The aim of this study is to identify a literature gap in the diagnosis of RHS in the context of PE. Various biochemical markers and imaging modalities to diagnose RHS with PE are assessed. Despite the available tools, the current diagnostic approaches remain limited due to the absence of standardized measurement techniques and guidelines for right heart strain assessment on CTPA and echocardiography. Standardization of the assessment of right heart structure and function should be established, as this significantly impacts patient management. This study invites the researchers and international collaboration to set guidelines for the diagnosis of right heart strain in the context of pulmonary embolism to improve patient management and outcomes. This will also help to reduce mortality worldwide. A narrative review of existing studies, imaging techniques, and blood test markers was conducted to highlight existing gaps and call for future guidelines. A literature search was conducted using the Google Scholar database for articles published from 2000 to the most recent ones. Keywords included 'pulmonary embolism,' 'right ventricular dysfunction,' 'right heart strain,' 'thromboembolism,' 'deep venous thrombosis,' 'CT pulmonary angiogram,' 'echocardiography,' and 'anticoagulation.' No limitations were placed on the search to maximize inclusion of relevant literature. Duplicates and non-English articles were excluded.