Perspective
Right heart failure: Toward a common language

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In this perspective, the International Right Heart Foundation Working Group moves a step forward to develop a common language to describe the development and defects that exemplify the common syndrome of right heart failure. We first propose fundamental definitions of the distinctive components of the right heart circulation and provide consensus on a universal definition of right heart failure. These definitions will form the foundation for describing a uniform nomenclature for right heart circulatory failure with a view to foster collaborative research initiatives and conjoint education in an effort to provide insight into echanisms of disease unique to the right heart.

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Definition 1: Distinction between right heart failure and right ventricular failure

Right heart failure represents a disturbance or dysfunction in any of the components that constitute the right heart circulatory system (defined below). Thus, right ventricular failure, in contradistinction, is one component (albeit major) of a pathophysiological entity that can result in right heart circulatory failure.

Definition 2: Components of the right heart system

The right heart circulatory system is comprised of the systemic veins up to the pulmonary capillaries–at which point deoxygenated blood transitions to oxygenated blood. The right heart system can be classified into systemic and pulmonary circuits. The systemic circuit includes the systemic veins, right atrium, coronary sinus (and cardiac venous drainage), tricuspid valve, right ventricular free wall, right ventricular outflow tract and pulmonic valve. The pulmonary circuit includes the main

Definition 3: What is right heart failure?

We define right heart failure as a clinical syndrome due to an alteration of structure and/or function of the right heart circulatory system that leads to sub-optimal delivery of blood flow (high or low) to the pulmonary circulation and/or elevated venous pressures–at rest or with exercise.

Distinctively, this definition is broad and classifies right heart failure as a syndrome, which may result from anatomic or physiologic aberrations, or both, from a variety of etiologies that are not

Disclosure statement

M.R.M. reports consulting for St. Judes, Boston Scientific, Thoratec, Baxter, Johnson and Johnson (Janssen), Medtronic, the National Institutes of Health and the American Board of Internal Medicine; M.H.P. reports consulting for Actelion Pharmaceuticals, Bayer, Gilead Sciences and United Therapeutics; M.J.L. reports research funding and trial executive committee appointments from Actelion and Myogen and the NHLBI; A.L. reports no specific disclosures; A.B.W. reports research grant support from

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