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Assessment and treatment of right ventricular failure

Nature Reviews Cardiology volume 10, pages 204–218 (2013)Cite this article

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Abstract

Right ventricular (RV) failure is a complex problem with poor outcomes. Diagnosis requires a high degree of clinical suspicion, because many of the signs and symptoms of this condition are nonspecific and can be acute or chronic. Identification of the underlying aetiology, which can include pulmonary hypertension, cardiomyopathy, myocardial infarction, congenital or valvular heart disease, and sepsis, is essential. Echocardiography is the technique of choice for first-line assessment, but cardiac MRI is the current gold standard for anatomical and functional assessment of the right ventricle. Therapy for RV failure should be directed at the underlying cause, although management of symptoms is also important. Therapeutic options range from pharmacological treatment to mechanical RV support and heart transplantation. The complex 3D geometry of the right ventricle and its intricate interactions with the left ventricle have left many questions about RV failure unanswered. However, promising new targeted therapies are under development and mechanical support is becoming increasingly feasible. The next decade will be an exciting time for advances in our understanding and management of RV failure.

Key Points

  • Right ventricular failure has many aetiologies, including cardiomyopathies, congenital or valvular heart disease, arrhythmias, sepsis, and pressure overload

  • Diagnosis of right ventricular failure requires a high degree of clinical suspicion

  • Modalities to assess right ventricular function continue to evolve, but the mainstays are echocardiography, cardiac MRI, and invasive haemodynamic assessment

  • Effective therapy for right ventricular failure must be directed towards the underlying aetiology as well as the clinical presentation

  • Treatment for right ventricular failure ranges from pharmacological management to mechanical support

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Figure 1: Flowchart for the diagnostic evaluation of suspected RV failure associated with suspected PH.
Figure 2: Pressure–volume loops of the right and left ventricles.
Figure 3: Ventricular assist devices that have been used for right ventricular support.

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  1. Division of Cardiology, Department of Medicine, University of Pittsburgh, Heart & Vascular Institute, University of Pittsburgh Medical Center, Scaife Hall S-555, 200 Lothrop Street, Pittsburgh, 15213, PA, USA

    Marc A. Simon

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M. A. Simon has received research support from AHA, Pfizer, and The Pittsburgh Foundation, and has acted as a consultant for United Therapeutics.

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Simon, M. Assessment and treatment of right ventricular failure. Nat Rev Cardiol 10, 204–218 (2013). https://doi.org/10.1038/nrcardio.2013.12

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