Skip to main content
Erschienen in:

26.11.2021

Right ventricular failure: a comorbidity or a clinical emergency?

verfasst von: Pamelika Das, Rajarajan A. Thandavarayan, Kenichi Watanabe, Ravichandiran Velayutham, Somasundaram Arumugam

Erschienen in: Heart Failure Reviews | Ausgabe 5/2022

Einloggen, um Zugang zu erhalten

Abstract

There has been ample data providing a convincing perception about the underlying mechanism pertaining to left ventricle (LV) hypertrophy progressing towards LV failure. In comparison, data available on the feedback of right ventricle (RV) due to volume or pressure overload is minimal. Advanced imaging techniques have aided the study of physiology, anatomy, and diseased state of RV. However, the treatment scenario of right ventricular failure (RVF) demands more attention. It is a critical clinical risk in patients with carcinoid syndrome, pulmonary hypertension, atrial septal defect, and several other concomitant diseases. Although the remodeling responses of both ventricles on an increase of end-diastolic pressure are mostly identical, the stressed RV becomes more prone to oxidative stress activating the apoptotic mechanism with diminished angiogenesis. This instigates the advancement of RV towards failure in contrast to LV. Empirical heart failure (HF) therapies have been ineffective in improving the mortality rate and cardiac function in patients, which prompted a difference between the underlying pathophysiology of RVF and LV failure. Treatment strategies should be devised, taking into consideration the anatomical and physiological characteristics of RV. This review would emphasize on the pathophysiology of the RVF and the differences between two ventricles in molecular response to stress. A proper insight into the underlying pathophysiology is required to develop optimized therapeutic management in RV-specific HF.
Literatur
1.
Zurück zum Zitat Raina A, Meeran T (2018) Right ventricular dysfunction and its contribution to morbidity and mortality in left ventricular heart failure. Curr Heart Fail Rep 15:94–105CrossRef Raina A, Meeran T (2018) Right ventricular dysfunction and its contribution to morbidity and mortality in left ventricular heart failure. Curr Heart Fail Rep 15:94–105CrossRef
2.
Zurück zum Zitat Kormos RL, Teuteberg JJ, Pagani FD et al (2010) Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg 139:1316–1324CrossRef Kormos RL, Teuteberg JJ, Pagani FD et al (2010) Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg 139:1316–1324CrossRef
3.
Zurück zum Zitat LaRue SJ, Raymer DS, Pierce BR et al (2017) Clinical outcomes associated with INTERMACS-defined right heart failure after left ventricular assist device implantation. J Hear Lung Transplant 36:475–477CrossRef LaRue SJ, Raymer DS, Pierce BR et al (2017) Clinical outcomes associated with INTERMACS-defined right heart failure after left ventricular assist device implantation. J Hear Lung Transplant 36:475–477CrossRef
4.
Zurück zum Zitat Galiè N, Humbert M, Vachiery J-L et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endor. Eur Heart J 37:67–119CrossRef Galiè N, Humbert M, Vachiery J-L et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endor. Eur Heart J 37:67–119CrossRef
5.
Zurück zum Zitat Greyson CR (2008) Pathophysiology of right ventricular failure. Crit Care Med 36:S57–S65CrossRef Greyson CR (2008) Pathophysiology of right ventricular failure. Crit Care Med 36:S57–S65CrossRef
6.
Zurück zum Zitat Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480CrossRef Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480CrossRef
7.
Zurück zum Zitat Lambermont B, Ghuysen A, Kolh P et al (2003) Effects of endotoxic shock on right ventricular systolic function and mechanical efficiency. Cardiovasc Res 59:412–418CrossRef Lambermont B, Ghuysen A, Kolh P et al (2003) Effects of endotoxic shock on right ventricular systolic function and mechanical efficiency. Cardiovasc Res 59:412–418CrossRef
8.
Zurück zum Zitat Arrigo M, Huber LC, Winnik S et al (2019) Right ventricular failure: pathophysiology, diagnosis and treatment. Card Fail Rev 5:140CrossRef Arrigo M, Huber LC, Winnik S et al (2019) Right ventricular failure: pathophysiology, diagnosis and treatment. Card Fail Rev 5:140CrossRef
9.
Zurück zum Zitat Stobierska-Dzierzek B, Awad H, Michler RE (2001) The evolving management of acute right-sided heart failure in cardiac transplant recipients. J Am Coll Cardiol 38:923–931CrossRef Stobierska-Dzierzek B, Awad H, Michler RE (2001) The evolving management of acute right-sided heart failure in cardiac transplant recipients. J Am Coll Cardiol 38:923–931CrossRef
10.
Zurück zum Zitat Kaul TK, Fields BL (2000) Postoperative acute refractory right ventricular failure: incidence, pathogenesis, management and prognosis. Cardiovasc Surg 8:1–9CrossRef Kaul TK, Fields BL (2000) Postoperative acute refractory right ventricular failure: incidence, pathogenesis, management and prognosis. Cardiovasc Surg 8:1–9CrossRef
11.
Zurück zum Zitat La Vecchia L, Zanolla L, Varotto L et al (2001) Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction. Am Heart J 142:181–189CrossRef La Vecchia L, Zanolla L, Varotto L et al (2001) Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction. Am Heart J 142:181–189CrossRef
12.
Zurück zum Zitat Goldstein JA (2002) Pathophysiology and management of right heart ischemia. J Am Coll Cardiol 40:841–853CrossRef Goldstein JA (2002) Pathophysiology and management of right heart ischemia. J Am Coll Cardiol 40:841–853CrossRef
13.
Zurück zum Zitat Nieminen MS, Brutsaert D, Dickstein K et al (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27:2725–2736CrossRef Nieminen MS, Brutsaert D, Dickstein K et al (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27:2725–2736CrossRef
17.
Zurück zum Zitat McIntyre KM, Sasahara AA (1977) The ratio of pulmonary arterial pressure to pulmonary vascular obstruction: index of preembolic cardiopulmonary status. Chest 71:692–697CrossRef McIntyre KM, Sasahara AA (1977) The ratio of pulmonary arterial pressure to pulmonary vascular obstruction: index of preembolic cardiopulmonary status. Chest 71:692–697CrossRef
18.
Zurück zum Zitat Wrobel JP, Thompson BR, Williams TJ (2012) Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: a pathophysiologic review. J Hear Lung Transplant 31:557–564CrossRef Wrobel JP, Thompson BR, Williams TJ (2012) Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: a pathophysiologic review. J Hear Lung Transplant 31:557–564CrossRef
19.
Zurück zum Zitat Arrigo M, Huber LC (2013) Eponyms in cardiopulmonary reflexes. Am J Cardiol 112:449–453CrossRef Arrigo M, Huber LC (2013) Eponyms in cardiopulmonary reflexes. Am J Cardiol 112:449–453CrossRef
20.
21.
Zurück zum Zitat Hilde JM, Skjørten I, Grøtta OJ et al (2013) Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol 62:1103–1111CrossRef Hilde JM, Skjørten I, Grøtta OJ et al (2013) Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol 62:1103–1111CrossRef
25.
Zurück zum Zitat Gorter TM, van Veldhuisen DJ, Bauersachs J et al (2018) Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 20:16–37. https://doi.org/10.1002/ejhf.1029CrossRefPubMed Gorter TM, van Veldhuisen DJ, Bauersachs J et al (2018) Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 20:16–37. https://​doi.​org/​10.​1002/​ejhf.​1029CrossRefPubMed
55.
Zurück zum Zitat Pawlush DG, Musch TI, Moore RL (1989) Ca2+-dependent heterometric and homeometric autoregulation in hypertrophied rat heart. Am J Physiol Circ Physiol 256:H1139–H1147CrossRef Pawlush DG, Musch TI, Moore RL (1989) Ca2+-dependent heterometric and homeometric autoregulation in hypertrophied rat heart. Am J Physiol Circ Physiol 256:H1139–H1147CrossRef
57.
Zurück zum Zitat Marino TA, Kent RL, Uboh CE et al (1985) Structural analysis of pressure versus volume overload hypertrophy of cat right ventricle. Am J Physiol Circ Physiol 249:H371–H379CrossRef Marino TA, Kent RL, Uboh CE et al (1985) Structural analysis of pressure versus volume overload hypertrophy of cat right ventricle. Am J Physiol Circ Physiol 249:H371–H379CrossRef
58.
Zurück zum Zitat Moudgil R, Michelakis ED, Archer SL (2005) Hypoxic pulmonary vasoconstriction. J Appl Physiol 98:390–403CrossRef Moudgil R, Michelakis ED, Archer SL (2005) Hypoxic pulmonary vasoconstriction. J Appl Physiol 98:390–403CrossRef
59.
Zurück zum Zitat Schmitt J-M, Vieillard-Baron A, Augarde R et al (2001) Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit Care Med 29:1154–1158CrossRef Schmitt J-M, Vieillard-Baron A, Augarde R et al (2001) Positive end-expiratory pressure titration in acute respiratory distress syndrome patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit Care Med 29:1154–1158CrossRef
60.
Zurück zum Zitat Vlahakes GJ, Turley K, Hoffman JIE (1981) The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 63:87–95CrossRef Vlahakes GJ, Turley K, Hoffman JIE (1981) The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 63:87–95CrossRef
61.
Zurück zum Zitat Davlouros PA, Niwa K, Webb G, Gatzoulis MA (2006) The right ventricle in congenital heart disease. Heart 92:i27–i38CrossRef Davlouros PA, Niwa K, Webb G, Gatzoulis MA (2006) The right ventricle in congenital heart disease. Heart 92:i27–i38CrossRef
62.
Zurück zum Zitat Reddy S, Bernstein D (2015) Molecular mechanisms of right ventricular failure. Circulation 132:1734–1742CrossRef Reddy S, Bernstein D (2015) Molecular mechanisms of right ventricular failure. Circulation 132:1734–1742CrossRef
63.
Zurück zum Zitat Haddad F, Doyle R, Murphy DJ, Hunt SA (2008) Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 117:1717–1731CrossRef Haddad F, Doyle R, Murphy DJ, Hunt SA (2008) Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 117:1717–1731CrossRef
66.
Zurück zum Zitat Piao L, Fang Y-H, Parikh KS et al (2012) GRK2-mediated inhibition of adrenergic and dopaminergic signaling in right ventricular hypertrophy: therapeutic implications in pulmonary hypertension. Circulation 126:2859–2869CrossRef Piao L, Fang Y-H, Parikh KS et al (2012) GRK2-mediated inhibition of adrenergic and dopaminergic signaling in right ventricular hypertrophy: therapeutic implications in pulmonary hypertension. Circulation 126:2859–2869CrossRef
67.
Zurück zum Zitat Shaddy RE, Boucek MM, Hsu DT et al (2007) Carvedilol for children and adolescents with heart failure: a randomized controlled trial. JAMA 298:1171–1179CrossRef Shaddy RE, Boucek MM, Hsu DT et al (2007) Carvedilol for children and adolescents with heart failure: a randomized controlled trial. JAMA 298:1171–1179CrossRef
68.
Zurück zum Zitat Rouleau JL, Kapuku G, Pelletier S et al (2001) Cardioprotective effects of ramipril and losartan in right ventricular pressure overload in the rabbit: importance of kinins and influence on angiotensin II type 1 receptor signaling pathway. Circulation 104:939–944CrossRef Rouleau JL, Kapuku G, Pelletier S et al (2001) Cardioprotective effects of ramipril and losartan in right ventricular pressure overload in the rabbit: importance of kinins and influence on angiotensin II type 1 receptor signaling pathway. Circulation 104:939–944CrossRef
69.
Zurück zum Zitat Nagaya N, Nishikimi T, Uematsu M et al (2000) Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 102:865–870CrossRef Nagaya N, Nishikimi T, Uematsu M et al (2000) Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 102:865–870CrossRef
70.
Zurück zum Zitat Ueno M, Miyauchi T, Sakai S et al (1999) Effects of physiological or pathological pressure load in vivo on myocardial expression of ET-1 and receptors. Am J Physiol Integr Comp Physiol 277:R1321–R1330CrossRef Ueno M, Miyauchi T, Sakai S et al (1999) Effects of physiological or pathological pressure load in vivo on myocardial expression of ET-1 and receptors. Am J Physiol Integr Comp Physiol 277:R1321–R1330CrossRef
78.
Zurück zum Zitat Gold FL, Bache RJ (1982) Transmural right ventricular blood flow during acute pulmonary artery hypertension in the sedated dog. Evidence for subendocardial ischemia despite residual vasodilator reserve. Circ Res 51:196–204CrossRef Gold FL, Bache RJ (1982) Transmural right ventricular blood flow during acute pulmonary artery hypertension in the sedated dog. Evidence for subendocardial ischemia despite residual vasodilator reserve. Circ Res 51:196–204CrossRef
79.
Zurück zum Zitat Zong P, Tune JD, Downey HF (2005) Mechanisms of oxygen demand/supply balance in the right ventricle. Exp Biol Med 230:507–519CrossRef Zong P, Tune JD, Downey HF (2005) Mechanisms of oxygen demand/supply balance in the right ventricle. Exp Biol Med 230:507–519CrossRef
86.
Zurück zum Zitat MacNee W (1994) State of the art pathophysiology of cor pulmonale in chronic obstrudive. Am J Respir Crit Care Med 150:833–852CrossRef MacNee W (1994) State of the art pathophysiology of cor pulmonale in chronic obstrudive. Am J Respir Crit Care Med 150:833–852CrossRef
99.
Zurück zum Zitat Suga H (2003) Cardiac energetics: from Emax to pressure–volume area. Clin Exp Pharmacol Physiol 30:580–585CrossRef Suga H (2003) Cardiac energetics: from Emax to pressure–volume area. Clin Exp Pharmacol Physiol 30:580–585CrossRef
Metadaten
Titel
Right ventricular failure: a comorbidity or a clinical emergency?
verfasst von
Pamelika Das
Rajarajan A. Thandavarayan
Kenichi Watanabe
Ravichandiran Velayutham
Somasundaram Arumugam
Publikationsdatum
26.11.2021
Verlag
Springer US
Erschienen in
Heart Failure Reviews / Ausgabe 5/2022
Print ISSN: 1382-4147
Elektronische ISSN: 1573-7322
DOI
https://doi.org/10.1007/s10741-021-10192-9

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Kardiologie

Lp(a) zur Risikoeinschätzung bei Thoraxschmerzen

Der Lp(a)-Wert kann dazu beitragen, bei stabilen Patienten mit neu aufgetretenen Thoraxschmerzen und ohne KHK-Diagnose die Wahrscheinlichkeit für das Vorliegen von Koronarstenosen abzuschätzen.

Finerenon bei eGFR-Verlust nicht gleich absetzen!

Der Mineralokortikoid-Rezeptor-Antagonist Finerenon verbessert die Prognose bei Herzinsuffizienz mit leicht reduzierter oder erhaltener Ejektionsfraktion. Ein Rückgang der eGFR zu Beginn der Therapie scheint diese Wirkung nicht wesentlich zu mindern.

LVAD auch bei kalt-trockener terminaler Herzinsuffizienz wirksam

Auch Personen mit kalt-trockener terminaler Herzinsuffizienz profitieren von einem linksventrikulären Unterstützungssystem (LVAD), wie Daten aus einem US-Register nahelegen. Doch es gibt Besonderheiten.     

Koronare Herzkrankheit: Das waren die Top-Studien 2024

Zum Thema Koronare Herzkrankheit gab es 2024 wichtige neue Studien. Beleuchtet wurden darin unter anderem der Stellenwert von Betablockern nach Herzinfarkt, neue Optionen für eine Lipidsenkung sowie die Therapie bei infarktbedingtem kardiogenem Schock.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.