RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.

Non–vitamin K oral anticoagulants (NOACs) are now widely used as alternatives to warfarin for stroke prevention in atrial fibrillation and management of venous thromboembolism. In clinical practice, there is still widespread uncertainty on how to manage patients on NOACs who bleed or who are at risk for bleeding. Clinical trial data related to NOAC reversal for bleeding and perioperative management are sparse, and recommendations are largely derived from expert opinion. Knowledge of time of last ingestion of the NOAC and renal function is critical to managing these patients given that laboratory measurement is challenging because of the lack of commercially available assays in the United States. Idarucizumab is available as an antidote to rapidly reverse the effects of dabigatran. At present, there is no specific antidote available in the United States for the oral factor Xa inhibitors. Prothrombin concentrate may be considered in life-threatening bleeding. Healthcare institutions should adopt a NOAC reversal and perioperative management protocol developed with multidisciplinary input.

Cardiac fibroblasts (CFs) play critical roles in heart development, homeostasis, and disease. The limited availability of human CFs from native heart impedes investigations of CF biology and their role in disease. Human pluripotent stem cells (hPSCs) provide a highly renewable and genetically defined cell source, but efficient methods to generate CFs from hPSCs have not been described. Here, we show differentiation of hPSCs using sequential modulation of Wnt and FGF signaling to generate second heart field progenitors that efficiently give rise to hPSC-CFs. The hPSC-CFs resemble native heart CFs in cell morphology, proliferation, gene expression, fibroblast marker expression, production of extracellular matrix and myofibroblast transformation induced by TGFβ1 and angiotensin II. Furthermore, hPSC-CFs exhibit a more embryonic phenotype when compared to fetal and adult primary human CFs. Co-culture of hPSC-CFs with hPSC-derived cardiomyocytes distinctly alters the electrophysiological properties of the cardiomyocytes compared to co-culture with dermal fibroblasts. The hPSC-CFs provide a powerful cell source for research, drug discovery, precision medicine, and therapeutic applications in cardiac regeneration.

Coronary artery disease with associated myocardial infarction continues to be a major cause of death and morbidity around the world despite significant advances in therapy. Patients who suffer large myocardial infarctions are at highest risk for progressive heart failure and death, and cell-based therapies offer new hope for these patients. A recently discovered cell source for cardiac repair has emerged as a result of a breakthrough reprogramming somatic cells to induced pluripotent stem cells (iPSCs). The iPSCs can proliferate indefinitely in culture and can differentiate into cardiac lineages including cardiomyocytes, smooth muscle cells, endothelial cells, and cardiac progenitors. Thus large quantities of desired cell products can be generated without being limited by cellular senescence. The iPSCs can be obtained from patients to allow autologous therapy or, alternatively, banks of HLA diverse iPSCs are possible for allogeneic therapy. Preclinical animal studies using a variety of cell preparations generated from iPSCs have shown evidence of cardiac repair. Methodology for the production of clinical grade products from human iPSCs is in place. Ongoing studies of the safety of various iPSC preparations with regard to the risk of tumor formation, immune rejection, induction of arrhythmias, and formation of stable cardiac grafts are needed as the field advances toward the first in man trials of iPSCs post-MI.

Time-resolved cardiac imaging is particularly interesting in the interventional setting since it would provide both image guidance for accurate procedural planning and cardiac functional evaluations directly in the operating room. Imaging the heart in vivo using a slowly rotating C-arm system is extremely challenging due to the limitations of the data acquisition system and the high temporal resolution required to avoid motion artifacts. In this paper, a data acquisition scheme and an image reconstruction method are proposed to achieve time-resolved cardiac cone-beam computed tomography imaging with isotropic spatial resolution and high temporal resolution using a slowly rotating C-arm system. The data are acquired within 14 s using a single gantry rotation with a short scan angular range. The enabling image reconstruction method is the prior image constrained compressed sensing (PICCS) algorithm. The prior image is reconstructed from data acquired over all cardiac phases. Each cardiac phase is then reconstructed from the retrospectively gated cardiac data using the PICCS algorithm. To validate the method, several studies were performed. Both numerical simulations using a hybrid motion phantom with static background anatomy as well as physical phantom studies have been used to demonstrate that the proposed method enables accurate reconstruction of image objects with a high isotropic spatial resolution. A canine animal model scanned in vivo was used to further validate the method.