Right heart failure from right ventricular (RV) pressure overload is a major cause of morbidity and mortality, but its mechanism is incompletely understood. We tested the hypothesis that right heart failure during 4 hours of RV pressure overload is associated with alterations of the focal adhesion protein talin, and that the inhibition of calpain attenuates RV dysfunction and preserves RV talin. Anesthetized open-chest pigs treated with the calpain inhibitor MDL-28170 (n ¼ 20) or inactive vehicle (n ¼ 23) underwent 4 hours of RV pressure overload by pulmonary artery constriction (initial RV systolic pressure, 64 6 1 and 66 6 1 mm Hg in MDL-28170 and vehicle-treated pigs, respectively). Progressive RV contractile dysfunction was attenuated by MDL-28170: after 4 hours of RV pressure overload, RV systolic pressure was 44 6 4 mm Hg versus 49 6 6 mm Hg (P ¼ 0.011), and RV stroke work was 72 6 5% of baseline versus 90 6 5% of baseline, (P ¼ 0.027), in vehicle-treated versus MDL-28170-treated pigs, respectively. MDL-28170 reduced the incidence of hemodynamic instability (death or systolic blood pressure of , 85 mm Hg) by 46% (P ¼ 0.013). RV pressure overload disrupted talin organization. MDL-28170 preserved talin abundance in the RV free wall (P ¼ 0.039), and talin abundance correlated with the maintenance of RV free wall stroke work (r ¼ 0.58, P ¼ 0.0039). a-actinin and vinculin showed similar changes according to immunohistology. Right heart failure from acute RV pressure overload is associated with reduced talin abundance and disrupted talin organization. Calpain inhibition preserves the abundance and organization of talin and RV function. Calpain inhibition may offer clinical utility in treating acute cor pulmonale.Keywords: right ventricular dysfunction; pulmonary hypertension; calpain; talin; heart failure Right ventricular (RV) failure from acute right ventricular pressure overload (RVPO) is a major cause of morbidity and mortality in conditions such as pulmonary embolism and hypoxic pulmonary vasoconstriction, and in the early period after cardiopulmonary bypass or cardiac transplantation (1, 2). In the past, the conventional understanding of the pathophysiology of acute RV failure attributed it either to RV ischemia or to abnormal loading conditions during RVPO. However, we and others (3-5) previously demonstrated that the pathophysiology is more complex: a brief period of RVPO without RV ischemia results in intrinsic RV contractile dysfunction that persists beyond the period of RVPO itself, despite the restoration of normal loading conditions. Thus, the mechanism of intrinsic contractile dysfunction provoked by RVPO remains uncertain.Current clinical treatments for acute RV failure from RVPO depend almost exclusively on inotropic therapy or measures intended to relieve the underlying RVPO, such as thrombolysis, pulmonary thromboendarterectomy, and pulmonary vasodilators. These measures often result in serious complications, do not fully mitigate the high mortality, and do not directly address the mechanisms o...