Right ventricular failure in left heart disease: from pathophysiology to clinical manifestations and prognosis

Abstract

Right heart failure (RHF) is a clinical syndrome in which symptoms and signs are caused by dysfunction and/or overload of the right heart structures, predominantly the right ventricle (RV), resulting in systemic venous hypertension, peripheral oedema and finally, the impaired ability of the right heart to provide tissue perfusion. Pathogenesis of RHF includes the incompetence of the right heart to maintain systemic venous pressure sufficiently low to guarantee an optimal venous return and to preserve renal function. Virtually, all myocardial diseases involving the left heart may be responsible for RHF. This may result from coronary artery disease, hypertension, valvular heart disease, cardiomyopathies and myocarditis. The most prominent clinical signs of RHF comprise swelling of the neck veins with an elevation of jugular venous pressure and ankle oedema. As the situation worsens, fluid accumulation becomes generalised with extensive oedema of the legs, congestive hepatomegaly and eventually ascites. Diagnosis of RHF requires the presence of signs of elevated right atrial and venous pressures, including dilation of neck veins, with at least one of the following criteria: (1) compromised RV function; (2) pulmonary hypertension; (3) peripheral oedema and congestive hepatomegaly. Early recognition of RHF and identifying the underlying aetiology as well as triggering factors are crucial to treating patients and possibly reversing the clinical manifestations effectively and improving prognosis.

The right ventricular dysfunction and ventricular interdependence in patients with DM: assessment using cardiac MR feature tracking

“…Diffusion tensor magnetic resonance image elaborated the common myocardial fiber encircled the ventricle [ 31 ]. LV geometry and function alterations could contribute to RV dysfunction through ventricular interdependency mediated by the septum [ 13 , 32 ]. LV myocardial function has been reported to be highly associated with RVGLS in diabetic patients [ 33 – 36 ].…”

More than just a clinical syndrome: Biomarkers and echocardiography should be rapidly advised for anyone with suspected heart failure!

“…Additionally, the correct evaluation of cardiac filling pressures may aid in prognostication by stratifying patients at risk for heart failure admissions and/or mortality 6,10 . When taken together with clinical and laboratory findings, echocardiography is a highly important tool for risk stratification, as abnormal values for many echocardiographic parameters have been correlated with reduced event‐free survival 11 …”

The complex interplay between right ventricular dysfunction and atrial fibrillation – a narrative review

“…An enlarged right atrium and subsequent atrial fibrosis consistent with atrial cardiomyopathy is promoting a micro re-entrant substrate for the development of AF. [23] At the same time, arrhythmias have a deleterious role in the hemodynamic stability in patients with RV dysfunction, especially AF due to its irregular rhythm. Chou et al proved the beat to beat variation of RV function evaluated by the fractional area change (FAC), is dependent on the RR interval variability and on the mean heart rate.…”