Right ventricular function across the spectrum of health and disease

Abstract

Knowledge of right ventricular (RV) structure and function has historically lagged behind that of the left ventricle (LV). However, advancements in invasive and non-invasive evaluations, combined with epidemiological analyses, have advanced the current understanding of RV (patho)physiology across the spectrum of health and disease, and reinforce the centrality of the RV in contributing to clinical outcomes. In the healthy heart, ventricular-arterial coupling is preserved during rest and in response to increased myocardial demand (eg, exercise) due to substantial RV contractile reserve. However, prolonged exposure to increased myocardial demand, such as endurance exercise, may precipitate RV dysfunction, suggesting that unlike the LV, the RV is unable to sustain high levels of contractility for extended periods of time. Emerging data increasingly indicate that both LV and RV function contribute to clinical heart failure. Reductions in quality-of-life, functional capacity and overall clinical outcomes are worsened among patients with heart failure when there is evidence of RV dysfunction. In addition, the RV is adversely impacted by pulmonary vascular disease, and among affected patients, overall RV function differs based on mechanisms of the underlying pulmonary hypertension, which may result from variations in sarcomere function within RV cardiomyocytes.

Differences in right ventricular function and response to targeted therapy between patients with IPAH and PAH-CHD

“…The normal right ventricle is thin-walled, low afterload, and high-compliance distinct from the left ventricle. Anatomic and functional characteristics determine that the right ventricle is more capable of accommodating the volume overload rather than pressure overload ( Edward et al, 2022 ). In PAH, as a consequence of persistently elevated PAP, the RV afterload and wall stress are increased resulting in RV hypertrophy, dilation, and dysfunction under suitable conditions, and the severity is affected by the duration of the pressure overload.…”

“…In PAH, as a consequence of persistently elevated PAP, the RV afterload and wall stress are increased resulting in RV hypertrophy, dilation, and dysfunction under suitable conditions, and the severity is affected by the duration of the pressure overload. Interestingly, abundant literature demonstrated that RV structure and function in people lacking cardiopulmonary disease vary with age, gender, race, exercise ( Kawut et al, 2011 ; Cornwell et al, 2020 ; Thenappan and Weir, 2020 ; Edward et al, 2022 ). Therefore, it is easy to understand the divergent responses of RV to PH subtypes with different pathogenesis and pathophysiology.…”

Epidemiology, pathophysiology, diagnosis and management of chronic right‐sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

“…Right HF and TR are debilitating conditions strongly affecting quality of life, hospitalization rates and survival. 38 as parts of a multi-organ syndrome involving cardiac (i.e. right heart chambers, TV apparatus) and extra-cardiac structures (i.e.…”

“…Right HF and TR are debilitating conditions strongly affecting quality of life, hospitalization rates and survival 38 . They can be considered as parts of a multi‐organ syndrome involving cardiac (i.e.…”

Cardiovascular Magnetic Resonance Imaging in Familial Dilated Cardiomyopathy

“…CMR is currently the imaging modality of choice to assess RV function with high reproducibility. Adverse RV remodelling is common in HF and DCM, and studies are continuing to unravel the clinical relevance of such changes [ 69 , 70 ]. In 250 DCM patients followed up over a median of 6.8 years, RV systolic dysfunction (RVSD), defined by a RV EF ≤ 45% by CMR, was a significant independent predictor of all-cause mortality or cardiac transplantation in DCM patients (hazard ratio, 3.90; 95% CI: 2.16–7.04; p < 0.001) [ 71 ]…”