The right-sided heart failure

The right-sided heart failure (RSHF) is a complex clinical syndrome including different pathogenic mechanisms and processes resulted from the right ventricle (RV) dysfunction and manifested with signs of heart failure (HF). Recently, there is a growing scientific interest in the right-sided acute and chronic heart abnormalities; this is due to growing knowledge in this field and development of novel diagnostic, therapeutic and pharmacological approaches to treatment of pulmonary hypertension that is a common cause of RSHF. Cardiac embryogenesis, anatomic particularities, difference and interdependence of RV and the left ventricle (LV) are described in the article in order to improve the knowledge on structure and function of both the right heart and the left heart. Discussion on pathophysiology, causes and clinical manifestations of acute RSHF (aRSHF) and chronic RSHF (cRSHF) should consider the right heart physiology. Pharmacological treatment should be targeted to ventricle pre-load, myocardial contractility and RV post-load, correction of pulmonary circulation and LV volume resulting in post-load reduction and improvement in the LV function. Patients with biventricular dysfunction should be treated according to current clinical guidelines on therapy of chronic HF. Vasoactive agents and diuretics have an important role for the treatment of RSHF as this is the basic therapy of pulmonary congestion both in aRSHF and cRSHF. Step-by-step therapeutic algorithm is given in the article.

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Right Heart Structure, Geometry and Function Assessed by Echocardiography in 6-Year-Old Children Born Extremely Preterm—A Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10010122 ◽

2020 ◽

Vol 10 (1) ◽

pp. 122

Author(s):

Lilly-Ann Mohlkert ◽

Jenny Hallberg ◽

Olof Broberg ◽

Gunnar Sjöberg ◽

Annika Rydberg ◽

...

Keyword(s):

Preterm Birth ◽

Ductus Arteriosus ◽

Population Based ◽

Right Heart ◽

Functional Changes ◽

Cardiac Phenotype ◽

Extremely Preterm ◽

Healthy Control ◽

The Right ◽

And Function

Preterm birth has been associated with altered cardiac phenotype in adults. Our aim was to test the hypothesis that children surviving extremely preterm birth have important structural or functional changes of the right heart or pulmonary circulation. We also examined relations between birth size, gestational age, neonatal diagnoses of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) with cardiac outcomes. We assessed a population-based cohort of children born in Sweden before 27 weeks of gestation with echocardiography at 6.5 years of age (n = 176). Each preterm child was matched to a healthy control child born at term. Children born preterm had significantly smaller right atria, right ventricles with smaller widths, higher relative wall thickness and higher estimated pulmonary vascular resistance (PVR) than controls. In preterm children, PVR and right ventricular myocardial performance index (RVmpi’) were significantly higher in those with a PDA as neonates than in those without PDA, but no such associations were found with BPD. In conclusion, children born extremely preterm exhibit higher estimated PVR, altered right heart structure and function compared with children born at term.

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The Assessment of the Right Heart Failure Syndrome

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0035-1564925 ◽

2015 ◽

Vol 36 (06) ◽

pp. 934-942 ◽

Cited By ~ 2

Author(s):

Cyrus Kholdani ◽

Ronald Oudiz ◽

Wassim Fares

Keyword(s):

Heart Failure ◽

Right Heart Failure ◽

Right Heart ◽

The Right

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Contribution of ventricular remodeling to pathogenesis of heart failure in rats

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.2001.280.2.h674 ◽

2001 ◽

Vol 280 (2) ◽

pp. H674-H683 ◽

Cited By ~ 91

Author(s):

Gregory L. Brower ◽

Joseph S. Janicki

Keyword(s):

Heart Failure ◽

Ventricular Remodeling ◽

Volume Fraction ◽

Volume Overload ◽

Left Ventricular ◽

Morbidity And Mortality ◽

Compliance Matrix ◽

Hypertrophic Response ◽

Lv Volume ◽

And Function

We previously reported an approximately 50% incidence of rats with symptoms of congestive heart failure (CHF) at 8 wk postinfrarenal aorto-caval fistula. However, it was not clear whether compensatory ventricular remodeling could continue beyond 8 wk or whether the remaining animals would have developed CHF or died. Therefore, the intent of this study was to complete the characterization of this model of sustained volume overload by determining the morbidity and mortality and the temporal response of left ventricular (LV) remodeling and function beyond 8 wk. The findings demonstrate an upper limit to LV hypertrophy and substantial increases in LV volume and compliance, matrix metalloproteinase activity, and collagen volume fraction associated with the development of CHF. There was an 80% incidence of morbidity and mortality following 21 wk of chronic volume overload. These findings indicate that the development of CHF is triggered by marked ventricular dilatation and increased compliance occurring once the myocardial hypertrophic response is exhausted.

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Metastatic adenocarcinoma involving the right ventricle and pulmonary artery leading to right heart failure: case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2016.0351280117 ◽

2017 ◽

Vol 136 (3) ◽

pp. 262-265 ◽

Cited By ~ 1

Author(s):

Turgut Karabag ◽

Caner Arslan ◽

Turab Yakisan ◽

Aziz Vatan ◽

Duygu Sak

Keyword(s):

Heart Failure ◽

Case Report ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Right Ventricular Outflow Tract ◽

Right Heart Failure ◽

Ventricular Outflow Tract ◽

Right Heart ◽

The Right

ABSTRACT CONTEXT: Obstruction of the right ventricular outflow tract due to metastatic disease is rare. Clinical recognition of cardiac metastatic tumors is rare and continues to present a diagnostic and therapeutic challenge. CASE REPORT: We present the case of a patient who had severe respiratory insufficiency and whose clinical examinations revealed a giant tumor mass extending from the right ventricle to the pulmonary artery. We discuss the diagnostic and therapeutic options. CONCLUSION: In patients presenting with acute right heart failure, right ventricular masses should be kept in mind. Transthoracic echocardiography appears to be the most easily available, noninvasive, cost-effective and useful technique in making the differential diagnosis.

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Drug-Induced Heart Failure (Part 2: Mechanisms of Development, Clinical Signs, Differential Diagnosis, Risk Factors, Treatment and Prevention)

Safety and Risk of Pharmacotherapy ◽

10.30895/2312-7821-2020-8-2-57-65 ◽

2020 ◽

Vol 8 (2) ◽

pp. 57-65

Author(s):

O. D. Ostroumova ◽

I. V. Goloborodova

Keyword(s):

Heart Failure ◽

Beta Blockers ◽

Clinical Signs ◽

Clinical Manifestations ◽

Left Ventricular ◽

Clinical Syndrome ◽

Channel Blockers ◽

Drug Induced ◽

Treatment And Prevention ◽

Developing Heart

Heart failure is a complex clinical syndrome caused by an impaired pumping function of the heart muscle, etiologically associated with cardiovascular disease and, in the vast majority of cases, requiring complex therapeutic regimens and simultaneous prescription of several drugs. To date, we know several classes of drugs (including those used for heart failure) which can induce development/progression of heart failure in both patients with left ventricular dysfunction, and in patients who do not have cardiovascular diseases. The aim of the study was to analyse and systematize data on development mechanisms, as well as methods of prevention and treatment of drug-induced heart failure when using diff erent groups of drugs. It has been established that drug-induced heart failure is most often associated with the use of calcium channel blockers (verapamil, diltiazem, nifedipine), beta-blockers, antiarrhythmic drugs (disopyramide, fl ecainide, propafenone, amiodarone, ibutilide, dofetilide, dronedarone), anthracyclines (doxorubicin) and other antitumor drugs (trastuzumab, bevacizumab, infl iximab), hypoglycemic drugs (thiazolidinediones, saxagliptin, alogliptin), and nonsteroidal anti-infl ammatory drugs, including selective cyclooxygenase-2 inhibitors. The study revealed various mechanisms of heart failure development following drug treatment. In some patients, heart failure development is associated with the cardiotoxic eff ect of a particular drug, in others with adverse eff ects on hemodynamics. Much depends on risks of developing heart failure, including specifi c risks attributable to groups of drugs and individual drugs. The identifi cation of drugs that can contribute to the development/ progression of heart failure, and possible clinical manifestations of drug-induced heart failure, as well as provision of timely information to physicians, and engagement of clinical pharmacologists with the aim of optimizing treatment of patients can facilitate timely diagnosis, treatment and prevention of drug-induced heart failure.

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Abstract 14468: Right Heart: Renal Venous Stasis Determinant in Acute Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.14468 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Alessandro Vella ◽

Gianmarco Carenini ◽

Francesco Bandera ◽

Marco Guazzi

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Prognostic Significance ◽

Right Atrial ◽

Venous Stasis ◽

Main Role ◽

Prognostic Impact ◽

Primary Role ◽

Right Heart ◽

The Right

Introduction: The heart-kidney interaction in heart failure (HF) is a matter of special interest, especially due to its strong prognostic significance. The search for a reliable, non-invasive parameter with high pathophysiological and prognostic impact to evaluate HF-related renal congestion remains attractive. Doppler evaluation of intra-renal venous flow (IRVF) has been recently employed in HF patients, with a spectrum of findings ranging from a normal continuous flow to a monophasic discontinuous one, indicative of low and high degrees of renal congestion, respectively. Hypothesis: We postulated a role for right atrial dynamics in the renal congestion pathophysiology. The impairment in atrial deformation and pump function may play a primary role increasing the pulsatile backward load in the venous system, especially in acute heart failure (AHF) patients. Methods: 119 consecutive AHF patients were prospectively investigated within 48 hours from admission. Doppler-derived descriptors of renal hemodynamics included the renal arterial resistive index, IRVF pattern, venous impedance index and renal venous stasis index (RVSI). Results: Right atrial peak longitudinal strain (RAPLS) showed a strong correlation with IRVF pattern (Fig A) and various indices of RV function (TAPSE, S’, FAC) and RV coupling as represented by the TAPSE/PASP ratio (Fig B). At multivariate regression analysis, TAPSE/PASP ratio emerged as the main determinant of RVSI. On the other hand, considering only patients with a clearly impaired RV coupling (TAPSE/PASP <0.30), RAPLS emerged as the best determinant of RVSI (Fig C-D). Conclusions: Our data confirms the main role of the right heart in determining renal stasis in HF patients. When RV to pulmonary circulation uncoupling is severe, the right atrium becomes the key balancing factor in the venous renal flow response. Studies on the mechanistic contribution of the RA dysfunction and the recovery potential of interventions are warranted.

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Right Heart Phenotype in Heart Failure With Preserved Ejection Fraction

Circulation Heart Failure ◽

10.1161/circheartfailure.120.007840 ◽

2021 ◽

Author(s):

Marco Guazzi ◽

Robert Naeije

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Right Ventricular ◽

Ventricular Dysfunction ◽

Imaging Techniques ◽

Treatment Options ◽

Right Ventricular Dysfunction ◽

Preserved Ejection Fraction ◽

Right Heart ◽

The Right

The health burden of heart failure with preserved ejection fraction is increasingly recognized. Despite improvements in diagnostic algorithms and established knowledge on the clinical trajectory, effective treatment options for heart failure with preserved ejection fraction remain limited, mainly because of the high mechanistic heterogeneity. Diagnostic scores, big data, and phenomapping categorization are proposed as key steps needed for progress. In the meantime, advancements in imaging techniques combined to high-fidelity pressure signaling analysis have uncovered right ventricular dysfunction as a mediator of heart failure with preserved ejection fraction progression and as major independent determinant of poor outcome. This review summarizes the current understanding of the pathophysiology of right ventricular dysfunction in heart failure with preserved ejection fraction covering the different right heart phenotypes and offering perspectives on new treatments targeting the right ventricle in its function and geometry.

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The Hemodynamic Characteristics of Right Ventricle After Gradient Pulmonary Artery Banding in Rats

10.21203/rs.3.rs-49641/v1 ◽

2020 ◽

Author(s):

Song Jiyang ◽

Wan Nan ◽

Shen Shutong ◽

Wei Ying ◽

Cao Yunshan

Keyword(s):

Heart Failure ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Right Heart Failure ◽

Therapeutic Strategies ◽

Pulmonary Artery Banding ◽

Right Heart ◽

Pulmonary Arterial ◽

The Right

Abstract Background: Right ventricular (RV) failure induced by sustained pressure overload is a major contributor to morbidity and mortality in several cardiopulmonary disorders. Reliable and reproducible animal models of RV failure are important in order to investigate disease mechanisms and effects of potential therapeutic strategies. To establish a rat model of RV failure perfectly, we observed the right ventricle and carotid artery hemodynamics characteristics in different degrees of pulmonary artery banding of rats of different body weights. Methods: Rats were subjected to 6 groups：control(0%, n=5)(pulmonary arterial banding 0%), PAB(1-30%, n=4)(pulmonary arterial banding1-30%), PAB(31-60%, n=6)(pulmonary arterial banding31-60%),PAB(61-70%, n=5)(pulmonary arterial bandin61-70%), PAB(71-80%,n=4)(pulmonary arterial banding71-80%), PAB(100%, n=3)(pulmonary arterial banding 100%). We measured the right ventricular pressure(RVP) by right heart catheterization when the pulmonary arterial was ligated. Results: The RVP gradually increased with increasing degree of banding, but when occlusion level exceeding 70%, high pressure state can be only maintained for a few minutes or seconds, and then the RVP drops rapidly until it falls below the normal pressure, which in Group F particularly evident.Conclusions: RVP have different reactions when the occlusion level is not the same, and the extent of more than 70% ligation is a successful model of acute right heart failure. These results may have important consequences for therapeutic strategies to prevent acute right heart failure.

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