Right heart failure in pulmonary hypertension: Diagnosis and new perspectives on vascular and direct right ventricular treatment

Khodr Tello, Werner Seeger, Robert Naeije, Rebecca Vanderpool, Hossein Ardeschir Ghofrani, Manuel Richter, Ryan J Tedford, Harm J Bogaard

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Adaptation of right ventricular (RV) function to increased afterload - known as RV-arterial coupling - is a key determinant of prognosis in pulmonary hypertension. However, measurement of RV-arterial coupling is a complex, invasive process involving analysis of the RV pressure-volume relationship during preload reduction over multiple cardiac cycles. Simplified methods have therefore been proposed, including echocardiographic and cardiac MRI approaches. This review describes the available methods for assessment of RV function and RV-arterial coupling, and the effects of pharmacotherapy on these parameters. Overall, pharmacotherapies for pulmonary hypertension have shown beneficial effects on various measures of RV function, but it is often unclear if these are direct RV effects or indirect results of afterload reduction. Studies of the effects of pharmacotherapies on RV-arterial coupling are limited and mostly restricted to experimental models. Simplified methods to assess RV-arterial coupling should be validated and incorporated into routine clinical follow-up and future clinical trials.

Original languageEnglish
JournalBritish Journal of Pharmacology
DOIs
Publication statusE-pub ahead of print - 13 Sep 2019

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