The Relationship Between the Right Ventricle and its Load in Pulmonary Hypertension

Anton Vonk Noordegraaf*, Berend E. Westerhof, Nico Westerhof

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review


In pulmonary hypertension, the right ventricle adapts to the increasing vascular load by enhancing contractility (“coupling”) to maintain flow. Ventriculoarterial coupling implies that stroke volume changes little while preserving ventricular efficiency. Ultimately, a phase develops where ventricular dilation occurs in an attempt to limit the reduction in stroke volume, with uncoupling and increased wall stress as a consequence. With pressure–volume analysis, we separately describe the changing properties of the pulmonary vascular system and the right ventricle, as well as their coupling, as important concepts for understanding the changes that occur in pulmonary hypertension. On the basis of the unique properties of the pulmonary circulation, we show how all relevant physiological parameters can be derived using an integrative approach. Because coupling is maintained by hypertrophy until the end stage of the disease, when progressive dilation begins, right ventricular volume is the essential parameter to measure in follow-up of patients with pulmonary hypertension.

Original languageEnglish
Pages (from-to)236-243
Number of pages8
JournalJournal of the American College of Cardiology
Issue number2
Publication statusPublished - 17 Jan 2017

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