Treatment of right ventricular dysfunction and heart failure in pulmonary arterial hypertension

Chakradhari Inampudi, Ryan J. Tedford, Anna R. Hemnes, Georg Hansmann, Harm Jan Bogaard, Martin Koestenberger, Irene Marthe Lang, Evan L. Brittain*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Right heart dysfunction and failure is the principal determinant of adverse outcomes in patients with pulmonary arterial hypertension (PAH). In addition to right ventricular (RV) dysfunction, systemic congestion, increased afterload and impaired myocardial contractility play an important role in the pathophysiology of RV failure. The behavior of the RV in response to the hemodynamic overload is primarily modulated by the ventricular interaction and its coupling to the pulmonary circulation. The presentation can be acute with hemodynamic instability and shock or chronic producing symptoms of systemic venous congestion and low cardiac output. The prognostic factors associated with poor outcomes in hospitalized patients include systemic hypotension, hyponatremia, severe tricuspid insufficiency, inotropic support use and the presence of pericardial effusion. Effective therapeutic management strategies involve identification and effective treatment of the triggering factors, improving cardiopulmonary hemodynamics by optimization of volume to improve diastolic ventricular interactions, improving contractility by use of inotropes, and reducing afterload by use of drugs targeting pulmonary circulation. The medical therapies approved for PAH act primarily on the pulmonary vasculature with secondary effects on the right ventricle. Mechanical circulatory support as a bridge to transplantation has also gained traction in medically refractory cases. The current review was undertaken to summarize recent insights into the evaluation and treatment of RV dysfunction and failure attributable to PAH.

Original languageEnglish
Pages (from-to)1659-1674
Number of pages16
JournalCardiovascular Diagnosis and Therapy
Volume10
Issue number5
DOIs
Publication statusPublished - Oct 2020

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