Treatment strategies for the right heart in pulmonary hypertension

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

The function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension. While much progress has been made in the treatment of pulmonary hypertension, therapies for the RV are less well established. In this review of treatment strategies for the RV, first we focus on ways to reduce wall stress since this is the main determinant of changes to the ventricle. Secondly, we discuss treatment strategies targeting the detrimental consequences of increased RV wall stress. To reduce wall stress, afterload reduction is the essential. Additionally, preload to the ventricle can be reduced by diuretics, by atrial septostomy, and potentially by mechanical ventricular support. Secondary to ventricular wall stress, left-to-right asynchrony, altered myocardial energy metabolism, and neurohumoral activation will occur. These may be targeted by optimising RV contraction with pacing, by iron supplement, by angiogenesis and improving mitochondrial function, and by neurohumoral modulation, respectively. We conclude that several treatment strategies for the right heart are available; however, evidence is still limited and further research is needed before clinical application can be recommended.

Original languageEnglish
Pages (from-to)1465-1473
Number of pages9
JournalCardiovascular Research
Volume113
Issue number12
DOIs
Publication statusPublished - 1 Oct 2017

Cite this

@article{3e859d46ebd340ea9b0dcb6237f2297f,
title = "Treatment strategies for the right heart in pulmonary hypertension",
abstract = "The function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension. While much progress has been made in the treatment of pulmonary hypertension, therapies for the RV are less well established. In this review of treatment strategies for the RV, first we focus on ways to reduce wall stress since this is the main determinant of changes to the ventricle. Secondly, we discuss treatment strategies targeting the detrimental consequences of increased RV wall stress. To reduce wall stress, afterload reduction is the essential. Additionally, preload to the ventricle can be reduced by diuretics, by atrial septostomy, and potentially by mechanical ventricular support. Secondary to ventricular wall stress, left-to-right asynchrony, altered myocardial energy metabolism, and neurohumoral activation will occur. These may be targeted by optimising RV contraction with pacing, by iron supplement, by angiogenesis and improving mitochondrial function, and by neurohumoral modulation, respectively. We conclude that several treatment strategies for the right heart are available; however, evidence is still limited and further research is needed before clinical application can be recommended.",
keywords = "Beta-blockade, Cardiac resynchronisation, Diuretics, Mitochondrial function, Ventricular-assist device",
author = "Westerhof, {Berend E.} and Nabil Saouti and {Van Der Laarse}, {Willem J.} and Nico Westerhof and {Vonk Noordegraaf}, Anton",
year = "2017",
month = "10",
day = "1",
doi = "10.1093/cvr/cvx148",
language = "English",
volume = "113",
pages = "1465--1473",
journal = "Cardiovascular Research",
issn = "0008-6363",
publisher = "Oxford University Press",
number = "12",

}

Treatment strategies for the right heart in pulmonary hypertension. / Westerhof, Berend E.; Saouti, Nabil; Van Der Laarse, Willem J.; Westerhof, Nico; Vonk Noordegraaf, Anton.

In: Cardiovascular Research, Vol. 113, No. 12, 01.10.2017, p. 1465-1473.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Treatment strategies for the right heart in pulmonary hypertension

AU - Westerhof, Berend E.

AU - Saouti, Nabil

AU - Van Der Laarse, Willem J.

AU - Westerhof, Nico

AU - Vonk Noordegraaf, Anton

PY - 2017/10/1

Y1 - 2017/10/1

N2 - The function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension. While much progress has been made in the treatment of pulmonary hypertension, therapies for the RV are less well established. In this review of treatment strategies for the RV, first we focus on ways to reduce wall stress since this is the main determinant of changes to the ventricle. Secondly, we discuss treatment strategies targeting the detrimental consequences of increased RV wall stress. To reduce wall stress, afterload reduction is the essential. Additionally, preload to the ventricle can be reduced by diuretics, by atrial septostomy, and potentially by mechanical ventricular support. Secondary to ventricular wall stress, left-to-right asynchrony, altered myocardial energy metabolism, and neurohumoral activation will occur. These may be targeted by optimising RV contraction with pacing, by iron supplement, by angiogenesis and improving mitochondrial function, and by neurohumoral modulation, respectively. We conclude that several treatment strategies for the right heart are available; however, evidence is still limited and further research is needed before clinical application can be recommended.

AB - The function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension. While much progress has been made in the treatment of pulmonary hypertension, therapies for the RV are less well established. In this review of treatment strategies for the RV, first we focus on ways to reduce wall stress since this is the main determinant of changes to the ventricle. Secondly, we discuss treatment strategies targeting the detrimental consequences of increased RV wall stress. To reduce wall stress, afterload reduction is the essential. Additionally, preload to the ventricle can be reduced by diuretics, by atrial septostomy, and potentially by mechanical ventricular support. Secondary to ventricular wall stress, left-to-right asynchrony, altered myocardial energy metabolism, and neurohumoral activation will occur. These may be targeted by optimising RV contraction with pacing, by iron supplement, by angiogenesis and improving mitochondrial function, and by neurohumoral modulation, respectively. We conclude that several treatment strategies for the right heart are available; however, evidence is still limited and further research is needed before clinical application can be recommended.

KW - Beta-blockade

KW - Cardiac resynchronisation

KW - Diuretics

KW - Mitochondrial function

KW - Ventricular-assist device

UR - http://www.scopus.com/inward/record.url?scp=85030750102&partnerID=8YFLogxK

U2 - 10.1093/cvr/cvx148

DO - 10.1093/cvr/cvx148

M3 - Review article

VL - 113

SP - 1465

EP - 1473

JO - Cardiovascular Research

JF - Cardiovascular Research

SN - 0008-6363

IS - 12

ER -