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 language | English |
|---|---|
| Pages (from-to) | 1465-1473 |
| Number of pages | 9 |
| Journal | Cardiovascular Research |
| Volume | 113 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Oct 2017 |
Cite this
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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 journal › Review article › Academic › peer-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 -