This scientific statement summarizes current knowledge on right ventricular dysfunction in pulmonary hypertension, emphasizing its mechanisms, clinical relevance, and therapeutic potential.
This AHA scientific statement emphasizes the critical role of right ventricular dysfunction in pulmonary hypertension and highlights advanced molecular, metabolic, and imaging approaches for its characterization and targeted treatment.
Right ventricular (RV) dysfunction is a key predictor of outcomes in pulmonary hypertension (PH), substantially contributing to illness and death. As PH progresses, increased pulmonary vascular resistance places chronic pressure overload on the right ventricle. Initially, the right ventricle adapts through hypertrophic remodeling, thickening the heart wall to maintain cardiac output. Over time, this adaptive phase shifts to maladaptive remodeling, marked by RV dilation, fibrosis, stiffness, and decoupling from the pulmonary artery, known as RV–pulmonary arterial uncoupling. This uncoupling reflects the inability of the right ventricle to sustain contractility against elevated afterload, ultimately leading to right heart failure, the primary cause of death in late-stage PH. Awareness of RV dysfunction has grown, extending beyond PH and pulmonary arterial hypertension to systemic conditions, such as heart failure with preserved ejection fraction, congenital heart disease, COVID-19, and complications of left ventricular assist device implantation. Research is increasingly focused on understanding the molecular and hemodynamic drivers of RV failure, including inflammation and altered cellular signaling. Innovations in imaging and biomarker discovery are improving the detection of maladaptive RV remodeling. Promising treatments, such as the activin signaling inhibitor sotatercept, may reduce pulmonary vascular resistance and support RV recovery. Further work is needed to enhance RV function and prevent failure. This review summarizes current knowledge on RV dysfunction in PH, emphasizing its mechanisms, clinical relevance, and therapeutic potential. Recognizing the right ventricle as a central therapeutic target may lead to more personalized, effective interventions and improved patient outcomes in PH and related conditions.
“This scientific statement provides a comprehensive synthesis of knowledge on RV failure specifically in the context of PH, focusing on the complex mechanisms underlying RV dysfunction, its clinical relevance, molecular drivers, advanced diagnostics, emerging management strategies, and potential therapeutic interventions. By synthesizing recent advances in the field, we aim to deepen understanding and inspire innovative approaches that can improve outcomes for patients with right ventricle–related complications in PH. Our goal is to establish the right ventricle as a novel therapeutic target, paving the way for more effective treatments for PH.”
Pullamsetti et al. (Thu,) conducted a review in Right ventricular dysfunction in pulmonary hypertension. This scientific statement summarizes current knowledge on right ventricular dysfunction in pulmonary hypertension, emphasizing its mechanisms, clinical relevance, and therapeutic potential.
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