Key result
Optimizing volume, improving contractility, and reducing afterload effectively treat RV dysfunction in PAH.
Why the study?
Right heart dysfunction and failure is the primary determinant of adverse outcomes in pulmonary arterial hypertension, prompting a review to summarize recent insights into its evaluation and treatment.
Effective management of right ventricular failure in pulmonary arterial hypertension requires a multifaceted approach including volume optimization, inotropic support, pulmonary vasodilators, and potentially mechanical circulatory support.
May support integrated right ventricular management in pulmonary arterial hypertension; leaves open need for randomized validation.
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.
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Inampudi et al. (2020) studied this question. Effective treatment strategies for right ventricular dysfunction in pulmonary arterial hypertension include optimizing volume, improving contractility, and reducing afterload.
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