The right ventricle: the co-star in the complex history of heart failure

The natural history of patients with heart failure (HF), mainly affecting the left ventricle in the initial stages, is marked by the progressive involvement of the right ventricle (RV), which in the advanced stages of the disease becomes dilated and dysfunctional. The geometrical, functional, and pathological interdependence binding the two ventricles underlies this progressive path. Researchers' and clinicians' efforts must be aimed at interrupting the inevitable trajectory of HF, by preventing the development of pulmonary hypertension (PH) and RV dysfunction or the transition from isolated post-capillary PH to combined pre- and post-capillary PH. The search for drugs targeting the pulmonary circulation is another goal of PH researchers. Studies conducted so far on drugs currently approved for patients with pulmonary arterial hypertension have yielded contradictory results; an in-depth analysis of these trials could help researchers profile the patients with HF who might benefit from these treatments.