Key result
RV dysfunction emerges as an independent driver of worsening HF and predictor of SCD.
Why the study?
Emerging evidence suggests right ventricular dysfunction may independently predict sudden cardiac death, prompting an examination of its role in long-term risk and underlying mechanisms.
This review highlights the anatomical, physiological, and clinical aspects of right ventricular dysfunction as an emerging independent predictor of sudden cardiac death.
May support RV assessment in HF risk stratification; leaves open whether targeted therapies reduce SCD.
Sudden cardiac death (SCD), or sudden loss of life-sustaining systemic and cerebral perfusion, is most often due to left ventricular (LV) dysfunction secondary to ischemic or structural cardiac disease or channelopathies. Degeneration of sinus rhythm into ventricular tachycardia and ultimately ventricular fibrillation is the final common pathway for most heart failure patients. Right ventricular (RV) dysfunction is recognized as an independent contributor to worsening heart failure. There is emerging evidence that RV dysfunction may also be an independent predictor of SCD. This review examines the role of RV dysfunction on modifying long term risk of SCD, and explores possible mechanisms that may underlie SCD. The RV has unique anatomy and physiology compared to the LV. Subsequently, we begin with a review of cardiac embryology, focusing on the chambers, valves, coronary arteries, and cardiac conduction system to understand the origins of RV dysfunction. Static and dynamic physiology of the RV is contrasted with that of the LV. Particular emphasis is placed on ventriculo-arterial coupling, mechanical cardiac constraint, and ventricular interdependence. The epidemiology of SCD is briefly reviewed to highlight how causes of SCD are age-specific. In turn, the age-specific causes of RV dysfunction are presented, including those which predominate in childhood and adolescence [arrhythmogenic RV dysplasia (ARVD) and hypertrophic cardiomyopathy (HCM)] and older adulthood (cardiac ischemia, chronic congestive heart failure and post-capillary pulmonary hypertension, and pulmonary hypertension). There is a clear need for additional studies on the independent contribution of RV dysfunction to overall functional capacity, SCD-associated mortality, and non-SCD-associated mortality. Discovery would be aided by the development of prospective cohorts with excellent RV phenotyping, coupled with deeper biologic measurements linking mechanisms to clinically relevant outcomes.
No takes yet. Share an insight, caveat, or question.
Sanders et al. (2020) conducted a review in Right ventricular dysfunction and sudden cardiac death. Right ventricular dysfunction is recognized as an independent contributor to worsening heart failure and an emerging independent predictor of sudden cardiac death.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: