What is the clinical evidence from this study?

Study design: Review. Population: Pulmonary arterial hypertension. Intervention: Ventricular interdependence and left ventricular underfilling.

What question did this study set out to answer?

To review the pathobiological mechanisms linking right ventricular overload to left heart dysfunction and explore how ventricular interdependence impacts pulmonary arterial hypertension progression.

June 19, 2026Heart Failure ReviewsOpen Access

Beyond the right ventricle: left heart involvement in pulmonary arterial hypertension

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Key result

LV dysfunction in PAH stems from chronic underfilling and ventricular interdependence, not intrinsic myocardial disease.

Why the study?

Although normal left-sided filling pressures define PAH, left ventricular mechanics may be substantially affected, yet secondary myocardial remodeling in advanced disease remains debated.

Design

Narrative review

Authors

MCMaría José Cabada-GarcíaMinistry of Health JRJahir Rodriguez-RiveraUniversity of Monterrey JPJathniel PanneflekDoctors Hospital at Renaissance

Discussion

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Implication

LV mechanics merit attention in PAH; extends ventricular interdependence data but leaves therapeutic implications open.

Key Points

To review the pathobiological mechanisms linking right ventricular overload to left heart dysfunction and explore how ventricular interdependence impacts pulmonary arterial hypertension progression.
Synthesized current clinical and physiological literature on right ventricular-pulmonary arterial uncoupling, interventricular septal shift, and left heart underfilling in pulmonary arterial hypertension.
Assessed cardiac magnetic resonance and echocardiographic imaging biomarkers that characterize left ventricular and left atrial geometric and strain alterations.
Identified chronic left ventricular underfilling driven by leftward septal displacement, pericardial constraint, and diminished pulmonary venous return as the primary mechanism of left-sided dysfunction.
Highlighted evidence showing that each 1 mL/m² decrease in left ventricular end-systolic or end-diastolic volume index on cardiac magnetic resonance increases mortality risk by 2.1% and 2.3%, respectively.
Demonstrated that advanced imaging parameters, including left ventricular global longitudinal strain and left atrial reservoir strain, identify subclinical left heart dysfunction and improve risk stratification.

Structured PICO

Population

Patients with pulmonary arterial hypertension (PAH)

Left ventricular dysfunction in PAH, driven by ventricular interdependence and chronic underfilling, is an underrecognized component that may improve risk stratification.

Limitations

Evidence regarding intrinsic left ventricular contractile dysfunction and secondary myocardial adaptation in advanced disease remains conflicting.
Whether chronic left ventricular underfilling leads to true myocardial atrophy remains controversial.
Structural remodeling of the left atrium remains insufficiently characterized.

Cite This Study

Cabada-García et al. (2026) conducted a review in Pulmonary arterial hypertension. Ventricular interdependence and left ventricular underfilling was evaluated. Left ventricular dysfunction in pulmonary arterial hypertension is primarily driven by chronic underfilling and ventricular interdependence rather than intrinsic myocardial disease.

synapsesocial.com/papers/6a359850dd3be7785e70ed64 https://doi.org/10.1007/s10741-026-10643-1

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Ask AI

Bookmark

Beyond the right ventricle: left heart involvement in pulmonary arterial hypertension

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Beyond the right ventricle: left heart involvement in pulmonary arterial hypertension

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider