Pulmonary Hypertension and Right Ventricular Function in Advanced Heart Failure

Abstract

Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequently encountered in patients with advanced heart failure (HF). Both conditions aggravate prognosis and influence clinical decisions. Echocardiography is the screening tool of choice for pulmonary pressures and RV function, although invasive assessment of PH is necessary when advanced therapies are considered. Reversibility of PH in response to short-term pharmacologic treatment or even to long-term unloading after left ventricular assist device (LVAD) implantation is a favorable prognostic sign for both medically treated patients and heart transplant candidates. Although patients with severe PH secondary to HF have not derived benefit from pulmonary arterial hypertension therapies thus far, agents that modulate the cyclic guanosine monophosphate pathway, including phosphodiesterase 5A inhibitors, hold promise and are being actively investigated in advanced HF. Therapies that lead to reduction in left-sided pressures, including cardiac resynchronization and LVAD placement, also have a favorable effect on pulmonary pressures and RV function. However, no specific medical treatment for RV dysfunction exists to date, highlighting an important gap in the management of patients with advanced HF.

Influence of central apneas and chemoreflex activation on pulmonary artery pressure in chronic heart failure

“…PH is frequently observed in patients with advanced HF, with a 25 to 50% prevalence, depending on the population and the definition used [1,2]. In HF patients, due to the imbalance between lung ventilation and perfusion, the occurrence of PH is associated with impaired functional capacity and ventilatory efficiency during effort, mirrored by increased exertional dyspnea [3,23].…”

“…However, in up to 30% of patients the transpulmonary gradient is disproportionate and a "reactive" component due to pulmonary vasoconstriction is observed. The pathogenetic mechanisms of this "reactive" component are still a matter of debate [1,2].…”

Advantages of Real Time Three‐Dimensional Echocardiography in the Assessment of Right Ventricular Volumes and Function in Patients with Pulmonary Hypertension Compared with Conventional Two‐Dimensional Echocardiography

“…[1][2][3][4] The biggest advantage of real time threedimensional echocardiography (RT3DE) is that offline volumetric evaluation using dedicated software does not require any geometric assumption, unlike 2D ultrasound. This is obviously even more important in RV assessment, since its volume is often difficult to estimate by 2D echo due to its complex geometry.…”

Clinical and histopathological relationship of sildenafil and bosentan treatments in rats with monocrotaline induced pulmonary hypertension

“…Pulmonary hypertension (PH) is characterized by a progressive increase in pulmonary arterial pressure and pulmonary vascular resistance (PVR), which can result in right heart failure, re-modelling in lung vasculature and death (1)(2)(3)(4). Right ventricular failure, which develops secondary to right ventricular remodelling, is the main prognostic factor that leads to death in patients with PAH (5).…”