Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

Monitillo, Francesco; Terlizzi, Vito; Gioia, Michele De; Barone, Roberta; Grande, Dario; Parisi, G.; Brunetti, Natale Daniele; Iacoviello, Massimo

doi:10.3390/jcdd7020012

Cited by 17 publications

(13 citation statements)

References 101 publications

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“…Despite the considerable amount of data on the benefits of sacubitril/valsartan for LV function, data on the effect of this drug on the RV are limited. RV-pulmonary artery (RV-PA) coupling, an index of the in vivo RV length vs. developed force, and a non-invasive assay of the RV contractile state [ 11 ] have been proposed as early markers of RV ventricular dysfunction [ 12 ]. Recently, the tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been proposed as the best echocardiographic method to evaluate it [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Masarone

Errigo

Melillo

et al. 2020

JCM

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Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction.

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Section: Introductionmentioning

confidence: 99%

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Masarone

Errigo

Melillo

et al. 2020

JCM

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“…Indeed, the variation of systolic time with the rate of impairment, which is peculiar to the ventricular systolic dysfunction 24,25 , emerged as crucial in order to obtain results in accordance with clinical evidences. In particular, the increase in ventricular end-diastolic pressure and the reduction in the systolic one, well known for the left ventricular failure 31,41 , has been recently reported also in the case of RV systolic impairment 42 . This result is clearly represented by the model in presence of right systolic dysfunction.…”

Section: Discussionmentioning

confidence: 90%

Understanding and Recognition of the Right Ventricular Function and Dysfunction: A Numerical Study

Comunale

Peruzzo

Castaldi

et al. 2020

Preprint

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The role played by the right ventricular (RV) dysfunction has long been underestimated in clinical practice. Recent findings are progressively confirming that when the RV efficiency deteriorates both the right and the left circulation is (significantly) affected, but studies dedicated to a detailed description of RV hemodynamic role still lack. In response to such a gap in knowledge, this work proposes a numerical model that for the first time evaluates the effect of isolated RV dysfunction on the whole circulation. Lumped parameter modelling was applied to represent the physio-pathological hemodynamics. Different grades of impairment were simulated for three dysfunctions i.e., systolic, diastolic, and combined systolic and diastolic. Hemodynamic alterations (i.e., of blood pressure, flow, global hemodynamic parameters), arising from the dysfunctions, are calculated and analysed. Results well accord with clinical observations, showing that RV dysfunction significantly affects both the pulmonary and systemic hemodynamics. Successful validation against in vivo data proved the clinical potentiality of the model i.e., the capability of identifying the degree of RV impairment for given hemodynamic conditions. This study aims at contributing to the improvement of RV dysfunction recognition and treatment, and to the development of tools for the clinical management of pathologies involving the right heart.

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“…Indeed, the variation of systolic time with the rate of impairment, which is peculiar to the ventricular systolic dysfunction 25 , 26 , emerged as crucial in order to obtain results in accordance with clinical evidences. In particular, the increase in ventricular end-diastolic pressure and the reduction in the systolic one, well known for the left ventricular failure 32 , 42 , has been recently reported also in the case of RV systolic impairment 43 . This result is clearly represented by the model in presence of right systolic dysfunction, when RA is forced to increase its pressure to overcome the pressure into the overfilled ventricle and open the tricuspid valve, while P pua decreases 4 , 44 .…”

Section: Discussionmentioning

confidence: 91%

Understanding and recognition of the right ventricular function and dysfunction via a numerical study

Comunale

Peruzzo

Castaldi

et al. 2021

Sci Rep

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The role played by the right ventricular (RV) dysfunction has long been underestimated in clinical practice. Recent findings are progressively confirming that when the RV efficiency deteriorates both the right and the left circulation is (significantly) affected, but studies dedicated to a detailed description of RV hemodynamic role still lack. In response to such a gap in knowledge, this work proposes a numerical model that for the first time evaluates the effect of isolated RV dysfunction on the whole circulation. Lumped parameter modelling was applied to represent the physio-pathological hemodynamics. Different grades of impairment were simulated for three dysfunctions i.e., systolic, diastolic, and combined systolic and diastolic. Hemodynamic alterations (i.e., of blood pressure, flow, global hemodynamic parameters), arising from the dysfunctions, are calculated and analysed. Results well accord with clinical observations, showing that RV dysfunction significantly affects both the pulmonary and systemic hemodynamics. Successful verification against in vivo data proved the clinical potentiality of the model i.e., the capability of identifying the degree of RV impairment for given hemodynamic conditions. This study aims at contributing to the improvement of RV dysfunction recognition and treatment, and to the development of tools for the clinical management of pathologies involving the right heart.

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Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach

Cited by 17 publications

References 101 publications

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction

Understanding and Recognition of the Right Ventricular Function and Dysfunction: A Numerical Study

Understanding and recognition of the right ventricular function and dysfunction via a numerical study

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