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Right Side of the Heart Pulmonary Circulation Unit Involvement in Left-Sided Heart Failure br Diagnostic, Prognostic, and Therapeutic Implications From the Forgotten Chamber to the Chamber of Secrets

journal contribution
posted on 27.06.2022, 10:31 authored by Alberto M Marra, Alexander E Sherman, Andrea Salzano, Marco Guazzi, Rajan Saggar, Iain B Squire, Antonio Cittadini, Richard N Channick, Eduardo Bossone
Although long neglected, the right side of the heart (RH) is now widely accepted as a pivotal player in heart failure (HF) either with reduced or preserved ejection fraction. The chronic overload of the pulmonary microcirculation results in an initial phase characterized by right ventricular (RV) hypertrophy, right atrial dilation, and diastolic dysfunction. This progresses to overt RH failure when RV dilation and systolic dysfunction lead to RV-pulmonary arterial (RV-PA) uncoupling with low RV output. In the context of its established relevance to progression of HF, clinicians should consider assessment of the RH with information from clinical assessment, biomarkers, and imaging. Notably, no single parameter can predict prognosis alone in HF. Assessments simultaneously should encompass RV systolic function, pulmonary pressures, an estimation of RV-PA coupling, and RH morphologic features. Despite a large volume of evidence indicating the relevance of RH function to the clinical syndrome of HF, evidence-based management strategies are lacking. Targeting RH dysfunction in HF should be an objective of future investigations, being an unmet need in the current management of HF.

History

Citation

Chest, Volume 161, Issue 2, February 2022, Pages 535-551

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

AM (Accepted Manuscript)

Published in

CHEST

Volume

161

Issue

2

Pagination

535 - 551 (17)

Publisher

ELSEVIER

issn

0012-3692

eissn

1931-3543

Acceptance date

17/09/2021

Copyright date

2022

Available date

27/09/2022

Spatial coverage

United States

Language

English