Right ventricular failure in patients with preserved ejection fraction and diastolic dysfunction: an underrecognized clinical entity.
It is well recognized that patients with severe left ventricular (LV) systolic dysfunction develop pulmonary venous hypertension or postcapillary pulmonary hypertension, which leads to an increase in pulmonary vascular resistance (PVR) and right ventricular (RV) systolic failure. It is often underrecognized, however, that patients with heart failure with preserved LV ejection fraction and diastolic dysfunction may also develop postcapillary pulmonary hypertension with elevated PVR leading to RV systolic failure. This form of biventricular failure is a result of diastolic failure on the left in patients with preserved LV ejection fraction and systolic failure on the right. At this time, there are no randomized trials or guidelines addressing the management of patients with diastolic heart failure with and without resultant RV failure. The authors review the pathophysiology, clinical presentation, and suggested treatment of this underrecognized clinical entity.
Zakir
Ramzan M
RM
Department of Medicine, Hackensack University Medical Center, Affiliate of University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Hackensack, NJ, USA.
Al-Dehneh
Anthony
A
Maher
James
J
Saric
Muhamed
M
Berkowitz
Robert L
RL
D015415:Biomarkers / Q000097:blood; D003971:Diastole; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain