New insights for the diagnosis and management of right ventricular failure, from molecular imaging to targeted right ventricular therapy.
OBJECTIVE
Despite the recognition of a critical role of the right ventricle (RV) in many aspects of cardiovascular medicine, there has been surprisingly little interest in right ventricular-targeted imaging and therapeutic approaches. Compared with the left ventricle, the RV has a different embryologic origin, undergoes a dramatic change during the transition from the fetal to the adult circulation and normally operates in a low resistance or impedance arterial system. Here, we review new insights on the pathophysiology, assessment and management of right ventricular failure.


RESULTS
Our understanding of the mechanisms underlying right ventricular failure has improved. As in the left ventricle, decrease in alpha-myosin heavy chain and a switch towards glycolysis from fatty acid oxidation is observed in the stressed RV, but the key question remains unanswered: why is the RV so much more vulnerable to failure upon afterload increase compared with the left ventricle? In assessing the RV, it is becoming increasingly important to consider the RV and pulmonary artery as a unit. New therapies that could specifically target the RV, such as metabolic modulators and phosphodiesterase type 5 inhibitors, are now being considered.


CONCLUSIONS
A better understanding of the molecular mechanisms of right ventricular failure will lead to the development of new strategies for the diagnosis and management of right ventricular failure. Right ventricular-targeted therapies are needed in a number of diseases in which only the RV fails.
Division of Cardiovascular Medicine, Stanford School of Medicine, Palo Alto, California 94305, USA. fhaddad@stanford.edu
Francois
F
Haddad
Euan
E
Ashley
Evangelos D
ED
Michelakis
D000818:Animals; D003324:Coronary Artery Disease / Q000150:complications; D005227:Fatty Acids / Q000378:metabolism; D006019:Glycolysis; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000473:pathology; D057054:Molecular Imaging; D018995:Myosin Heavy Chains / Q000378:metabolism; D011651:Pulmonary Artery / Q000473:pathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control
D005227:Fatty Acids; D018995:Myosin Heavy Chains