title: Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology.
abstract: Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia. Dysfunction leads to impaired RV filling and increased right atrial pressures. As dysfunction progresses to overt RV failure, the RV chamber becomes more spherical and tricuspid regurgitation is aggravated, a cascade leading to increasing venous congestion. Ventricular interdependence results in impaired left ventricular filling, a decrease in left ventricular stroke volume, and ultimately low cardiac output and cardiogenic shock. Identification and treatment of the underlying cause of RV failure, such as acute pulmonary embolism, acute respiratory distress syndrome, acute decompensation of chronic pulmonary hypertension, RV infarction, or arrhythmia, is the primary management strategy. Judicious fluid management, use of inotropes and vasopressors, assist devices, and a strategy focusing on RV protection for mechanical ventilation if required all play a role in the clinical care of these patients. Future research should aim to address the remaining areas of uncertainty which result from the complexity of RV haemodynamics and lack of conclusive evidence regarding RV-specific treatment approaches.
authors.affiliation: Emergency Medicine, Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.affiliation: University Paris Diderot, Sorbonne Paris Cité, Paris, France.|U942 Inserm, AP-HP, Paris, France.|APHP, Department of Anaesthesia and Critical Care, Hôpitaux Universitaires Saint Louis-Lariboisière, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
authors.forename: Jelena
authors.initials: J
authors.lastname: Čelutkienė
authors.affiliation: Institute of Anaesthesiology, University Hospital Zurich, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares (CNIC).|Instituto de Investigación i + 12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.|Universidad Complutense de Madrid, Spain.
authors.forename: Hector
authors.initials: H
authors.lastname: Bueno
authors.affiliation: University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease, Bucharest, Romania.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Chioncel
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, La Coruna, Spain.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Athens University Hospital Attikon, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: Imperial College, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Gibbs
authors.affiliation: Departamento de Fisiologia e Cirurgia Cardiotorácica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
authors.forename: Adelino
authors.initials: A
authors.lastname: Leite-Moreira
authors.affiliation: Cardiology, Helsinki University, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.affiliation: Hospital Sant Joan Despí Moisès Broggi and Hospital General de l'Hospitalet, University of Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Department of Cardiology, Ziekenhuis Oost Limburg, Genk - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Mullens
authors.affiliation: Department of Physiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
authors.affiliation: Vrije Universiteit Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: Anton Vonk
authors.initials: AV
authors.lastname: Nordegraaf
authors.affiliation: Attikon University Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: Imperial College, London, United Kingdom.
authors.forename: Jillian P
authors.initials: JP
authors.lastname: Riley
authors.affiliation: Department of Cardiology of the Clinical Centre of Serbia and, Belgrade University School of Medicine, Belgrade, Serbia.
authors.forename: Arsen
authors.initials: A
authors.lastname: Ristic
authors.affiliation: IRCCS San Raffaele Hospital Roma, Rome, Italy.|Cardiovascular and Cell Sciences Institute, St George's University of London, London, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
authors.affiliation: Cardio-surgical Intensive Care Unit, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Rudiger
authors.affiliation: Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Centre, Belgrade University Medical Centre, Belgrade, Serbia.
authors.forename: Petar
authors.initials: P
authors.lastname: Seferovic
authors.affiliation: Réanimation polyvalente, Hôpital Antoine Béclère, Hôpitaux univeristaires Paris Sud, AP-HP, Clamart, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sztrymf
authors.affiliation: INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
authors.affiliation: Department of Cardiology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
authors.forename: Mehmet Birhan
authors.initials: MB
authors.lastname: Yilmaz
authors.affiliation: Centre for Thrombosis and Haemostasis (CTH), University Medical Centre Mainz, Mainz, Germany.|Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D004452:Echocardiography; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D011652:Pulmonary Circulation / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy
keywords: Cardiogenic shock; Heart failure; Intensive care; Right ventricular dysfunction; Right ventricular function