Trying to succeed when the right ventricle fails

Compared with the left ventricle, studies of right ventricular failure as a distinct clinical entity have lagged behind. Evolving appreciation of the prognostic significance of right ventricular dysfunction in the heart failure population and advances in noninvasive imaging have provided the impetus for recent investigation into the assessment and management of right ventricular failure.

Pulmonary hypertension and attendant right ventricular dysfunction are prevalent in patients with systolic and diastolic heart failure and are associated with poor survival. Simple echocardiographic and MRI indices of right ventricular function relate to prognosis and may also be useful in following response to therapy. Management of acute and chronic right ventricular failure is largely empiric and is focused on treating the underlying cause along with judicious use of diuretics and inotropes. The use of left ventricular assist devices to help treat pulmonary hypertension in heart failure is an emerging strategy in transplant-eligible patients.

Right ventricular failure is clinically significant and merits further dedicated study. Parameters of right ventricular dysfunction can be assessed noninvasively. An approach to the management of acute and chronic right ventricular failure should take into consideration novel pharmacologic and device-based therapies.