Pulmonary hypertension and right ventricular function in advanced heart failure

Area of Science:

• Cardiology
• Pulmonary Medicine
• Heart Failure Research

Background:

• Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are common in advanced heart failure (HF).
• These conditions significantly impact patient prognosis and treatment strategies.
• Echocardiography is the primary screening tool, but invasive assessment is crucial for advanced therapy decisions.

Purpose of the Study:

• To review the interplay between PH, RV dysfunction, and advanced HF.
• To discuss the prognostic implications of PH and RV dysfunction reversibility.
• To highlight current and emerging therapeutic strategies.

Main Methods:

• Literature review focusing on PH and RV dysfunction in advanced HF.
• Analysis of prognostic significance of PH/RV function reversibility.
• Evaluation of current and investigational pharmacologic and device-based therapies.

Main Results:

• Reversibility of PH and RV dysfunction, particularly after left ventricular assist device (LVAD) implantation, is a favorable prognostic sign.
• Current pulmonary arterial hypertension therapies have not shown benefit in HF-related PH.
• Therapies reducing left-sided pressures positively impact pulmonary pressures and RV function.

Conclusions:

• While therapies reducing left-sided pressures improve PH and RV function in advanced HF, a significant gap exists in direct medical treatment for RV dysfunction.
• Agents targeting the cyclic guanosine monophosphate pathway show promise for PH in advanced HF.
• Further research is needed to develop specific treatments for RV dysfunction in this patient population.