A right ventricular state of mind in the progression of heart failure with reduced ejection fraction: implications for left ventricular assist device therapy

Right ventricular (RV) function in patients with preexisting left ventricular (LV) systolic dysfunction is key to determining prognosis and identifying appropriate candidates for cardiac replacement therapy. This becomes particularly relevant during selection for left ventricular assist device (LVAD) therapy, since adequate cardiac output, differently from heart transplantation, still relies on native RV function. Importantly, accumulating evidence indicates that RV failure (RVF) carries detrimental consequences of progressive end-organ dysfunction due to systemic venous congestion-mediated inflammation and oxidative stress. Therefore, it is crucial to detect RVF early on in the disease state through heightened clinical suspicion and noninvasive and/or invasive modalities before the RV fails and organ damage ensues, precluding patients from life saving measures such as LVAD therapy. The purpose of this review is to discuss the pathogenesis of RVF, its systemic consequences, implications for pre- and post-LVAD management, and its impact on clinical outcomes.