Right ventricle in heart failure with preserved ejection fraction

Area of Science:

• Cardiology
• Pulmonology
• Medical Imaging

Background:

• Heart failure with preserved ejection fraction (HFpEF) impacts numerous patients, with the right ventricle (RV) emerging as a key area of research.
• Right ventricular dysfunction (RVD) affects a significant portion of HFpEF patients, often linked to pulmonary hypertension and comorbidities.
• Assessing RVD is complex due to the RV's unique anatomy, physiology, and load conditions.

Purpose of the Study:

• To review the current understanding of right ventricular dysfunction (RVD) in heart failure with preserved ejection fraction (HFpEF).
• To discuss the diagnostic challenges and emerging imaging techniques for RVD assessment.
• To highlight the limitations of current pharmacotherapies and the need for novel interventions.

Main Methods:

• Review of existing literature on RVD in HFpEF.
• Discussion of echocardiographic parameters (e.g., FAC, TAPSE, S') for RV function assessment.
• Exploration of advanced imaging modalities like speckle tracking echocardiography and cardiac magnetic resonance (CMR).
• Consideration of RV [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging.

Main Results:

• RVD prevalence in HFpEF ranges from 4% to 50%.
• Pulmonary hypertension and comorbidities like COPD, obesity, sleep apnea, and atrial fibrillation contribute to RVD.
• Standard RV function measurements have limitations; advanced imaging like CMR shows promise.
• RV [18F]FDG PET imaging requires further validation for prognostic significance.
• Current pharmacotherapies (PDE inhibitors, GC stimulators, nitrates) have not improved RVD in HFpEF.

Conclusions:

• RVD is a critical factor in HFpEF pathophysiology and patient outcomes.
• Novel diagnostic tools and imaging techniques are essential for accurate RVD assessment.
• There is an urgent need to develop and evaluate new pharmacological treatments targeting RVD in HFpEF.