The Right Ventricle in Pulmonary Hypertension

Area of Science:

• Cardiology
• Pulmonary Medicine
• Physiology

Background:

• The right ventricle (RV) is critical in pulmonary hypertension (PH), with its adaptation to pressure overload dictating patient outcomes.
• Unlike the left ventricle, the healthy RV operates in a low-pressure system and is not well-suited for sustained pressure overload.
• In PH, RV contractility must increase to maintain cardiac output, but hypertrophy can lead to myocardial stiffening and impaired function.

Approach:

• This review details normal RV and right atrial (RA) structure and function.
• It examines the adaptive changes in the RV under pressure overload conditions.
• The review discusses the consequences of RV failure and its impact on RA function.

Key Points:

• RV hypertrophy, a hallmark of PH adaptation, can cause ventricular stiffening and diastolic dysfunction.
• Impaired RV filling due to stiffness necessitates increased right atrial (RA) work, potentially leading to RA dysfunction.
• The interplay between RV diastolic stiffness and RA function critically influences RV filling and venous return.

Conclusions:

• Accurate assessment of both RV and RA function is essential for evaluating PH patient status and risk stratification.
• Recent guidelines increasingly incorporate RV parameters into PH risk assessment.
• Understanding the unique anatomy and pathophysiology of the RV is key to managing PH and preventing RV failure.