Evidence-based Management of Heart Failure in the Systemic Right Ventricle

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Heart Failure Research

Background:

• Systemic right ventricular (SRV) failure presents distinct pathophysiological characteristics.
• Conventional heart failure (HF) treatments show limited efficacy in SRV failure.
• Understanding SRV failure is crucial for developing targeted therapeutic strategies.

Purpose of the Study:

• To explore the clinical progression of SRV failure.
• To identify diagnostic challenges and evolving treatment modalities for SRV failure.
• To highlight key advancements and research gaps in SRV failure management.

Main Methods:

• Review of recent evidence on SRV failure pathophysiology and treatment.
• Analysis of advanced imaging techniques including echocardiography with speckle-tracking, 3D imaging, and cardiac MRI.
• Evaluation of emerging pharmacotherapies (e.g., SGLT2 inhibitors) and interventional procedures (transcatheter tricuspid valve interventions, ventricular assist devices).

Main Results:

• SRV failure exhibits unique pathophysiology, necessitating tailored treatments beyond standard HF therapies.
• Advanced echocardiography and cardiac MRI are essential for diagnosis and characterization.
• SGLT2 inhibitors show potential for modulating ventricular remodeling and fibrosis.
• Transcatheter interventions and ventricular assist devices offer new therapeutic avenues for advanced SRV failure.
• Machine learning models enhance prognostication and personalized care for SRV failure patients.

Conclusions:

• SRV failure is a distinct clinical entity requiring a personalized, multidisciplinary approach.
• Current advancements in diagnostics, pharmacotherapy, and mechanical support are transforming SRV failure management.
• Continued research is vital to address remaining gaps in risk stratification and treatment optimization for SRV failure.