Assessment of Right Ventricular Adaptability to Pressure Overloading for Critical Therapeutic Decision-Making...

Area of Science:

• Cardio-pulmonary medicine
• Cardiovascular physiology
• Pulmonary hypertension research

Background:

• Right ventricular pressure overload (RVPO) leads to maladaptive remodeling and dysfunction in pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH).
• Understanding RV response to pressure overload and pulmonary arterial circulation (PAC) alterations is crucial for patient outcomes.

Purpose of the Study:

• To review current knowledge on RV structural and functional responses to abnormal pressure overload.
• To evaluate tools for assessing RV adaptability to high afterload and its clinical utility in therapeutic decisions.

Main Methods:

• Literature review summarizing current understanding of RVPO.
• Analysis of diagnostic tools for RV adaptability assessment.
• Discussion of multiparametric approaches for RV dysfunction evaluation.

Main Results:

• Single parameters are unreliable for evaluating RV dysfunction and prognosis in RVPO.
• Integrated multiparametric approaches are reliable for assessing RV dysfunction and predicting recovery.
• Multiparametric approaches improve prediction of RV responsiveness to afterload reduction, impacting survival.

Conclusions:

• Multiparametric approaches are essential for accurate RV dysfunction assessment and prognosis in RVPO.
• Predicting RV adaptability to afterload abolition is critical for therapeutic decisions, especially for transplant or VAD candidates.
• Complex interactions and tricuspid regurgitation can complicate RVPO evaluation.