Treatment strategies for the right heart in pulmonary hypertension.

Abstract:

:The function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension. While much progress has been made in the treatment of pulmonary hypertension, therapies for the RV are less well established. In this review of treatment strategies for the RV, first we focus on ways to reduce wall stress since this is the main determinant of changes to the ventricle. Secondly, we discuss treatment strategies targeting the detrimental consequences of increased RV wall stress. To reduce wall stress, afterload reduction is the essential. Additionally, preload to the ventricle can be reduced by diuretics, by atrial septostomy, and potentially by mechanical ventricular support. Secondary to ventricular wall stress, left-to-right asynchrony, altered myocardial energy metabolism, and neurohumoral activation will occur. These may be targeted by optimising RV contraction with pacing, by iron supplement, by angiogenesis and improving mitochondrial function, and by neurohumoral modulation, respectively. We conclude that several treatment strategies for the right heart are available; however, evidence is still limited and further research is needed before clinical application can be recommended.

journal_name

Cardiovasc Res

journal_title

Cardiovascular research

authors

Westerhof BE,Saouti N,van der Laarse WJ,Westerhof N,Vonk Noordegraaf A

doi

10.1093/cvr/cvx148

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

1465-1473

issue

12

eissn

0008-6363

issn

1755-3245

pii

4104488

journal_volume

113

pub_type

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