Right Heart Adaptation to Pulmonary Arterial Hypertension Physiology and Pathobiology

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Review

Vonk-Noordegraaf, Anton¹  Haddad, Francois²  Chin, Kelly M.³  Forfia, Paul R.⁴  Kawut, Steven M.⁵  Lumens, Joost⁶  Naeije, Robert⁷  Newman, John⁸  Oudiz, Ronald J.⁹  Provencher, Steve¹⁰  Torbicki, Adam¹¹  Voelkel, Norbert F.^12,13,14  Hassoun, Paul M.³ 

[1] Vrije Univ Amsterdam Med Ctr, Dept Pneumol, NL-1081 HV Amsterdam, Netherlands

[2] Stanford Univ, Dept Med, Div Cardiovasc Med, Stanford, CA 94305 USA

[3] Univ Texas SW Med Ctr Dallas, Dept Internal Med, Div Pulm, Dallas, TX 75390 USA

[4] Temple Univ Hosp & Med Sch, Pulm Hypertens & Right Heart Failure Program, Philadelphia, PA 19140 USA

[5] Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA

[6] Maastricht Univ, CARIM Sch Cardiovasc Dis, Maastricht, Netherlands

[7] Free Univ Brussels, Fac Med, Dept Pathophysiol, Brussels, Belgium

[8] Vanderbilt Univ, Sch Med, Dept Med, Div Allergy Pulm & Crit Care Med, Nashville, TN 37212 USA

[9] Univ Calif Los Angeles, David Geffen Sch Med, Liu Ctr Pulm Hypertens, Div Cardiol,Biomed Res Inst,Harbor UCLA Med Ctr, Torrance, CA USA

[10] Inst Univ Cardiol & Pneumol Quebec, Ctr Rech, Pulm Hypertens Res Grp, Quebec City, PQ, Canada

[11] ECZ, Ctr Postgrad Med Educ, Dept Pulm Circulat & Thromboembol Dis, Otwock, Poland

[12] Virginia Commonwealth Univ, Div Pulm & Crit Care Med, Richmond, VA USA

[13] Virginia Commonwealth Univ, Victoria Johnson Lab Lung Res, Richmond, VA USA

[14] Johns Hopkins Univ, Baltimore, MD USA

关键词: echocardiography;    heart failure;    MRI;    myocardium;    pulmonary artery hypertension;    right ventricle;   

DOI  :  10.1016/j.jacc.2013.10.027

来源: Elsevier

【 摘 要 】

Survival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation. (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

Free