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Right ventricular function in pulmonary (arterial) hypertension

Rechtsventrikuläre Funktion bei pulmonaler (arterieller) Hypertonie

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Abstract

The right ventricle (RV) is the main determinant of prognosis in pulmonary hypertension. Adaptation and maladaptation of the RV are of crucial importance. In the course of disease, RV contractility increases through changes in muscle properties and muscle hypertrophy. At a certain point, the point of “uncoupling,” the afterload exceeds contractility, and maladaptation as well as dilation occurs to maintain stroke volume (SV). To understand the adaptational processes and to further develop targeted medication directly affecting load-independent contractility, an accurate and precise assessment of contractility and RV–pulmonary artery (PA) coupling should be performed. In this review, we shed light on existing methods to assess RV function, including the gold standard measurement of contractility and RV–PA coupling, and we evaluate existing surrogates of RV–PA coupling.

Zusammenfassung

Die Funktion des rechten Ventrikels (RV) ist für die Prognose der pulmonalen Hypertonie (PH) ein entscheidender Faktor. Dabei spielen adaptive und maladaptive Prozesse eine wichtige Rolle. Ein entscheidender Faktor der Adaptation ist die Erhöhung der nachlastunabhängigen Kontraktilität des RV als Reaktion auf die Nachlast. Diese wird zu Beginn der Erkrankung durch z. B. muskuläre Hypertrophie gesteigert. Am Beginn der Maladaptation kann jedoch die Kontraktilität den Anstieg der Nachlast nicht kompensieren, und es kommt zu einem „Entkoppeln“ der Achse zwischen RV und Pulmonalarterien (PA) und zu einer Maladaptation und Dilatation, um das das Schlagvolumen (SV) zu erhalten. Um einerseits diese adaptiven und maladaptiven Prozesse zu analysieren und andererseits therapeutische Strategien zu entwickeln, die auf die lastunabhängige Kontraktilität zielen, sollte die Kontraktilität des RV bestmöglich gemessen werden. In diesem Übersichtsartikel werden Methoden vorgestellt, die nach derzeitigem Stand die Funktion der RV-PA-Achse am genauesten darstellen, und Methoden beurteilt, die als Surrogate dafür verwendet werden.

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Authors and Affiliations

  1. Department of Internal Medicine, Universities of Gießen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Gießen, Klinikstraße 32, 35392, Gießen, Germany

    K. Tello, H. Gall, M. Richter, A. Ghofrani & R. Schermuly

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  2. H. Gall
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Correspondence to K. Tello.

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K. Tello, H. Gall, M. Richter, A. Ghofrani, and R. Schermuly declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Tello, K., Gall, H., Richter, M. et al. Right ventricular function in pulmonary (arterial) hypertension. Herz 44, 509–516 (2019). https://doi.org/10.1007/s00059-019-4815-6

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