TY - JOUR
T1 - RV pressure overload
T2 - From hypertrophy to failure
AU - Van Der Bruggen, Cathelijne E.E.
AU - Tedford, Ryan J.
AU - Handoko, Martin Louis
AU - Van Der Velden, Jolanda
AU - De Man, Frances S.
N1 - Funding Information:
JvdV, MLH and FSdM were supported by the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation, Dutch federation of University Medical Centers, the Organization for Health Research and Development and the Royal Netherlands Academy of Sciences (CVON-2011-11 ARENA, CVON-2014-40 DOSIS, CVON-EARLY-HFpEF, CVON-2012-08 PHAEDRA). JvdV and FSdM received a grant from the Netherlands Organization for Scientific Research (NWO-VIDI 917.11.344; NWO-VENI: 916.14.099). FSdM is further supported by L’Oreal/Unesco for Women in Science and Netherlands Institute for Advanced Studies (NIAS), the American Thoracic Society (ATS: Jerry Wojciechowski Memorial Pulmonary Hypertension Research Grant) and the European Respiratory Society.
Publisher Copyright:
© Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - In pulmonary arterial hypertension (PAH), right ventricular (RV) adaptation is essential to overcome the chronic increases in RV pressure overload. Ultimately, RV compensatory mechanisms are not sufficient and patients succumb to RV failure. The processes underlying the transition of RV adaptation to RV failure are not well understood. In this review, we propose that important insights in RV adaptation processes can be obtained by comparing different etiologies of PAH, namely patients with PAH secondary to Eisenmenger syndrome, patients with PAH secondary to systemic sclerosis and patients where no cause is identified: idiopathic PAH. Although the amount of RV afterload does not differ between these patient groups, their prognosis is distinctly different. We will show that an adaptive RV phenotype, as is observed in Eisenmenger patients, coincides with RV hypertrophy, increased RV contractility, low RV fibrosis and low RV diastolic stiffness. Whereas a phenotype of RV failure, as is observed in patients with PAH-secondary to systemic sclerosis, is characterized by impaired contractile reserve, RV fibrosis and RV diastolic stiffness.
AB - In pulmonary arterial hypertension (PAH), right ventricular (RV) adaptation is essential to overcome the chronic increases in RV pressure overload. Ultimately, RV compensatory mechanisms are not sufficient and patients succumb to RV failure. The processes underlying the transition of RV adaptation to RV failure are not well understood. In this review, we propose that important insights in RV adaptation processes can be obtained by comparing different etiologies of PAH, namely patients with PAH secondary to Eisenmenger syndrome, patients with PAH secondary to systemic sclerosis and patients where no cause is identified: idiopathic PAH. Although the amount of RV afterload does not differ between these patient groups, their prognosis is distinctly different. We will show that an adaptive RV phenotype, as is observed in Eisenmenger patients, coincides with RV hypertrophy, increased RV contractility, low RV fibrosis and low RV diastolic stiffness. Whereas a phenotype of RV failure, as is observed in patients with PAH-secondary to systemic sclerosis, is characterized by impaired contractile reserve, RV fibrosis and RV diastolic stiffness.
KW - Eisenmenger syndrome
KW - Pulmonary arterial hypertension
KW - Right ventricle
KW - Systemic sclerosis
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U2 - 10.1093/cvr/cvx145
DO - 10.1093/cvr/cvx145
M3 - Review article
C2 - 28957530
AN - SCOPUS:85030752644
SN - 0008-6363
VL - 113
SP - 1423
EP - 1432
JO - Cardiovascular research
JF - Cardiovascular research
IS - 12
ER -