Department of Pulmonology, VU University Medical Center/Institute for Cardiovascular Research, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
Cardiovasc Res. 2017 Oct 1;113(12):1441-1452. doi: 10.1093/cvr/cvx159.
Right ventricular failure (RVF) is the main determinant of mortality in patients with pulmonary arterial hypertension (PAH). Although the exact pathophysiology underlying RVF remains unclear, inflammation may play an important role, as it does in left heart failure. Perivascular pulmonary artery and systemic inflammation is relatively well studied and known to contribute to the initiation and maintenance of the pulmonary vascular insult in PAH. However, less attention has been paid to the role of cardiac inflammation in RVF and PAH. Consistent with many other types of heart failure, cardiac inflammation, triggered by systemic and local stressors, has been shown in RVF patients as well as in RVF animal models. RV inflammation likely contributes to impaired RV contractility, maladaptive remodelling and a vicious circle between RV and pulmonary vascular injury. Although the potential to improve RV function through anti-inflammatory therapy has not been tested, this approach has been applied clinically in left ventricular failure patients, with variable success. Because inflammation plays a dual role in the development of both pulmonary vascular pathology and RVF, anti-inflammatory therapies may have a potential double benefit in patients with PAH and associated RVF.
右心衰竭（RVF）是肺动脉高压（PAH）患者死亡的主要决定因素。尽管 RVF 的具体病理生理学机制尚不清楚，但炎症可能起着重要作用，就像在左心衰竭中一样。肺血管周围和全身炎症的研究相对较多，已知其会导致 PAH 中的肺血管损伤的发生和持续。然而，人们对心脏炎症在 RVF 和 PAH 中的作用关注较少。与许多其他类型的心力衰竭一样，RVF 患者和 RVF 动物模型中也显示出由全身和局部应激源触发的心脏炎症。RV 炎症可能导致 RV 收缩功能障碍、适应性重塑以及 RV 和肺血管损伤之间的恶性循环。尽管尚未通过抗炎治疗来改善 RV 功能的潜力，但这种方法已在左心衰竭患者中临床应用，但效果不一。由于炎症在肺血管病变和 RVF 的发展中起着双重作用，因此抗炎治疗可能对合并 RVF 的 PAH 患者具有潜在的双重益处。
