Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Department of Medical Biology, Academic Medical Center, Amsterdam, The Netherlands.
Cardiovasc Res. 2017 Oct 1;113(12):1465-1473. doi: 10.1093/cvr/cvx148.
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.
右心室（RV）的功能决定了肺动脉高压患者的预后。虽然肺动脉高压的治疗已经取得了很大进展，但 RV 的治疗方法还不太确定。在这篇关于 RV 治疗策略的综述中，首先我们关注的是降低壁应力的方法，因为这是心室变化的主要决定因素。其次，我们讨论了针对 RV 壁应力增加的有害后果的治疗策略。为了降低壁应力，降低后负荷是必不可少的。此外，通过利尿剂、房间隔造口术以及可能通过机械心室支持来降低心室前负荷。继发于心室壁应力，会发生左右心室不同步、心肌能量代谢改变和神经激素激活。通过起搏优化 RV 收缩、铁补充、血管生成和改善线粒体功能以及神经激素调节可以分别针对这些问题进行治疗。我们的结论是，有几种治疗右心的策略；然而，证据仍然有限，在推荐临床应用之前还需要进一步的研究。
