Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, TX, USA.
Eur Respir J. 2019 Jan 24;53(1). doi: 10.1183/13993003.01900-2018. Print 2019 Jan.
The function of the right ventricle determines the fate of patients with pulmonary hypertension. Since right heart failure is the consequence of increased afterload, a full physiological description of the cardiopulmonary unit consisting of both the right ventricle and pulmonary vascular system is required to interpret clinical data correctly. Here, we provide such a description of the unit and its components, including the functional interactions between the right ventricle and its load. This physiological description is used to provide a framework for the interpretation of right heart catheterisation data as well as imaging data of the right ventricle obtained by echocardiography or magnetic resonance imaging. Finally, an update is provided on the latest insights in the pathobiology of right ventricular failure, including key pathways of molecular adaptation of the pressure overloaded right ventricle. Based on these outcomes, future directions for research are proposed.
右心室的功能决定了肺动脉高压患者的命运。由于右心衰竭是后负荷增加的结果，因此需要对包括右心室和肺血管系统在内的心肺单元进行全面的生理学描述，才能正确解释临床数据。在这里，我们提供了该单元及其组成部分的这种描述，包括右心室与其负荷之间的功能相互作用。这种生理学描述用于为右心导管插入术数据以及通过超声心动图或磁共振成像获得的右心室成像数据的解释提供框架。最后，提供了关于右心室衰竭的病理生物学的最新见解的最新信息，包括压力超负荷右心室的分子适应的关键途径。基于这些结果，提出了未来的研究方向。
