Medicine-Cardiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA.
Medicine-Cardiology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
Heart. 2023 Feb 14;109(5):349-355. doi: 10.1136/heartjnl-2021-320526.
Knowledge of right ventricular (RV) structure and function has historically lagged behind that of the left ventricle (LV). However, advancements in invasive and non-invasive evaluations, combined with epidemiological analyses, have advanced the current understanding of RV (patho)physiology across the spectrum of health and disease, and reinforce the centrality of the RV in contributing to clinical outcomes. In the healthy heart, ventricular-arterial coupling is preserved during rest and in response to increased myocardial demand (eg, exercise) due to substantial RV contractile reserve. However, prolonged exposure to increased myocardial demand, such as endurance exercise, may precipitate RV dysfunction, suggesting that unlike the LV, the RV is unable to sustain high levels of contractility for extended periods of time. Emerging data increasingly indicate that both LV and RV function contribute to clinical heart failure. Reductions in quality-of-life, functional capacity and overall clinical outcomes are worsened among patients with heart failure when there is evidence of RV dysfunction. In addition, the RV is adversely impacted by pulmonary vascular disease, and among affected patients, overall RV function differs based on mechanisms of the underlying pulmonary hypertension, which may result from variations in sarcomere function within RV cardiomyocytes.
右心室（RV）的结构和功能知识一直落后于左心室（LV）。然而，侵入性和非侵入性评估的进步，加上流行病学分析，已经提高了当前对 RV（病理）生理学的理解，涵盖了健康和疾病的各个方面，并强调了 RV 在对临床结果的影响。在健康的心脏中，由于 RV 有很大的收缩储备，心室-动脉耦联在休息时和心肌需求增加（例如运动）时得以保持。然而，长时间暴露于心肌需求增加，如耐力运动，可能会引发 RV 功能障碍，这表明与 LV 不同，RV 无法长时间维持高水平的收缩力。越来越多的新数据表明，LV 和 RV 的功能都与临床心力衰竭有关。当有 RV 功能障碍的证据时，心力衰竭患者的生活质量、功能能力和整体临床结局会恶化。此外，RV 会受到肺血管疾病的影响，在受影响的患者中，RV 整体功能因潜在肺动脉高压的机制而异，这可能是由于 RV 心肌细胞中肌节功能的变化所致。
