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Right Ventricular Pathobiology

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The Right Heart

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Abstract

Right ventricular (RV) function is a strong independent determinant of outcomes in a broad range of cardiopulmonary diseases. Despite this recognition, the underlying pathobiology of RV failure remains poorly understood and no RV-specific therapies exist for RV dysfunction. The variable response of RV function to different medical therapies and among etiologies of pulmonary hypertension suggests that elevated afterload is not the sole determinant of RV function. Various molecular mechanisms have been identified that contribute to RV failure. RV ischemia, neurohormonal activation, maladaptive myocardial hypertrophy, metabolic remodeling, and mitochondrial dysfunction are key pathogenic mechanisms that have been demonstrated in both experimental models and humans with RV dysfunction. Genetics may also contribute to RV dysfunction as in heritable pulmonary arterial hypertension and arrhythmogenic RV dysplasia. Metabolic dysregulation and neurohormonal antagonism are currently being tested as RV-specific therapeutic targets in PAH. More detailed understanding of the molecular underpinnings of RV failure will lead to additional therapeutic avenues. Molecular imaging tools such as positron emission tomography may provide a more mechanistic understanding of RV pathophysiology in vivo and allow translation of basic science findings to humans.

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Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, Medical Center East, Nashville, 37204, TN, USA

    Evan L. Brittain MD

  2. Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, T1218 Medical Center North, Nashville, 37232, TN, USA

    Anna R. Hemnes MD

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  1. Evan L. Brittain MD
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  2. Anna R. Hemnes MD
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Correspondence to Anna R. Hemnes MD .

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Editors and Affiliations

  1. National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland

    Sean P. Gaine

  2. Department of Cardiology, Erasme University Hospital, Brussels, Belgium

    Robert Naeije

  3. Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Glasgow, United Kingdom

    Andrew John Peacock

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Brittain, E.L., Hemnes, A.R. (2014). Right Ventricular Pathobiology. In: Gaine, S., Naeije, R., Peacock, A. (eds) The Right Heart. Springer, London. https://doi.org/10.1007/978-1-4471-2398-9_4

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  • DOI: https://doi.org/10.1007/978-1-4471-2398-9_4

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