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The Pathobiology of Chronic Right Ventricular Failure

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The Right Ventricle in Health and Disease

Part of the book series: Respiratory Medicine ((RM))

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Abstract

The final and therapeutically highly challenging chapter in the medical history of patients with severe pulmonary hypertension is right heart dysfunction and right ventricular failure (RVF), frequently leading to the death of the patient. Because RVF is potentially preventable and reversible, a deep understanding of the cellular and molecular mechanisms of chronic RVF will be necessary in order to develop treatment strategies that target RV function independent of the traditional pulmonary artery pressure treatment target. In this chapter we propose that there are intrinsic and extrinsic mechanisms that contribute to the syndrome of chronic RVF. We review mechanical concepts of RV dysfunction, the contribution of the “sick lung circulation” to the molecular pathobiology of chronic RVF, capillary rarefaction and capillary endothelial cell dysfunction, and RV fibrosis. The mechanisms of beta-adrenergic receptor blockade in chronic RVF are introduced, and we recommend that thought should be given to the possibility that novel antiproliferative drugs, developed for the treatment of severe pulmonary hypertension, may have the potential to damage the pressure-overloaded and stressed RV.

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Authors and Affiliations

  1. Department of Medicine, Virginia Commonwealth University, 1220 E. Broad Street, Richmond, VA, 23298, USA

    Norbert F. Voelkel M.D.

  2. Department of Immunology, University of Pittsburgh, Pittsburgh, VA, USA

    Jose Gomez-Arroyo M.D., Ph.D.

  3. VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA

    Antonio Abbate M.D., Ph.D.

  4. Department of Pulmonary Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Harm J. Bogaard M.D., Ph.D.

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  1. Norbert F. Voelkel M.D.
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  2. Jose Gomez-Arroyo M.D., Ph.D.
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  3. Antonio Abbate M.D., Ph.D.
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  4. Harm J. Bogaard M.D., Ph.D.
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Correspondence to Norbert F. Voelkel M.D. .

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Editors and Affiliations

  1. Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA

    Norbert F. Voelkel

  2. Pediatric Heart Center, Justus-Liebig University, Giessen, Germany

    Dietmar Schranz

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Voelkel, N.F., Gomez-Arroyo, J., Abbate, A., Bogaard, H.J. (2015). The Pathobiology of Chronic Right Ventricular Failure. In: Voelkel, N., Schranz, D. (eds) The Right Ventricle in Health and Disease. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1065-6_13

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