Skip to main content
SpringerLink
Log in

Right Ventricular Pulmonary Hypertension

  • Prevention of Heart Failure After Myocardial Infarction (M St. John Sutton, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

In heart failure (HF) syndrome, the development of pulmonary hypertension (PH), right ventricular (RV) dysfunction and failure are ominous prognostic signs. Pathophysiology, clinical interest and targeted therapeutic approaches for left-sided PH and its consequences on RV function have been traditionally confined to advanced HF stages. Community- and population-based studies have clearly indicated that PH is frequent even in HF patients with preserved ejection fraction, and may carry important prognostic implications in normal ageing as well. HF guidelines are inconclusive on both preventive and curative strategies for left-sided PH and its consequences on RV function. The search for new therapeutic opportunities targeted on pulmonary vascular and right heart remodeling are an important challenge for the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. ESC Committee for Practice Guidelines (CPG). Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. 2009;30:2493–537.

    Article  PubMed  Google Scholar 

  2. • Guazzi M, Arena R. Pulmonary hypertension with left-sided heart disease. Nat Rev Cardiol. 2010;7:648–59. Extensive literature revision on the epidemiology and pathophysiology and clinical impact of left-sided PH.

    Article  PubMed  Google Scholar 

  3. •• Lam CS, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, Redfield MM. Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation. 2009;119:2663–70. Peculiar demonstration that ageing may be associated with an abnormal increase in PASP, a condition that powerfully predicts survival as compared to reference echo-derived prognosticators, such as LV mass, left atrial volume index and E/E’

    Article  PubMed  Google Scholar 

  4. Miller WL, Mahoney DW, Michelena HI, Pislaru SV, Topilsky Y, Enriquez-Sarano M. Contribution of ventricular diastolic dysfunction to pulmonary hypertension complicating chronic systolic heart failure. J Am Coll Cardiol Img. 2011;4:946–54.

    Google Scholar 

  5. Bursi F, McNallan SM, Redfield MM, Nkomo VT, Lam CS, Weston SA, et al. Pulmonary pressures and death in heart failure: a community study. J Am Coll Cardiol. 2012;59:222–31.

    Article  PubMed  Google Scholar 

  6. Leung CC, Moondra V, Catherwood E, Andrus BW. Prevalence and risk factors of pulmonary hypertension in patients with elevated pulmonary venous pressure and preserved ejection fraction. Am J Cardiol. 2010;106:284–6.

    Article  PubMed  Google Scholar 

  7. Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009;53:1119–26.

    Article  PubMed  Google Scholar 

  8. De Groote P, Millaire A, Foucher-Hossein C, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol. 1998;32:948–54.

    Article  PubMed  Google Scholar 

  9. Di Salvo TG, Mathier M, Semigran MJ, Dec WG. Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol. 1995;25:1143–53.

    Article  PubMed  Google Scholar 

  10. •• Ghio S, Gavazzi A, Campana C, et al. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol. 2001;37:183–8. Landmark observations showing that the presence of RV dysfunction has important implications for risk stratification in Group 2 PH above and beyond pulmonary pressures.

    Article  PubMed  CAS  Google Scholar 

  11. Desai RV, Meyer P, Ahmed MI, Mujib M, Adamopoulos C, White M, et al. Relationship between left and right ventricular ejection fractions in chronic advanced systolic heart failure: insights from the BEST trial. Eur J Heart Fail. 2011;13:392–7.

    Article  PubMed  CAS  Google Scholar 

  12. Gavazzi A, Berzuini C, Campana C, Inserra C, Ponzetta M, Sebastiani R, et al. Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure. J Heart Lung Transpl. 1997;16:774–85.

    CAS  Google Scholar 

  13. Meyer P, Filippatos GS, Ahmed MI, Iskandrian AE, Bittner V, Perry GJ, et al. Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure. Circulation. 2010;121:252–8.

    Article  PubMed  Google Scholar 

  14. Ghio S, Recusani F, Klersy C, Sebastiani R, Laudisa ML, Campana C, et al. Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 2000;85:837–42.

    Article  PubMed  CAS  Google Scholar 

  15. Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J, et al. Prevalence of, Associations with, and Prognostic Value of Tricuspid Annular Plane Systolic Excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012;18:216–25.

    Article  PubMed  Google Scholar 

  16. D'Andrea A, Gravino R, Riegler L, Salerno G, Scarafile R, Romano M, et al. Right ventricular ejection fraction and left ventricular dyssynchrony by 3D echo correlate with functional impairment in patients with dilated cardiomyopathy. J Card Fail. 2011;17:309–17.

    Article  PubMed  Google Scholar 

  17. Lewis GD, Shah RV, Pappagianopolas PP, Systrom DM, Semigran MJ. Determinants of ventilatory efficiency in heart failure: the role of right ventricular performance and pulmonary vascular tone. Circ Heart Fail. 2008;1:227–33.

    Article  PubMed  CAS  Google Scholar 

  18. Murphy RM, Shah RV, Malhotra R, Pappagianopoulos PP, Hough SS, Systrom DM, et al. Exercise oscillatory ventilation in systolic heart failure: an indicator of impaired hemodynamic response to exercise. Circulation. 2011;124:1442–51.

    Article  PubMed  Google Scholar 

  19. Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation. 2009;120:992–1007.

    Article  PubMed  Google Scholar 

  20. •• Saouti N, Westerhof N, Postmus PE, Vonk-Noordegraaf A. The arterial load in pulmonary hypertension. Eur Respir Rev. 2010;19:197–203. Remarkable overview on pulmonary arterial/right ventricular coupling.

    Article  PubMed  CAS  Google Scholar 

  21. Lankhaar JW, Westerhof N, Faes TJ, Gan CT, Marques KM, Boonstra A, et al. Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension. Eur Heart J. 2008;29:1688–95.

    Article  PubMed  Google Scholar 

  22. Tedford RJ, Hassoun PM, Mathai SC, Girgis RE, Russell SD, Thiemann DR, et al. Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation. 2012;17:289–97.

    Article  Google Scholar 

  23. Urashima T, Zhao M, Wagner R, et al. Molecular and physiological characterization of RV remodeling in a murine model of pulmonary stenosis. Am J Physiol Heart Circ Physiol. 2008;295:H1351–68.

    Article  PubMed  CAS  Google Scholar 

  24. •• Bogaard HJ, Natarajan R, Henderson SC, Long CS, Kraskauskas D, Smithson L, et al. Chronic pulmonary artery pressure elevation is insufficient to explain right heart failure. Circulation. 2009;120:1951–60. Very elegant demonstration that RV remodeling may be somewhat independent of hemodynamic load comparing an experimental model of pulmonary artery banding with an established model of angioproliferative pulmonary hypertension associated with fatal RV failure.

    Article  PubMed  Google Scholar 

  25. La Vecchia L, Zanolla L, Varotto L, Bonanno C, Spadaro GL, Ometto R, et al. Reduced right ventricular ejection fraction as a marker for idiopathic dilated cardiomyopathy compared with ischemic left ventricular dysfunction. Am Heart J. 2001;142:181–9.

    Article  PubMed  Google Scholar 

  26. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53:589–96.

    Article  PubMed  Google Scholar 

  27. Dini FL, Demmer RT, Simioniuc A, Morrone D, Donati F, Guarini G, et al. Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure. Eur J Heart Fail. 2012;14:287–94.

    Article  PubMed  CAS  Google Scholar 

  28. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29:2388–442.

    Article  PubMed  CAS  Google Scholar 

  29. Voelkel NF, Quaife RA, Leinwand LA, et al. Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation. 2006;114:1883–91.

    Article  PubMed  Google Scholar 

  30. Cody RJ, Haas GJ, Binkley PF, Capers Q, Kelley R. Plasma endothelin correlates with the extent of pulmonary hypertension in patients with chronic congestive heart failure. Circulation. 1992;85:504–9.

    Article  PubMed  CAS  Google Scholar 

  31. Wada A, Tsutamoto T, Fukai D, Ohnishi M, Maeda K, Hisanaga T, et al. Comparison of the effects of selective endothelin ETA and ETB receptor antagonists in congestive heart failure. J Am Coll Cardiol. 1997;30:1385–92.

    Article  PubMed  CAS  Google Scholar 

  32. Kalra PR, Moon JC, Coats AJ. Do results of the ENABLE (Endothelin Antagonist Bosentan for Lowering Cardiac Events in Heart Failure) study spell the end for non-selective endothelin antagonism in heart failure? Int J Cardiol. 2002;85:195–7.

    Article  PubMed  Google Scholar 

  33. Packer M, McMurray J, Massie BM, Caspi A, Charlon V, Cohen-Solal A, et al. Clinical effects of endothelin receptor antagonism with bosentan in patients with severe chronic heart failure: results of a pilot study. J Card Fail. 2005;11:12–20.

    Article  PubMed  CAS  Google Scholar 

  34. Lüscher TF, Enseleit F, Pacher R, Mitrovic V, Schulze MR, Willenbrock R, et al. Heart Failure ET(A) Receptor Blockade Trial. Hemodynamic and neurohumoral effects of selective endothelin A (ET(A)) receptor blockade in chronic heart failure: the Heart Failure ET(A) Receptor Blockade Trial (HEAT). Circulation. 2002;106:2666–72.

    Article  PubMed  Google Scholar 

  35. Anand I, McMurray J, Cohn JN, Konstam MA, Notter T, Quitzau K, et al. EARTH investigators. Long-term effects of darusentan on left-ventricular remodelling and clinical outcomes in the EndothelinA Receptor Antagonist Trial in Heart Failure (EARTH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:347–54.

    Article  PubMed  CAS  Google Scholar 

  36. Yui Y, Nakajima H, Kawai C, Murakami T. Prostacyclin therapy in patients with congestive heart failure. Am J Cardiol. 1982;50:320–4.

    Article  PubMed  CAS  Google Scholar 

  37. Sablotzki A, Czeslick E, Schubert S, Friedrich I, Mühling J, Dehne MG, et al. Iloprost improves hemodynamics in patients with severe chronic cardiac failure and secondary pulmonary hypertension. Can J Anaesth. 2002;49:1076–80.

    Article  PubMed  Google Scholar 

  38. Califf RM, Adams KF, McKenna WJ, Gheorghiade M, Uretsky BF, McNulty SE, et al. A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: the Flolan International Randomized Survival Trial (FIRST). Am Heart J. 1997;134:44–54.

    Article  PubMed  CAS  Google Scholar 

  39. Argenziano M, Choudhri AF, Moazami N, Rose EA, Smith CR, Levin HR, et al. Randomized, double-blind trial of inhaled nitric oxide in LVAD recipients with pulmonary hypertension. Ann Thorac Surg. 1998;65:340–5.

    Article  PubMed  CAS  Google Scholar 

  40. Kieler-Jensen N, Ricksten SE, Stenqvist O, Bergh CH, Lindelöv B, Wennmalm A, et al. Inhaled nitric oxide in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance. J Heart Lung Transplant. 1994;13:366–75.

    PubMed  CAS  Google Scholar 

  41. Bocchi EA, Bacal F, Auler Júnior JO, Carmone MJ, Bellotti G, Pileggi F. Inhaled nitric oxide leading to pulmonary edema in stable severe heart failure. Am J Cardiol. 1994;74:70–2.

    Article  PubMed  CAS  Google Scholar 

  42. Miller OI, Tang SF, Keech A, Celermajer DS. Rebound pulmonary hypertension on withdrawal from inhaled nitric oxide. Lancet. 1995;346:51–2.

    Article  PubMed  CAS  Google Scholar 

  43. Guazzi M. Clinical use of phophodiesterase-5 inhibitors in chronic heart failure. Circ Heart Fail. 2008;1:272–80.

    Article  PubMed  Google Scholar 

  44. Guazzi M, Tumminello G, Di Marco F, Fiorentini C, Guazzi MD. The effects of phosphodiesterase-5 inhibition with sildenafil on pulmonary hemodynamics and diffusion capacity, exercise ventilatory efficiency, and oxygen uptake kinetics in chronic heart failure. J Am Coll Cardiol. 2004;44:2339–48.

    Article  PubMed  CAS  Google Scholar 

  45. Melenovsky V, Al-Hiti H, Kazdova L, Jabor A, Syrovatka P, Malek I, et al. Transpulmonary B-type natriuretic peptide uptake and cyclic guanosine monophosphate release in heart failure and pulmonary hypertension: the effects of sildenafil. J Am Coll Cardiol. 2009;54:595–600.

    Article  PubMed  CAS  Google Scholar 

  46. Guazzi M, Samaja M, Arena R, Vicenzi M, Guazzi MD. Long-term use of sildenafil in the therapeutic management of heart failure. J Am Coll Cardiol. 2007;50:2136–44.

    Article  PubMed  CAS  Google Scholar 

  47. Lewis GD, Shah R, Shahzad K, Camuso JM, Pappagianopoulos PP, Hung J, et al. Sildenafil improves exercise capacity and quality of life in patients with systolic heart failure and secondary pulmonary hypertension. Circulation. 2007;116:1555–62.

    Article  PubMed  CAS  Google Scholar 

  48. Behling A, Rohde LE, Colombo FC, Goldraich LA, Stein R, Clausell N. Effects of 5'-phosphodiesterase four-week long inhibition with sildenafil in patients with chronic heart failure: a double-blind, placebo-controlled clinical trial. J Card Fail. 2008;14:189–97.

    Article  PubMed  CAS  Google Scholar 

  49. Nagendran J, Archer SL, Soliman D, Gurtu V, Moudgil R, Haromy A, et al. Phosphodiesterase type 5 is highly expressed in the hypertrophied human right ventricle, and acute inhibition of phosphodiesterase type 5 improves contractility. Circulation. 2007;116:238–48.

    Article  PubMed  CAS  Google Scholar 

  50. Yin J, Kukucka M, Hoffmann J, Sterner-Kock A, Burhenne J, Haefeli WE, et al. Sildenafil preserves lung endothelial function and prevents pulmonary vascular remodeling in a rat model of diastolic heart failure. Circ Heart Fail. 2011;4:198–206.

    Article  PubMed  CAS  Google Scholar 

  51. Guazzi M, Vicenzi M, Arena R, Guazzi MD. Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study. Circulation. 2011;124:164–74.

    Article  PubMed  CAS  Google Scholar 

  52. Telford RJ, Hemnes AR, Russel SD, Wittstein IS, Mahmud M, Zaiman AL, et al. PDE5 inhibitor treatment of persistent pulmonary hypertension after mechanical circulatory support. Circ. Heart Fail. 2008;1:213–9.

    Article  Google Scholar 

  53. Bleeker GB, Schalij MJ, Nihoyannopoulos P, Steendijk P, Molhoek SG, van Erven L, et al. Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy. J Am Coll Cardiol. 2005;46:2264–9.

    Article  PubMed  Google Scholar 

  54. Haddad H, Elabbassi W, Moustafa S, et al. Left ventricular assist device as bridge to heart transplantation in congestive heart failure with pulmonaryhypertension. ASAIO J. 2005;51:456–60.

    Article  PubMed  Google Scholar 

  55. Zimpfer D, Zrunek P, Sandner S, et al. Posttransplant survival after lowering fixed pulmonary hypertension using left ventricular assist devices. Eur J Cardiothorac Surg. 2007;31:698–702.

    Article  PubMed  Google Scholar 

  56. Patel ND, Weiss ES, Schaffer J, et al. Right heart dysfunction after left ventricular assist device implantation: a comparison of the pulsatile HeartMate I and axial-flow HeartMate II devices. Ann Thorac Surg. 2008;86:832–40.

    Article  PubMed  Google Scholar 

  57. Menicanti L, Castelvecchio S. Left ventricular reconstruction concomitant to coronary artery bypass grafting: when and how? Curr Opin Cardiol. 2011;26:523–7.

    Article  PubMed  Google Scholar 

  58. Patel ND, Williams JA, Nwakanma LU, Waldron MM, Bluemke DA, Conte JV. Surgical ventricular restoration for advanced congestive heart failure: should pulmonary hypertension be a contraindication? Ann Thorac Surg. 2006;82:879–88.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Heart Failure Unit, I.R.C.C.S., Policlinico San Donato, University of Milan, Milan, Italy

    Marco Guazzi, Serenella Castelvecchio & Francesco Bandera

  2. Department of Cardiac Surgery, I.R.C.C.S., Policlinico San Donato, Milan, Italy

    Lorenzo Menicanti

  3. Heart Failure Unit, I.R.C.C.S., Policlinico San Donato, University of Milano, P-za E. Malan 2, 20097, San Donato Milanese, Milano, Italy

    Marco Guazzi

Authors
  1. Marco Guazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serenella Castelvecchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Bandera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorenzo Menicanti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Guazzi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guazzi, M., Castelvecchio, S., Bandera, F. et al. Right Ventricular Pulmonary Hypertension. Curr Heart Fail Rep 9, 303–308 (2012). https://doi.org/10.1007/s11897-012-0106-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-012-0106-8

Keywords

Search

Navigation