Systemic Consequences of Right Ventricular Failure

  • Vlad Damian Vintilă
  • Ana-Maria Vintilă


Right ventricular failure can occur as an acute or chronic dysfunction. It can occur during an acute pathology of the right heart (for example, inferior acute myocardial infarction with right ventricle involvement) or of the lungs (for example massive venous thromboembolism). It can also arise in a chronic situation as a secondary dysfunction of the lungs or of the heart (for example pulmonary hypertension, pulmonary infiltrative diseases or pulmonary stenosis). There are multiple organ dysfunctions involved in heart failure. It is difficult to separate right ventricle for left ventricle dysfunction since there is an interventricular mechanism of loading, pressure and contraction. Quantitation of the degree of heart failure is difficult since the most frequent biomarkers have altered clearance in right heart failure.


Systemic disorder Interventricular coupling Organ failure Biomarkers 


  1. 1.
    Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008;117(13):1717–31.CrossRefGoogle Scholar
  2. 2.
    Kevin LG, Barnard M. Right ventricular failure. Contin Educ Anaesth Crit Care Pain. 2007;7(3):89–94.CrossRefGoogle Scholar
  3. 3.
    Piazza G, Goldhaber SZ. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest. 2005;128(3):1836–52.CrossRefGoogle Scholar
  4. 4.
    Lahm T, McCaslin CA, Wozniak TC, Ghumman W, Meldrum DR. Medical and surgical treatment of acute right ventricular failure. J Am Coll Cardiol. 2010;56(18):1435–46.CrossRefPubMedGoogle Scholar
  5. 5.
    Bleeker GB, Steendijk P, Holman ER, Yu C-M, Breithardt OA, Kaandorp TAM, Schalij MJ, van der Wall EE, Nihoyannopoulos P, Bax JJ. Assessing right ventricular function: the role of echocardiography and complementary technologies. Heart. 2006;92:i19–26. Scholar
  6. 6.
    Gayat E, Mebazaa A. Normal physiology and pathophysiology of the right ventricle. In: Acute heart failure. London: Springer. p. 63–9. isbn:978-1-84628-781-7.CrossRefGoogle Scholar
  7. 7.
    Lunkenheimer PP, Muller RP, Konermann CHR, Lunkenheimer A, Kohler F. Architecture of the myocardium in computed tomography. Investig Radiol. 1984;19:271–8.CrossRefGoogle Scholar
  8. 8.
    Torrent-Guasp F, Kocica MJ, Corno AF, Komeda M, Carreras-Costa F, Flotats A, Cosin-Aguillar J, Wen H. Towards new understanding of the heart structure and function. Eur J Cardiothorac Surg. 2005;27:191–201.CrossRefPubMedGoogle Scholar
  9. 9.
    Hrymak C, Strumpher A, Jacobsohn E. Acute right ventricle failure in the intensive care unit: assessment and management. Can J Cardiol. 2017;33:61–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Averin K, Michelfelder E, Sticka J, Cash M, Hirsch R. Changes in ventricular geometry predict severity of right ventricular hypertension. Pediatr Cardiol. 2016;37(3):575–81.CrossRefPubMedGoogle Scholar
  11. 11.
    Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, Crespo-Leiro MG, Falk V, Filippatos G, Gibbs S, Leite-Moreira A, Lassus J, Masip J, Mueller C, Mullens W, Naeije R, Nordegraaf AV, Parissis J, Riley JP, Ristic A, Rosano G, Rudiger A, Ruschitzka F, Seferovic P, Sztrymf B, Vieillard-Baron A, Yilmaz MB, Konstantinides S. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. Eur J Heart Fail. 2016;18(3):226–41.CrossRefGoogle Scholar
  12. 12.
    Denault AY, Haddad F, Jacobsohn E, Deschamps A. Perioperative right ventricular dysfunction. Curr Opin Anaesthesiol. 2013;26:71–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Drazner MH, Eduardo Rame J, Stevenson LW, Dries DL. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med. 2001;345:574–81.CrossRefPubMedGoogle Scholar
  14. 14.
    Lévy P, Ryan S, Oldenburg O, Parati G. Sleep apnoea and the heart. Eur Respir Rev. 2013;22:333–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Orea-Tejeda A, Bozada-Gutiérrez K, Pineda-Juárez J, González-Islas D, Santellano-Juárez B, Keirns-Davies C, Peláez-Hernández V, Hernández-Zenteno R, Sánchez-Santillán R, Cintora-Martínez C. Right heart failure as a risk for stroke in patients with chronic obstructive pulmonary disease: a case-control study. J Stroke Cerebrovasc Dis. 2017;26:2988–93. Scholar
  16. 16.
    Fouad YM, Yehia R. Hepato-cardiac disorders. World J Hepatol. 2014;6(1):41–54.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Dunn GD, Hayes P, Breen KJ, Schenker S. The liver in congestive heart failure: a review. Am J Med Sci. 1973;265(3):174–89.CrossRefPubMedGoogle Scholar
  18. 18.
    Wanless IR, Liu JJ, Butany J. Role of thrombosis in the pathogenesis of congestive hepatic fibrosis (cardiac cirrhosis). Hepatology. 1995;21(5):1232–7.PubMedGoogle Scholar
  19. 19.
    Møller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013;34(36):2804–11.CrossRefPubMedGoogle Scholar
  20. 20.
    Cogger VC, Fraser R, Le Couteur DG. Liver dysfunction and heart failure. Am J Cardiol. 2003;91(11):1399.CrossRefPubMedGoogle Scholar
  21. 21.
    Lefkowitch JH, Mendez L. Morphologic features of hepatic injury in cardiac disease and shock. J Hepatol. 1986;2(3):313–27.CrossRefPubMedGoogle Scholar
  22. 22.
    Caraceni P, Bianchi C, Domenicali M, Maria Pertosa A, Maiolini E, Parenti Castelli G, Nardo B, Trevisani F, Lenaz G, Bernardi M. Impairment of mitochondrial oxidative phosphorylation in rat fatty liver exposed to preservation-reperfusion injury. J Hepatol. 2004;41:82–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Alvarez AM, Mukherjee D. Liver abnormalities in cardiac diseases and heart failure. Int J Angiol. 2011;20:135–42.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, Katz SD, Klapholz M, Moser DK, Rogers JG, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16:e1–194.CrossRefPubMedGoogle Scholar
  25. 25.
    House AA. Cardio-renal syndrome type 4: epidemiology, pathophysiology and treatment. Semin Nephrol. 2012;32(1):40–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Ganda A, Onat D, Demmer RT, et al. Venous congestion and endothelial cell activation in acute decompensated heart failure. Curr Heart Fail Rep. 2010;7:66–74.CrossRefPubMedGoogle Scholar
  27. 27.
    Blake WD, Wegria R, Keating RP, et al. Effect of increased renal venous pressure on renal function. Am J Phys. 1949;157:1–13.Google Scholar
  28. 28.
    Afsar B, Ortiz A, Covic A, Yalcin S, Goldsmith D, Kambay M. Focus on renal congestion in heart failure. Clin Kidney J. 2016;9(1):39–47.CrossRefPubMedGoogle Scholar
  29. 29.
    Testani JM, Khera AV, St John Sutton MG, Keane MG, Wiegers SE, Shannon RP, Kirkpatrick JN. Effect of right ventricular function and venous congestion on cardiorenal interactions during the treatment of decompensated heart failure. Am J Cardiol. 2010;105(4):511–6.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Westenbrink BD, Voors AA, de Boer RA, Schuringa JJ, Klinkenberg T, van der Harst P, Vellenga E, van Veldhuisen DJ, van Gilst WH. Bone marrow dysfunction in chronic heart failure patients. Eur J Heart Fail. 2010;12(7):676–84.CrossRefPubMedGoogle Scholar
  31. 31.
    Morgan AD, Sharma C, Rothnie KJ, Potts J, Smeeth L, Quint JK. Chronic obstructive pulmonary disease and the risk of stroke. Ann Am Thorac Soc. 2017;14(5):754–65.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Joyce E, Kamperidis V, Ninaber MK, Katsanos S, Debonnaire P, Schalij MJ, Taube C, Bax JJ, Delgado V, Ajmone Marsan N. Prevalence and correlates of early right ventricular dysfunction in sarcoidosis and its association with outcome. J Am Soc Echocardiogr. 2016;29(9):871–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, on behalf of the Authors/Task Force Members, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2016;37(29):2315–81.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35(48):3452–62.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Aschauer S, Kammerlander AA, Zotter-Tufaro C, Ristl R, Pfaffenberger S, Bachmann A, Duca F, Marzluf BA, Bonderman D, Mascherbauer J. The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics. Eur J Heart Fail. 2016;18:71–80.CrossRefPubMedGoogle Scholar
  36. 36.
    Ponikowski P, Voors AA, Anker SD, Cleland JGF, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129–200.CrossRefGoogle Scholar
  37. 37.
    Metwaly A, Khalik AA, Nasr FM, Sabry AI, Gouda MF, Hassan M. Brain natriuretic peptide in liver cirrhosis and fatty liver: correlation with cardiac performance. Electron Physician. 2016;8(2):1984–93.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Willging S, Keller F, Steinbach G. Specificity of cardiac troponins I and T in renal disease. Clin Chem Lab Med. 1998;36(2):87–92.CrossRefPubMedGoogle Scholar
  39. 39.
    Egemnazarov B, Schmidt A, Crnkovic S, Sydykov A, Nagy BM, Kovacs G, Weissmann N, Olschewski H, Olschewski A, Kwapiszewska G, Marsh LM. Pressure overload creates right ventricular diastolic dysfunction in a mouse model: assessment by echocardiography. J Am Soc Echocardiogr. 2015;28(7):828–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vlad Damian Vintilă
    • 1
  • Ana-Maria Vintilă
    • 2
  1. 1.Department of CardiologyUniversity Emergency Hospital, “Carol Davila” University of Medicine and PharmacyBucharestRomania
  2. 2.Department of Internal MedicineColţea Clinical Hospital, “Carol Davila” University of Medicine and PharmacyBucharestRomania

Personalised recommendations